IRS Form 990-PF for 2009 - Blue Shield of California Foundation

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CALIFORNIA PHYSICIANS' SERVICE FDN (DBA 94-2822302 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-PF OTHER ASSETS STATEMENT 12 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} BEGINNING OF END OF YEAR FAIR MARKET DESCRIPTION YR BOOK VALUE BOOK VALUE VALUE }}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} ACCRUED INVESTMENT INCOME TO FORM 990-PF, PART II, LINE 15 45,010. }}}}}}}}}}}}}} 45,010. 9,230. }}}}}}}}}}}}}} 9,230. 9,230. }}}}}}}}}}}}}} 9,230. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-PF PART VIII - LIST OF OFFICERS, DIRECTORS STATEMENT 13 TRUSTEES AND FOUNDATION MANAGERS }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} EMPLOYEE TITLE AND COMPEN- BEN PLAN EXPENSE NAME AND ADDRESS AVRG HRS/WK SATION CONTRIB ACCOUNT }}}}}}}}}}}}}}}} }}}}}}}}}}}}} }}}}}}}}}}} }}}}}}}} }}}}}}}} CRYSTAL HAYLING PRESIDENT AND CEO C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 40.00 0. 0. 0. SAN FRANCISCO, CA 94105 EZRA DAVIDSON, JR., M.D. CHAIRMAN/TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 9,000. 0. 0. SAN FRANCISCO, CA 94105 TOM EPSTEIN SECRETARY/TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 0. 0. 0. SAN FRANCISCO, CA 94105 ESTA SOLER VICE-CHAIR/TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 10,000. 0. 0. SAN FRANCISCO, CA 94105 ALIZA LIFSHITZ, M.D. TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 10,000. 0. 0. SAN FRANCISCO, CA 94105 HEIDI FIELDS TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 0. 0. 0. SAN FRANCISCO, CA 94105 21 STATEMENT(S) 12, 13 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
CALIFORNIA PHYSICIANS' SERVICE FDN (DBA 94-2822302 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} BELVA DAVIS TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 9,500. 0. 0. SAN FRANCISCO, CA 94105 DAVE KEARS TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 11,500. 0. 0. SAN FRANCISCO, CA 94105 BILL HAUCK TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 7,000. 0. 0. SAN FRANCISCO, CA 94105 ANTONIA HERNANDEZ TRUSTEE C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 10,500. 0. 0. SAN FRANCISCO, CA 94105 MICHAEL ELLIS SECRETARY C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 2.00 0. 0. 0. SAN FRANCISCO, CA 94105 EMILY GLIDDEN TREASURER C/O BLUE SHIELD OF CA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR 1.00 0. 0. 0. SAN FRANCISCO, CA 94105 }}}}}}}}}}} }}}}}}}} }}}}}}}} TOTALS INCLUDED ON 990-PF, PAGE 6, PART VIII 67,500. 0. 0. ~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~~ 22 STATEMENT(S) 13 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
Page 1 and 2: November 9, 2010 California Physici
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IRS Form 990-PF for 2009 - Blue Shield of California Foundation

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