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 />
Integrated Healthcare Association<br />
344 Thomas Berkley Way, Suite 350<br />
Oakland, CA 94612<br />
(2) Grant Amount:<br />
$675,000<br />
Date <strong>of</strong> Grant:<br />
6/1/2006<br />
(3) Purpose:<br />
To execute a demonstration project in the Los Angeles County area that will improve the<br />
data, establish benchmarks, enhance collaboration, and align financial incentives among<br />
hospitals, physician organizations, and health plans to improve quality, safety, cost,<br />
efficiency, and access in the adoption and usage <strong>of</strong> cardiovascular and orthopedic<br />
medical devices in Cali<strong>for</strong>nia.<br />
(4) Total Paid:<br />
$168,750 paid on 5/31/2006<br />
$168,750 paid on 1/16/2007<br />
$168,750 paid on 6/14/2007<br />
$168,750 paid on 1/15/2008<br />
TOTAL $675,000<br />
Amount <strong>of</strong> Grant Spent by Grantee:<br />
$675,000<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 />
11/30/2006<br />
5/31/2007<br />
11/30/2007<br />
7/1/2008<br />
5/29/<strong>2009</strong> (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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