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 />
Long Beach Network <strong>for</strong> Health<br />
333 W. Broadway, #208<br />
Long Beach, CA 90802<br />
(2) Grant Amount:<br />
$125,000<br />
Date <strong>of</strong> Grant:<br />
1/1/<strong>2009</strong><br />
(3) Purpose:<br />
To provide Health In<strong>for</strong>mation Exchange (HIE) grants to <strong>for</strong>mer or current <strong>Blue</strong> <strong>Shield</strong> <strong>of</strong><br />
Cali<strong>for</strong>nia <strong>Foundation</strong> (BSCF) grantees to strengthen and/or complete core aspects <strong>of</strong><br />
their projects, to develop long term strategic plans, and to give them time to secure<br />
future funding from other organizations.<br />
(4) Total Paid:<br />
$62,500 paid on 1/13/<strong>2009</strong><br />
$62,500 paid on 8/13/<strong>2009</strong><br />
TOTAL: $125,000<br />
Amount <strong>of</strong> Grant Spent by Grantee:<br />
$125,000<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 />
7/10/<strong>2009</strong><br />
2/2/2010 (FINAL)<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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