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 GRANT APPLICATION SUBMISSION INFORMATION STATEMENT 16 PART XV, LINES 2A THROUGH 2D }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} NAME AND ADDRESS OF PERSON TO WHOM APPLICATIONS SHOULD BE SUBMITTED }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} BLUE SHIELD OF CALIFORNIA FOUNDATION 50 BEALE STREET, FOURTEENTH FLOOR SAN FRANCSICO, CA 94105 TELEPHONE NUMBER }}}}}}}}}}}}}}}} 415-229-5785 FORM AND CONTENT OF APPLICATIONS }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} GO TO OUR WEBSITE: WWW.BLUESHIELDCAFOUNDATION.ORG/GRANT-CENTER/ ANY SUBMISSION DEADLINES }}}}}}}}}}}}}}}}}}}}}}}} SEE WEBSITE FOR CURRENT DEADLINES. RESTRICTIONS AND LIMITATIONS ON AWARDS }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} THE BLUE SHIELD OF CALIFORNIA FOUNDATION IS COMMITTED TO MAKING HEALTH CARE EFFECTIVE, SAFE AND ACCESSIBLE FOR ALL CALIFORNIANS, PARTICULARLY UNDERSERVED PEOPLE, AND TO ENDING DOMESTIC VIOLENCE. WE PROVIDE GRANT AWARDS TO ORGANIZATIONS WHO SERVE CALIFORNIANS, AND ARE PURSUING ACTIVITIES DIRECTLY RELATED TO ONE OF OUR THREE PROGRAM AREAS OF FUNDING: 1) HEALTH CARE AND COVERAGE 2) HEALTH AND TECHNOLOGY 3) BLUE SHIELD AGAINST VIOLENCE }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} 25 STATEMENT(S) 16 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
Form Department of the Treasury Internal Revenue Service Name | See separate instructions. | Attach to the corporation's tax return. Note: Generally, the corporation is not required to file Form 2220 (see Part II below for exceptions) because the IRS will figure any penalty owed and bill the corporation. However, the corporation may still use Form 2220 to figure the penalty. If so, enter the amount from page 2, line 38 on the estimated tax penalty line of the corporation's income tax return, but do not attach Form 2220. Part I 2220 Underpayment of Estimated Tax by Corporations Required Annual Payment OMB No. 1545-0142 2009 FORM 990-PF CALIFORNIA PHYSICIANS' SERVICE FDN (DBA BLUE SHIELD OF CALIFORNIA FDN) 94-2822302 Employer identification number 1 Total tax (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 55,800. 2 a Personal holding company tax (Schedule PH (Form 1120), line 26) included on line 1 ~~~~~ b Look-back interest included on line 1 under section 460(b)(2) for completed long-term contracts or section 167(g) for depreciation under the income forecast method ~~~~~~~~ 2a 2b c Credit for federal tax paid on fuels (see instructions) ~~~~~~~~~~~~~~~~~~~ 2c d Total. Add lines 2a through 2c ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3 4 Subtract line 2d from line 1. If the result is less than $500, do not complete or file this form. The corporation does not owe the penalty Enter the tax shown on the corporation's 2008 income tax return (see instructions). Caution: If the tax is zero or the tax year was for less than 12 months, skip this line and enter the amount from line 3 on line 5 ~~~~~~~~~~~ 2d 3 4 55,800. 94,170. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Required annual payment. Enter the smaller of line 3 or line 4. If the corporation is required to skip line 4, enter the amount from line 3 5 Reasons for Filing - Check the boxes below that apply. If any boxes are checked, the corporation must file Form 2220 even if it does not owe a penalty (see instructions). The corporation is using the adjusted seasonal installment method. The corporation is using the annualized income installment method. X The corporation is a "large corporation" figuring its first required installment based on the prior year's tax. Part II Part III Figuring the Underpayment Installment due dates. Enter in columns (a) through (d) the 15th day of the 4th ( Form 990-PF filers: Use 5th month), 6th, 9th, and 12th months of the corporation's tax year ~~~~~~~~~~~~~~~~ Required installments. If the box on line 6 and/or line 7 above is checked, enter the amounts from Sch A, line 38. If the box on line 8 (but not 6 or 7) is checked, see instructions for the amounts to enter. If none of these boxes are checked, enter 25% of line 5 above in each column. ~~~~~~ ~ Estimated tax paid or credited for each period (see instructions). For column (a) only, enter the amount from line 11 on line 15 ~~~~~~~~~~~~~~~ Complete lines 12 through 18 of one column before going to the next column. Enter amount, if any, from line 18 of the preceding column Add lines 11 and 12 ~~~~~~~~~~~~~~~~~ Add amounts on lines 16 and 17 of the preceding column Subtract line 14 from line 13. If zero or less, enter -0- ~~ If the amount on line 15 is zero, subtract line 13 from line 14. Otherwise, enter -0- ~~~~~~~~~~~~~~~ Underpayment. If line 15 is less than or equal to line 10, subtract line 15 from line 10. Then go to line 12 of the next column. Otherwise, go to line 18 ~~~~~~~~~~~ Overpayment. If line 10 is less than line 15, subtract line 10 from line 15. Then go to line 12 of the next column 9 10 11 12 13 14 15 16 17 18 (a) (b) (c) (d) 55,800. 05/15/09 06/15/09 09/15/09 12/15/09 13,950. 13,950. 13,950. 13,950. 100,000. 86,050. 72,100. 58,150. 86,050. 72,100. 58,150. 100,000. 86,050. 72,100. 58,150. 0. 0. 86,050. 72,100. 58,150. Go to Part IV on page 2 to figure the penalty. Do not go to Part IV if there are no entries on line 17 - no penalty is owed. JWA For Paperwork Reduction Act Notice, see separate instructions. Form 2220 (2009) 912801 01-05-10 26 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
Page 1 and 2: November 9, 2010 California Physici
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MAIL TO: Registry of Charitable Tru
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IRS Form 990-PF for 2009 - Blue Shield of California Foundation

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