CALIFORNIA PHYSICIANS SERVICE FOUNDATION: Form 990PF, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- CALIFORNIA PHYSICIANS SERVICE FOUNDATION (EIN 94-2822302)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-07-15
- IRS object ID
- 201431979349100413
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990-PF
- Schedule B
- Accounting Fees Schedule
- Expenditure Responsibility Stmt
- General Explanation Attachment
- Investments Corp Stock Schedule
- Investments Other Schedule2
- Other Assets Schedule
- Other Decreases Schedule
- Other Expenses Schedule
- Other Increases Schedule
- Other Liabilities Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-07-15T18:14:39-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 946214841 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARMANINO LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12657 ALCOSTA BOULEVARD SUITE 500 | AddressLine1 |
| City | SAN RAMON | City |
| State | CA | State |
| ZIP Code | 945834600 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 942822302 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALIFORNIA PHYSICIANS' SERVICE FDN | BusinessNameLine1 |
| Business Name Line2 | DBA BLUE SHIELD OF CALIFORNIA FDN | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CALI | BusinessNameControlTxt |
| Phone | 4152295215 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 BEALE STREET FOURTEENTH FLOOR | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | PETER LONG | PersonNm |
| Person Title | CHIEF FINANCIAL OFFICER | PersonTitleTxt |
| Phone | 4152295215 | PhoneNum |
| Signature | 2014-07-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LYNN HENLEY | PreparerPersonNm |
| PTIN | P00356034 | PTIN |
| Phone | 9257902600 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-12-30 17:16:21Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $63,122,678 | FMVAssetsEOYAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rcvd Rev And Expnss | $37,466,142 | ContriRcvdRevAndExpnssAmt |
| Dividends Rev And Expnss | $239,520 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $239,520 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $969,500 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $37,135,010 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $24,599,738 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $38,675,162 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $24,839,258 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $54,000 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $0 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $54,000 | CompOfcrDirTrstDsbrsChrtblAmt |
| Oth Empl Slrs Wgs Rev And Expnss | $56,263 | OthEmplSlrsWgsRevAndExpnssAmt |
| Oth Empl Slrs Wgs Net Invst Incm | $0 | OthEmplSlrsWgsNetInvstIncmAmt |
| Oth Empl Slrs Wgs Dsbrs Chrtbl | $56,263 | OthEmplSlrsWgsDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $37,696 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $37,696 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $3,856,844 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $57,613 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $3,799,231 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $341,713 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $0 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Trav Conf Meeting Rev And Expnss | $129,833 | TravConfMeetingRevAndExpnssAmt |
| Trav Conf Meeting Net Invst Incm | $0 | TravConfMeetingNetInvstIncmAmt |
| Trav Conf Meeting Dsbrs Chrtbl | $129,833 | TravConfMeetingDsbrsChrtblAmt |
| Other Expenses Rev And Expnss | $620,209 | OtherExpensesRevAndExpnssAmt |
| Other Expenses Net Invst Incm | $0 | OtherExpensesNetInvstIncmAmt |
| Other Expenses Dsbrs Chrtbl | $620,209 | OtherExpensesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $5,096,558 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $57,613 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $4,697,232 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $34,681,593 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $38,511,605 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $39,778,151 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $57,613 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $43,208,837 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | -$1,102,989 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $24,781,645 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash BOY | $565,753 | CashBOYAmt |
| Cash EOY | $554,994 | CashEOYAmt |
| Cash EOYFMV | $554,994 | CashEOYFMVAmt |
