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

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Form Department of the Treasury Internal Revenue Service Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements. (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a).) OMB No. 1545-0052 For calendar year 2009, or tax year beginning , and ending G Check all that apply: Initial return Initial return of a former public charity Final return Amended return Address change Name change Use the IRS Name of foundation A Employer identification number CALIFORNIA PHYSICIANS' SERVICE FDN label. Otherwise, (DBA BLUE SHIELD OF CALIFORNIA FDN) 94-2822302 print Number and street (or P.O. box number if mail is not delivered to street address) Room/suite B Telephone number or type. 50 BEALE STREET, FOURTEENTH FLOOR (415) 229-5785 See Specific City or town, state, and ZIP code C If exemption application is pending, check here~| Instructions. SAN FRANCISCO, CA 94105 D1. Foreign organizations, check here ~~ | H Check type of organization: X Section 501(c)(3) exempt private foundation 2. Foreign organizations meeting the 85% test, check here and attach computation ~~~~ | Section 4947(a)(1) nonexempt charitable trust Other taxable private foundation E If private foundation status was terminated I Fair market value of all assets at end of year J Accounting method: Cash X Accrual under section 507(b)(1)(A), check here ~ | (from Part II, col. (c), line 16) Other (specify) F If the foundation is in a 60-month termination | $ 54,545,476. (Part I, column (d) must be on cash basis.) under section 507(b)(1)(B), check here~ | Part I Analysis of Revenue and Expenses (a) Revenue and (b) Net investment (c) Adjusted net (d) expenses per books income income Revenue Operating and Administrative Expenses 990-PF Return of Private Foundation or Section 4947(a)(1) Nonexempt Charitable Trust Treated as a Private Foundation 24,864,623. 1 Contributions, gifts, grants, etc., received ~~~ 2 Check | if the foundation is not required to attach Sch. B 3 Interest on savings and temporary cash investments ~~~~~~~~~~~~~~ 4 Dividends and interest from securities~~~~~ 5a Gross rents ~~~~~~~~~~~~~~~~ b Net rental income or (loss) 6a Net gain or (loss) from sale of assets not on line 10 ~~ -3,976,823. Gross sales price for all b assets on line 6a ~~ 31,065,669. 7 Capital gain net income (from Part IV, line 2) ~~~~~ 8 Net short-term capital gain ~~~~~~~~~ 9 Income modifications~~~~~~~~~~~~ Gross sales less returns 10a and allowances ~~~~ b Less: Cost of goods sold ~ c Gross profit or (loss) ~~~~~~~~~~~~ 11 Other income ~~~~~~~~~~~~~~~ 12 Total. Add lines 1 through 11 13 Compensation of officers, directors, trustees, etc. ~~~ 14 Other employee salaries and wages~~~~~~ 15 Pension plans, employee benefits ~~~~~~ 16a Legal fees~~~~~~~~~~~~~~~~~ STMT 2 b Accounting fees ~~~~~~~~~~~~~~ STMT 3 c Other professional fees ~~~~~~~~~~~ STMT 4 17 Interest ~~~~~~~~~~~~~~~~~~ 18 Taxes~~~~~~~~~~~~~~~~~~~ STMT 5 19 Depreciation and depletion ~~~~~~~~~ 20 Occupancy ~~~~~~~~~~~~~~~~ 21 Travel, conferences, and meetings ~~~~~~ 22 Printing and publications ~~~~~~~~~~ 23 Other expenses ~~~~~~~~~~~~~~ STMT 6 24 Total operating and administrative expenses. Add lines 13 through 23 ~~~~~ 25 Contributions, gifts, grants paid ~~~~~~~ 26 Total expenses and disbursements. Add lines 24 and 25 27 Subtract line 26 from line 12: a Excess of revenue over expenses and disbursements ~ -12,155,313. b Net investment income (if negative, enter -0-) ~~~ c Adjusted net income (if negative, enter -0-) LHA For Privacy Act and Paperwork Reduction Act Notice, see the instructions. 283,894. 283,894. 5,321,592. 2009 Disbursements for charitable purposes (cash basis only) STATEMENT 7 STATEMENT 1 21,171,694. 5,605,486. 0. 67,500. 0. 0. 67,500. 365. 0. 0. 365. 29,854. 0. 0. 29,854. 3,418,856. 25,500. 0. 3,468,576. 46,000. 0. 0. 0. 297,600. 0. 0. 303,464. 39,329. 0. 0. 54,764. 236,059. 0. 0. 236,698. 4,135,563. 25,500. 0. 4,161,221. 29,191,444. 34,725,931. 33,327,007. 25,500. 0. 38,887,152. 5,579,986. 0. 923501 02-02-10 Form 990-PF (2009) 1 09011109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
