Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2010
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2010 and ending 12-31-2010
BCheck if applicable:
CName of organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
ONE KAISER PLAZA 15L
 
Room/suite
City or town, state or country, and ZIP + 4
OAKLAND, CA94612
D Employer identification number

52-0954463
E Telephone number

G Gross receipts $ 2,591,167,453
F Name and address of principal officer:
MARILYN J KAWAMURA
ONE KAISER PLAZA 15L
OAKLAND,CA94612
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
N/A
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1972
M State of legal domicile: MD
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTH CARE SERVICES TO IMPROVE THE HEALTH OF OUR MEMBERS AND THE COMMUNITIES WE SERVE
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) .... 3 14
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 12
5 Total number of individuals employed in calendar year 2010 (Part V, line 2a) ... 5 6,481
6 Total number of volunteers (estimate if necessary) .... 6 374
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 395,270
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 1,000 0
9 Program service revenue (Part VIII, line 2g) ......... 2,072,471,716 2,167,518,178
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 17,190,027 14,051,735
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 331,594 844,684
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 2,089,994,337 2,182,414,597
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 7,413,818 13,959,286
14 Benefits paid to or for members (Part IX, column (A), line 4) .... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 442,095,453 484,757,781
16a Professional fundraising fees (Part IX, column (A), line 11e).... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 1,651,348,508 1,717,688,949
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 2,100,857,779 2,216,406,016
19 Revenue less expenses. Subtract line 18 from line 12...... -10,863,442 -33,991,419
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............ 774,115,404 770,152,177
21 Total liabilities (Part X, line 26)............ 625,509,440 671,862,797
22 Net assets or fund balances. Subtract line 21 from line 20 ..... 148,605,964 98,289,380
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(see instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? (see instructions) .........
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2010)
Form 990 (2010)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III . . . . . . . . . .
1
Briefly describe the organization’s mission: TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTH CARE SERVICES TO IMPROVE THE HEALTH OF OUR MEMBERS AND THE COMMUNITIES WE SERVE
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 2,011,821,948 including grants of $ 13,959,286 ) (Revenue $ 2,165,166,486 )
member health care services and medical training for care improvement Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP of MAS) provides medical and surgical care, including urgent care services, extended care and home health care, for its members without regards to age, sex, race, religion or national origin or the ability to pay. KFHP of MAS educates and trains medical students and other health care professionals and promotes scientific and nursing education in order to improve care. Additional information about Mid-Atlantic States Health Plan's charitable activities can be found in Schedule O.
4b (Code:   ) (Expenses $ 31,406,325 including grants of $ 0 ) (Revenue $ 2,153,003 )
Charitable Care (Medical Financial Assistance and Charitable Coverage) Health Plan provides charity care to low-income vulnerable patients through the Medical Financial Assistance (MFA) and Charitable Health Coverage (CHC) Programs. MFA - Health Plan offers financial assistance to help families and individuals that are unable to pay for all or part of the cost of urgent or emergent care provided in Kaiser Permanente facilities. In 2010, this program assisted 241 applicants, providing 270 prescriptions and 462 outpatient visits. CHC - these programs are available to low income adults and children who are not eligible for other public or privately sponsored coverage. More than 8,548 patients received comprehensive care for up to four years through these programs.
4c (Code:   ) (Expenses $ 9,719,685 including grants of $ 0 ) (Revenue $ 33,258 )
Participation in Government Sponsored Programs Mid-Atlantic Health Plan contributed $9.7 million to support the provision of medical care services to individuals in the state of Maryland. The Maryland Medical Assistance Program (MMA) provides funds to allow the state to increase rates that Medicaid pays to fee-for-service and managed care health care providers. The MMA program helps increase the number of practitioners willing to serve Medicaid patients, and without such practitioners, access to care could be seriously curtailed for vulnerable populations in Maryland.
(Code:   ) (Expenses $ 3,906,541 including grants of $ 0 ) (Revenue $ 0 )
SEE COMMUNITY BENEFIT REPORT
4d Other program services. (Describe in Schedule O.)
(Expenses $ 3,906,541 including grants of $ 0 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet$ 2,056,854,499
Form 990 (2010)
Form 990 (2010)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part III........................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete
Schedule D, Part IClick to see attachment.......................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in term, permanent,or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
Form 990 (2010)
Form 990 (2010)
Page 4
Part IV
Checklist of Required Schedules (continued)
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
Did the organization attach its audited financial statement to this return? Note: All Form 990 filers that operate one or more hospitals must attach audited financial statements. .....
20b
 