| Sav And Temp Cash Invst BOY | $49,439,550 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $47,668,913 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $47,668,913 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $8,160,047 | CorporateStockBOYAmt |
| Corporate Stock EOY | $11,030,107 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $11,030,107 | CorporateStockEOYFMVAmt |
| Other Investments BOY | $8,109,133 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $3,854,113 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $3,854,113 | OtherInvestmentsEOYFMVAmt |
| Other Assets BOY | $9,986 | OtherAssetsBOYAmt |
| Other Assets EOY | $14,551 | OtherAssetsEOYAmt |
| Other Assets EOYFMV | $14,551 | OtherAssetsEOYFMVAmt |
| Total Assets BOY | $66,284,469 | TotalAssetsBOYAmt |
| Total Assets EOY | $63,122,678 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $63,122,678 | TotalAssetsEOYFMVAmt |
| Accounts Payable BOY | $756,842 | AccountsPayableBOYAmt |
| Accounts Payable EOY | $690,576 | AccountsPayableEOYAmt |
| Grants Payable BOY | $8,875,234 | GrantsPayableBOYAmt |
| Grants Payable EOY | $4,916,222 | GrantsPayableEOYAmt |
| Other Liabilities BOY | $0 | OtherLiabilitiesBOYAmt |
| Other Liabilities EOY | $152,950 | OtherLiabilitiesEOYAmt |
| Total Liabilities BOY | $9,632,076 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $5,759,748 | TotalLiabilitiesEOYAmt |
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
| Unrestricted BOY | $56,652,393 | UnrestrictedBOYAmt |
| Unrestricted EOY | $55,137,930 | UnrestrictedEOYAmt |
| Temporarily Restricted EOY | $2,225,000 | TemporarilyRestrictedEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $56,652,393 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $57,362,930 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $66,284,469 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $63,122,678 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $56,652,393 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | -$1,102,989 | ExcessRevenueOverExpensesAmt |
| Other Increases | $4,455,433 | OtherIncreasesAmt |
| Subtotal | $60,004,837 | SubtotalAmt |
| Other Decreases | $2,641,907 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $57,362,930 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (2 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | AcquiredAcquiredDt | SoldSoldDt | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|---|---|
| PUBLICLY TRADED SECURITIES | P | 2013-12-31 | 2013-12-31 | $2,096,042 | $1,199,367 | $896,675 | $896,675 |
| PUBLICLY TRADED SECURITIES | D | 2013-12-31 | 2013-12-31 | $35,038,968 | $11,335,905 | $23,703,063 | $23,703,063 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $24,599,738 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | 0 | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $36,788,289 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $50,290,097 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.731522 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $28,860,573 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $42,953,810 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.671898 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $32,343,808 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $40,425,723 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.800080 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $38,831,352 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $50,303,453 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.771942 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $34,986,979 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $58,021,425 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.603001 | DistributionYr5Rt |
| Total Distribution | 3.578443 | TotalDistributionRt |
| Average Distribution | 0.715689 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $54,950,665 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $39,327,586 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $247,816 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $39,575,402 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $43,208,837 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Domestic Org Meeting Sect4940e | Yes (X) | DomesticOrgMeetingSect4940eInd |
| Investment Income Excise Tax | $247,816 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $247,816 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $247,816 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $243,768 | EstimatedPlusOvpmtIncmTxAmt |
| Applied To Es Tax | $70,000 | AppliedToEsTaxAmt |