Form 990-PF (2009) Assets Liabilities Net Assets or Fund Balances Part II 923511 02-02-10 Attached schedules and amounts in the description column should be for end-of-year amounts only. 1 Cash - non-interest-bearing~~~~~~~~~~~~~~~~~~~ 2 Savings and temporary cash investments ~~~~~~~~~~~~ 3 Accounts receivable9 Less: allowance for doubtful accounts 9 4 Pledges receivable 9 Less: allowance for doubtful accounts 9 5 Grants receivable ~~~~~~~~~~~~~~~~~~~~~~~ 6 Receivables due from officers, directors, trustees, and other disqualified persons ~~~~~~~~~~~~~~~~~~~~~~ 7 Other notes and loans receivable ~~~~~~~~ 9 Less: allowance for doubtful accounts 9 8 Inventories for sale or use ~~~~~~~~~~~~~~~~~~~ 9 Prepaid expenses and deferred charges ~~~~~~~~~~~~~ 10a Investments - U.S. and state government obligations ~~~~~~~ b Investments - corporate stock ~~~~~~~~~~~~~~~~~ STMT 10 c Investments - corporate bonds ~~~~~~~~~~~~~~~~~ 11 Investments - land, buildings, and equipment: basis ~~ Less: accumulated depreciation ~~~~~~~~ 9 12 Investments - mortgage loans ~~~~~~~~~~~~~~~~~ 13 Investments - other ~~~~~~~~~~~~~~~~~~~~~~ STMT 11 14 Land, buildings, and equipment: basis 9 Less: accumulated depreciation ~~~~~~~~ 15 Other assets (describe 9 STATEMENT 12 ) 16 17 18 19 20 21 22 Total assets (to be completed by all filers) Accounts payable and accrued expenses ~~~~~~~~~~~~~ Grants payable ~~~~~~~~~~~~~~~~~~~~~~~~ Deferred revenue ~~~~~~~~~~~~~~~~~~~~~~~ Loans from officers, directors, trustees, and other disqualified persons ~~~~ Mortgages and other notes payable ~~~~~~~~~~~~~~~ Other liabilities (describe ) 23 Total liabilities (add lines 17 through 22) Foundations that follow SFAS 117, check here X 9 and complete lines 24 through 26 and lines 30 and 31. 24 Unrestricted ~~~~~~~~~~~~~~~~~~~~~~~~~ 25 Temporarily restricted ~~~~~~~~~~~~~~~~~~~~~ 26 Permanently restricted~~~~~~~~~~~~~~~~~~~~~ Foundations that do not follow SFAS 117, check here 9 and complete lines 27 through 31. 27 28 29 30 Capital stock, trust principal, or current funds ~~~~~~~~~~~ Paid-in or capital surplus, or land, bldg., and equipment fund ~~~~ Retained earnings, accumulated income, endowment, or other funds~ Total net assets or fund balances~~~~~~~~~~~~~~~~ 31 Part III Balance Sheets CALIFORNIA PHYSICIANS' SERVICE FDN (DBA BLUE SHIELD OF CALIFORNIA FDN) 94-2822302 9 9 34,038. Total liabilities and net assets/fund balances Analysis of Changes in Net Assets or Fund Balances Page 2 Beginning of year End of year (a) Book Value (b) Book Value (c) Fair Market Value 58,064,624. 42,787,441. 42,787,441. 151,628. 34,038. 34,038. 1 Total net assets or fund balances at beginning of year - Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year's return) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 Enter amount from Part I, line 27a ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3 Other increases not included in line 2 (itemize) 9 SEE STATEMENT 7 & 8, PG 19 & 20 4 Add lines 1, 2, and 3 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5 Decreases not included in line 2 (itemize) SEE STATEMENT 7 & 9, PG 19 & 20 9 6 Total net assets or fund balances at end of year (line 4 minus line 5) - Part II, column (b), line 30 0. 7,107,926. 7,107,926. 9,955,356. 4,606,841. 4,606,841. 45,010. 9,230. 9,230. 68,216,618. 54,545,476. 54,545,476. 1,802,296. 45,983. 18,454,366. 12,919,879. ACCRUED EXPENSES 27,299. 0. 20,283,961. 12,965,862. 47,932,657. 41,579,614. 47,932,657. 41,579,614. 68,216,618. 54,545,476. SEE STATEMENT 8 SEE STATEMENT 9 1 2 3 4 5 6 47,932,657. -12,155,313. 7,865,110. 43,642,454. 2,062,840. 41,579,614. Form 990-PF (2009) 2 08521109 794095 155930.0 2009.04050 CALIFORNIA PHYSICIANS' SERV 15593001
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IRS Form 990-PF for 2009 - Blue Shield of California Foundation

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