IRS Form 990-PF for 2009 - Blue Shield of California Foundation
IRS Form 990-PF for 2009 - Blue Shield of California Foundation
IRS Form 990-PF for 2009 - Blue Shield of California Foundation
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Cali<strong>for</strong>nia Physicians' Service Fdn<br />
(dba <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> Cali<strong>for</strong>nia Fdn)<br />
FEIN: 94-2822302<br />
Attachment E<br />
<strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> Cali<strong>for</strong>nia <strong>Foundation</strong><br />
FEIN 94-2822302<br />
ATTACHMENT TO <strong>2009</strong> FORM <strong>990</strong>-<strong>PF</strong><br />
RETURN OF PRIVATE FOUNDATION<br />
STATEMENT REQUIRED BY REG. §53.4945-5(d)<br />
INFORMATION WITH RESPECT TO EXPENDITURE RESPONSIBILITY GRANTS<br />
(1) Grantee:<br />
Small Business Majority <strong>Foundation</strong>, Inc.<br />
4000 Bridgeway, Suite 101<br />
Sausalito, CA, CA 94965<br />
(2) Grant Amount:<br />
$600,000<br />
Date <strong>of</strong> Grant:<br />
6/1/<strong>2009</strong><br />
(3) Purpose:<br />
To continue to project the needs and voices <strong>of</strong> Cali<strong>for</strong>nia's small businesses in support<br />
<strong>of</strong> healthcare re<strong>for</strong>m in order to more effectively promote the need <strong>for</strong> national and/or<br />
statewide universal healthcare coverage.<br />
(4) Total Paid:<br />
$300,000 paid on 7/15/<strong>2009</strong><br />
$300,000 paid on 12/18/<strong>2009</strong><br />
TOTAL $600,000<br />
Amount <strong>of</strong> Grant Spent by Grantee:<br />
$479,547<br />
(5) Diversion:<br />
To the knowledge <strong>of</strong> the <strong>Foundation</strong>, and based on the report furnished by the grantee,<br />
no grant funds have been diverted from the purpose <strong>of</strong> the grant.<br />
(6) Date <strong>of</strong> Report(s) Received from Grantee:<br />
12/1/<strong>2009</strong><br />
3/9/2010<br />
(7) Verification<br />
<strong>Blue</strong> <strong>Shield</strong> <strong>of</strong> Cali<strong>for</strong>nia <strong>Foundation</strong> reviewed the grant reports received but did not<br />
undertake any verification <strong>of</strong> the grantee's reports as there has not been any reason to<br />
doubt their accuracy or reliability (Reg. 53.4945-5(c)).<br />
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