| Total Payments And Credits | $313,768 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $50 | EsPenaltyAmt |
| Overpayment | $65,902 | OverpaymentAmt |
| Applied To ES Tax | $65,902 | AppliedToESTaxAmt |
| Refund | $0 | RefundAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (1) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | CA | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | WWW.BLUESHIELDCAFOUNDATION.ORG | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CALIFORNIA PHYSICIANS' SRVC FDN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4152295215 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 BEALE STREET FOURTEENTH FLOOR | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | Yes (1) | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | Yes (1) | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | Yes (1) | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Acts Fail To Qlfy As Exceptions | 0 | ActsFailToQlfyAsExceptionsInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | 0 | UndistributedIncomePYInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Transactions Fail To Qlfy As Exc | 0 | TransactionsFailToQlfyAsExcInd |
| Maintained Expenditure Rspns | Yes (1) | MaintainedExpenditureRspnsInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (11 entries)
| Address Line1USAddress/AddressLine1 | Address Line2USAddress/AddressLine2 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|---|
| N MARCUS THYGESON M D | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | TRUSTEE | 1.00 | $0 | $0 | $0 |
| ELIZA DANIELY-WOOLFOLK | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | TRUSTEE | 1.00 | $0 | $0 | $0 |
| EDWARD CYMERYS | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | TRUSTEE | 1.00 | $0 | $0 | $0 |
| PETER LONG | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | PRESIDENT | 40.00 | $0 | $0 | $0 |
| DAVE KEARS | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | CHAIR | 1.00 | $13,000 | $0 | $0 |
| ANTONIA HERNANDEZ | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | VICE CHAIR | 1.00 | $9,000 | $0 | $0 |
| VIVIAN CLECAK | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | TRUSTEE | 1.00 | $6,500 | $0 | $0 |
| TOM EPSTEIN | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | TRUSTEE | 1.00 | $0 | $0 | $0 |
| FRANK GILLIAM | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | TRUSTEE | 1.00 | $10,000 | $0 | $0 |
| BILL HAUCK | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | TRUSTEE | 1.00 | $7,500 | $0 | $0 |
| SANDRA HERNANDEZ | |||||||||
| C/O BLUE SHIELD OF CA FOUNDATION 50 | BEALE STREET FOURTEENTH FLOOR | SAN FRANCISCO | CA | 94105 | TRUSTEE | 1.00 | $8,000 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
Compensation Of Hghst Pd Cntrct CompensationOfHghstPdCntrctGrp (5 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | Service TypeServiceTypeTxt | CompensationCompensationAmt |
|---|---|---|---|---|---|
| JEMMOTT ROLLINS GROUP INC | |||||
| 5443 OVERDALE DR | LOS ANGELES | CA | 90043 | CONSULTING | $471,315 |
| LANGER RESEARCH ASSOCIATES | |||||
| 140 W 74TH ST1E | NEW YORK | NY | 10023 | CONSULTING | $391,700 |
| FENTON COMMUNICATIONS | |||||
| 1000 VERMONT AVE NW STE 200 | WASHINGTON | DC | 20005 | CONSULTING | $311,990 |
| RDP CONSULTING | |||||
| 666 OAKLAND AVENUE 301 | OAKLAND | CA | 94611 | CONSULTING | $257,044 |
| PACIFIC HEALTH CONSULTING GROUP | |||||
| 72 OAK KNOLL AVE | SAN ANSELMO | CA | 94960 | CONSULTING | $242,220 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contractor Paid Over50k | 11 | ContractorPaidOver50kCnt |
Summary Of Direct Chrtbl Acty SummaryOfDirectChrtblActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description1 | PLEASE SEE ATTACHMENT D | Description1Txt |
| Expenses1 | $2,099,985 | Expenses1Amt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $17,667,067 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $38,120,410 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $55,787,477 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $55,787,477 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $836,812 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $54,950,665 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $2,747,533 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $2,747,533 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $247,816 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $247,816 | TotalTaxAmt |