 
21
Did the organization report more than $5,000 of grants and other assistance to governments and organizations in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II........................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor, or a grant selection committee member, or to a person related to such an individual? If “Yes,” complete Schedule L, Part III............... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35
Is any related organization a controlled entity within the meaning of section 512(b)(13)? .....
35
Yes
 
a
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2010)
Form 990 (2010)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V . . . . . . . . . .
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
5,967
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
6,481
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2010)
Form 990 (2010)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year ..............
1a
14
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? ..
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Does the organization have members or stockholders? ................
6
Yes
 
7a
Does the organization have members, stockholders, or other persons who may elect one or more members of the governing body? .........................
7a
Yes
 
b
Are any decisions of the governing body subject to approval by members, stockholders, or other persons? ..
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Does the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” does the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with those of the organization? ....
10b
 
 
11a
Has the organization provided a copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Does the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Are officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ...........................
12b
Yes
 
c
Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this is done ....................
12c
Yes
 
13
Does the organization have a written whistleblower policy? ...............
13
Yes
 
14
Does the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line a or b, describe the process in Schedule O. (See instructions.)
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
DC , MD , VA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and financial statements available to the public.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
VP - NATIONAL TAX COMPLIANCE
ONE KAISER PLAZA 15L
OAKLAND,CA94612
(510) 271-6385
Form 990 (2010)
Form 990 (2010)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . .
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) Anthony Barrueta
SVP, Government Relations
 5.0 X           0 571,456 116,411
(2) CHRISTINE K CASSEL
DIRECTOR
 .5 X           0 172,625 0
(3) THOMAS W CHAPMAN EDD
DIRECTOR
 1.0 X           11,000 174,427 59,810
(4) DANIEL P GARCIA
SVP, Chief Compliance Officer
 2.0 X           0 1,280,238 73,787
(5) WILLIAM R GRABER
DIRECTOR
 1.0 X           0 232,123 0
(6) J EUGENE GRIGSBY III PHD
DIRECTOR
 1.0 X           11,643 182,100 0
(7) GEORGE C HALVORSON
Chairman, CEO, President
 5.0 X   X       0 7,667,335 76,092
(8) JUDITH JOHANSEN
DIRECTOR
 .5 X           0 184,560 0
(9) KIM J KAISER
DIRECTOR
 .5 X           0 122,875 0
(10) PHILIP MARINEAU
DIRECTOR
 .5 X           0 193,623 0
(11) JENNY J MING
DIRECTOR
 .3 X           0 182,748 0
(12) EDWARD PEI
DIRECTOR
 .5 X           0 168,250 16,500
(13) J NEAL PURCELL
DIRECTOR
 .5 X           0 219,738 0
(14) CYNTHIA TELLES
DIRECTOR
 .5 X           0 182,647 0
(15) SANDRA THOMPKINS
DIRECTOR
 .5 X           0 166,951 0
(16) Marilyn Kawamura
Region President - MAS
 35.0     X       0 961,205 207,332
(17) Kathryn Lancaster
EVP & CFO
 4.0     X       0 1,558,076 296,474
Form 990 (2010)
Form 990 (2010)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (check all that apply) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) THOMAS R MEIER
SVP, Corporate Treasurer
 3.0     X       0 647,785 107,439
(19) Donald Orndoff
SVP, NFS
 5.0     X       0 508,058 70,932
(20) DeAnne Petersen
VP, CFO - MAS
 50.0     X       0 364,277 81,432
(21) ROCHELLE M ROTH
SENIOR DIRECTOR, QRM