| Distributable Before Adj | $2,499,717 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $2,499,717 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $2,499,717 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $43,208,837 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $43,208,837 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $247,816 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $42,961,021 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $2,499,717 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr5 | $32,183,548 | ExcessDistributionCyovYr5Amt |
| Excess Distribution Cyov Yr4 | $36,374,273 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr3 | $30,655,372 | ExcessDistributionCyovYr3Amt |
| Excess Distribution Cyov Yr2 | $27,003,462 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $34,646,587 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $160,863,242 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $43,208,837 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $2,499,717 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $40,709,120 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $0 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $0 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $201,572,362 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $32,183,548 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $169,388,814 | ExcessDistriCyovToNextYrAmt |
| Excess From Year4 | $36,374,273 | ExcessFromYear4Amt |
| Excess From Year3 | $30,655,372 | ExcessFromYear3Amt |
| Excess From Year2 | $27,003,462 | ExcessFromYear2Amt |
| Excess From Year1 | $34,646,587 | ExcessFromYear1Amt |
| Excess From Current Year | $40,709,120 | ExcessFromCurrentYearAmt |
Supplementary Information SupplementaryInformationGrp
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | BLUE SHIELD OF CALIFORNIA FOUNDATIO | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 BEALE STREET | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 4152295785 | RecipientPhoneNum |
| Form And Info And Materials | GO TO OUR WEBSITE: WWW.BLUESHIELDCAFOUNDATION.ORG/GRANTS/WHAT-WE-FUND | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | SEE WEBSITE FOR CURRENT DEADLINES. | SubmissionDeadlinesTxt |
| Restrictions 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) BLUE SHIELD AGAINST VIOLENCE. | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE ATTACHMENT A | BusinessNameLine1 |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O 50 BEALE STREET 14TH FLOOR | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Relationship | NONE | RecipientRelationshipTxt |
| Recipient Foundation Status | SEE ATTACHMENT A | RecipientFoundationStatusTxt |
| Grant Or Contribution Purpose | SEE ATTACHMENT A | GrantOrContributionPurposeTxt |
| Amt | $38,511,605 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $38,511,605 | TotalGrantOrContriPdDurYrAmt |
Grant Or Contri Apprv For Fut GrantOrContriApprvForFutGrp
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEE ATTACHMENT B | BusinessNameLine1 |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | C/O 50 BEALE STREET 14TH FLOOR | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Relationship | NONE | RecipientRelationshipTxt |
| Recipient Foundation Status | SEE ATTACHMENT B | RecipientFoundationStatusTxt |
| Grant Or Contribution Purpose | SEE ATTACHMENT B | GrantOrContributionPurposeTxt |
| Amt | $4,861,722 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Apprv Fut | $4,861,722 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 14 | ExclusionCd |
| Exclusion | $239,520 | ExclusionAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exclusion | 18 | ExclusionCd |
| Exclusion | $969,500 | ExclusionAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $1,209,020 | ExclusionAmt |
| Related Or Exempt Function Incm | $0 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $1,209,020 | TotalIncomeProducingActyAmt |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | 0 | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| General Rule | Yes (X) | GeneralRuleInd |
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | 1 | ContributorNum |
| Contributor Person | BLUE SHIELD OF CALIFORNIA | ContributorPersonNm |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 50 BEALE STREET 14TH FLOOR | AddressLine1 |
| City | SAN FRANCISCO | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | $37,466,142 | TotalContributionsAmt |
| Person Contribution | Yes (X) | PersonContributionInd |
| Noncash Contribution | Yes (X) | NoncashContributionInd |
Non Cash Property Contribution NonCashPropertyContributionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | 1 | ContributorNum |
| Noncash Property | STOCK PORTFOLIOSEE ATTACHMENT C | NoncashPropertyDesc |