 5.0     X       0 182,639 51,575
(22) ARTHUR M SOUTHAM MD
EVP, Health Plan Operations
 5.0     X       0 2,020,299 353,928
(23) Susan Spurlark
VP, Regional Counsel - MAS
 30.0     X       0 376,891 103,384
(24) Deborah Stokes
SVP, CORP CONTROLLER & CAO
 4.0     X       0 622,642 123,860
(25) BERNARD J TYSON
President & COO
 5.0     X       0 1,942,514 359,961
(26) Steven Zatkin
SVP, Gen Counsel & Secretary
 5.0     X       0 1,247,253 97,716
(27) VICTORIA B ZATKIN
VP, Off of Brd & Corp Gov Svcs
 4.0     X       0 311,369 83,647
(28) Mark Zemelman
SVP, Gen Counsel & Secretary
 4.0     X       0 806,199 150,636
(29) RUBEN J BURNETT
VP, SALES, MARKETING & BUS.
 30.0       X     0 398,683 94,288
(30) Carrie Harris-Muller
VP, Chief Admin Officer
 30.0       X     0 421,782 81,873
(31) KENDALL D HUNTER
VP, Chief Operating Officer
 30.0       X     0 499,236 104,518
(32) Russell Bradley
VP, HP Services & Admin
 30.0         X   253,643 0 49,055
(33) JUDITH L BRITTAIN
VP, DELIVERY SYS OPERATIONS
 30.0         X   302,531 0 80,136
(34) MARY E JAEGER
VP, HR - MAS
 30.0         X   0 288,267 77,950
(35) KAY W LEWIS
VP, UM, Risk Mgmt & Quality
 30.0         X   0 355,841 116,387
(36) TAMSEN L WESTMORELAND
Exec Dir Regional Comp - MAS
 30.0         X   0 235,609 40,734
(37) Christine Malcolm
FORMER SVP
 0.0           X 0 568,721 12,021
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 578,817 26,019,042 3,087,878
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 in reportable compensation from the organizationMediumBullet732
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
INOVA GROUP OF HOSPITALS
PO BOX 37019
BALTIMORE,MD21297 		HOSPITAL SERVICES 82,425,116
WASHINGTON HOSPITAL CENTER
PO BOX 631290
BALTIMORE,MD21263 		HOSPITAL SERVICES 56,051,648
HOLY CROSS HOSPITAL
9805 DAMERON DRIVE
SILVER SPRING,MD20902 		HOSPITAL SERVICES 63,431,065
CHILDRENS HOSPITAL
PO BOX 37215
BALTIMORE,MD21297 		HOSPITAL SERVICES 41,671,132
MID-ATLANTIC PERMANENTE MEDICAL GRO
2101 E JEFFERSON ST
ROCKVILLE,MD20852 		MEDICAL SERVICES 437,740,404
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization MediumBullet489
Form 990 (2010)
Form 990 (2010)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, gifts, grants and other similar amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 0
Program Service Revenue Business Code
2a MBR HLTH CARE PREM 621,400 1,843,855,315 1,843,855,315    
b SUPPL CHARGE/PHARM 621,400 97,524,030 97,370,834 153,196  
c NON-PLAN & IND REV 621,400 2,013,783 2,013,783    
d OTHER PRGM SERVICE 621,400 15,911,368 15,899,133 12,235  
e MEDICARE/MEDICAID 621,400 208,213,682 208,213,682    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 2,167,518,178
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 10,169,980     10,169,980
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross Rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 412,611,311 23,300
b Less: cost or other basis and sales expenses 408,535,029 217,827
c Gain or (loss) 4,076,282 -194,527
d Net gain or (loss)..........MediumBullet 3,881,755     3,881,755
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a PARKING LOT 812,930 844,684   229,839 614,845
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 844,684
12 Total revenue. See Instructions....MediumBullet 2,182,414,597 2,167,352,747 395,270 14,666,580
Form 990 (2010)
Form 990 (2010)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21 13,959,286 13,959,286
2 Grants and other assistance to individuals in the U.S. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 597,174 591,202 5,972  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 350,415,377 310,497,826 39,917,551  
8 Pension plan contributions (include section 401(k) and section 403(b) employer contributions) .... 37,409,765 36,145,866 1,263,899  
9 Other employee benefits ....... 70,103,818 58,223,217 11,880,601  
10 Payroll taxes ........... 26,231,647 23,791,649 2,439,998  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,103,248   1,103,248  
c Accounting ........... 1,522,624   1,522,624  
d Lobbying ........... 575,192   575,192  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 334,297 334,297    
g Other .......... 0      