| Fair Market Value | $34,966,142 | FairMarketValueAmt |
| Received | 2013-12-31 | ReceivedDt |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEES | CategoryTxt |
| Amt | $37,696 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $37,696 | DisbursementsCharitablePrpsAmt |
Expenditure Responsibility Stmt ExpenditureResponsibilityStmt
Expenditure Responsibility ExpenditureResponsibilityGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLEASE SEE ATTACHMENT E PAGES 1 THROUGH 9 | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PLEASE SEE ATTACHMENT E | AddressLine1 |
| City | ATTACHMENT E | City |
| State | CA | State |
| ZIP Code | 94105 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant | 2011-12-31 | GrantDt |
| Grant | $1,122,845 | GrantAmt |
| Purpose Of Grant | PLEASE SEE ATTACHMENT E | PurposeOfGrantTxt |
| Dates Of Reports By Grantee | PLEASE SEE ATTACHMENT E | DatesOfReportsByGranteeTxt |
General Explanation Attachment GeneralExplanationAttachment
General Explanation GeneralExplanationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | IN-KIND CONTRIBUTION | IdentifierTxt |
| Form And Line Reference | FORM 990-PF, PAGE 2, PART III, LINES 3 AND 5 | FormAndLineReferenceDesc |
| Medium Explanation | FORM 990-PF, PART III - OTHER INCREASES AND DECREASES IN NET ASSETS OR FUND BALANCES:CALIFORNIA PHYSICIANS SERVICE ( DBA BLUE SHIELD OF CALIFORNIA, INC.), A SUBSTANTIAL CONTRIBUTOR, PAID THE FOUNDATIONS STAFFING COST AND MUCH OF ITS ADMINISTARTIVE COSTS. CALIFORNIA PHYSICIANS SERVICE (DBA BLUE SHIELD OF CALIFORNIA, INC.) RECEIVED NO REIMBURSEMENT OR COMPENSATION FOR THESE COSTS, WHICH WERE RECORDED AS AN IN-KIND GIFT BY THE FOUNDATION. THE ESTIMATED VALUE OF THE ADMINISTRATIVE COSTS AND PERSONNEL PROVIDED TO THE FOUNDATION WAS APPROXIMATELY $ 2,641,907. | MediumExplanationTxt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Stock | COMMON STOCK-SEE ATTACHMENT F | StockNm |
| EOY Book Value | $11,030,107 | EOYBookValueAmt |
| EOYFMV | $11,030,107 | EOYFMVAmt |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category Or Item | FIXED INCOME FUNDS-SEE ATTACHMENT G | CategoryOrItemTxt |
| Listed At Cost Or FMV | FMV | ListedAtCostOrFMVCd |
| Book Value | $3,854,113 | BookValueAmt |
| EOYFMV | $3,854,113 | EOYFMVAmt |
Other Assets Schedule OtherAssetsSchedule
Other Assets Schedule OtherAssetsScheduleGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ACCRUED INVESTMENT INCOME | Desc |
| BOY Book Value | $9,986 | BOYBookValueAmt |
| EOY Book Value | $14,551 | EOYBookValueAmt |
| EOYFMV | $14,551 | EOYFMVAmt |
Other Decreases Schedule OtherDecreasesSchedule
Other Decreases Detail OtherDecreasesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | IN-KIND GIFTS OF PERSONNEL, ADMINISTRATIVE SERVICES, AND FACILITIES | Description |
| Amount | $2,641,907 | Amount |
Other Expenses Schedule OtherExpensesSchedule
Other Expenses Schedule OtherExpensesScheduleGrp (11 entries)
| DescDesc | Revenue And Expenses Per BooksRevenueAndExpensesPerBooksAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| BOARD MEETING EXPENSE | $17,877 | $0 | $17,877 |
| OFFICE EXPENSES | $22,773 | $0 | $22,773 |
| LICENSES & FEES | $19,282 | $0 | $19,282 |
| MARKETING | $43,052 | $0 | $43,052 |
| SUBSCRIPTIONS | $18,548 | $0 | $18,548 |
| EVENTS - HOSTED | $121,461 | $0 | $121,461 |
| HONORARIA | $22,050 | $0 | $22,050 |
| IT/TELECOMMUNICATIONS | $113,283 | $0 | $113,283 |
| BANK FEES | $643 | $0 | $643 |
| MEMBERSHIPS | $220,519 | $0 | $220,519 |
| STAFF TRAINING & DEVELOPMENT | $20,721 | $0 | $20,721 |
Other Increases Schedule OtherIncreasesSchedule
Other Increases Detail OtherIncreasesDetail (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| UNREALIZED GAIN/LOSS ON INVESTMENTS | $1,813,526 |
| IN-KIND GIFTS OF PERSONNEL, ADMINISTRATIVE SERVICES, AND FACILITIES | $2,641,907 |
Other Liabilities Schedule OtherLiabilitiesSchedule
Other Liabilities Detail OtherLiabilitiesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | EXCISE TAX PAYABLE | Desc |
| BOY Book Value | $0 | BOYBookValueAmt |
| EOY Book Value | $152,950 | EOYBookValueAmt |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (3 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| PROGRAM CONSULTING & EVALUATION | $3,781,251 | $0 | $3,781,251 |
| INVESTMENT MANAGEMENT FEES | $57,613 | $57,613 | $0 |
| HR CONSULTING | $17,980 | $0 | $17,980 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | EXCISE TAX EXPENSE | CategoryTxt |
| Amt | $341,713 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
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