12 Advertising and promotion .... 29,391,426 576,273 28,815,153  
13 Office expenses ....... 7,389,127 5,889,606 1,499,521  
14 Information technology ...... 124,436,076 124,436,076    
15 Royalties .. 0      
16 Occupancy ........... 51,933,591 51,933,591    
17 Travel ............ 2,326,934 1,956,858 370,076  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 1,185,771 781,406 404,365  
20 Interest ........... 1,037,111 1,037,111    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 35,857,504 35,857,504    
23 Insurance .............. 8,865,749 8,865,749    
24 Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a BASIC CONTRACTUAL PAYMENTS 645,383,779 645,383,779    
b PURCHASED MEDICAL SERVICES 376,416,231 376,416,231    
c SUPPLIES 294,578,086 273,671,991 20,906,095  
d INTER-REGIONAL CHARGES 57,418,237 54,274,072 3,144,165  
e PURCHASED NON-MEDICAL SVC 43,132,705   43,132,705  
f All other expenses 34,801,261 32,230,909 2,570,352  
25 Total functional expenses. Add lines 1 through 24f 2,216,406,016 2,056,854,499 159,551,517 0
26 Joint costs. Check here MediumBullet if following
SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation 		       
Form 990 (2010)
Form 990 (2010)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 6,027,088 1 7,993,398
2 Savings and temporary cash investments .......   2  
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 66,363,500 4 66,479,635
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5  
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use .............. 21,460,375 8 22,448,940
9 Prepaid expenses and deferred charges ............ 4,747,172 9 5,359,168
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 810,664,467
b Less: accumulated depreciation. ..... 10b 376,678,975 315,534,011 10c 433,985,492
11 Investments—publicly traded securities .......... 356,858,041 11 230,590,819
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 3,125,217 15 3,294,725
16 Total assets. Add lines 1 through 15 (must equal line 34)... 774,115,404 16 770,152,177
Liabilities 17 Accounts payable and accrued expenses . 218,313,743 17 243,566,511
18 Grants payable ..........   18  
19 Deferred revenue .......... 5,262,621 19 4,207,108
20 Tax-exempt bond liabilities .......... 12,964,664 20 12,939,271
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities. Complete Part X of Schedule D..... 388,968,412 25 411,149,907
26 Total liabilities. Add lines 17 through 25..... 625,509,440 26 671,862,797
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .....   27  
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ..... 6,795,610 30 6,795,610
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds 141,810,354 32 91,493,770
33 Total net assets or fund balances ..... 148,605,964 33 98,289,380
34 Total liabilities and net assets/fund balances ..... 774,115,404 34 770,152,177
Form 990 (2010)
Form 990 (2010)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI . . . . . . . . . .
1
Total revenue (must equal Part VIII, column (A), line 12) . . .
1
2,182,414,597
2
Total expenses (must equal Part IX, column (A), line 25) . . . . .
2
2,216,406,016
3
Revenue less expenses. Subtract line 2 from line 1 . . . .
3
-33,991,419
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . .
4
148,605,964
5
Other changes in net assets or fund balances (explain in Schedule O) . . . .
5
-16,325,165
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) . . . . . .
6
98,289,380
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . .
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?..
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O............................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2010)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .       1,000   1,000
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... 1,833,460,358 1,939,546,503 2,001,419,294 2,072,423,301 2,167,352,747 10,014,202,203
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5. 1,833,460,358 1,939,546,503 2,001,419,294 2,072,424,301 2,167,352,747 10,014,203,203
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)           10,014,203,203
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6... 1,833,460,358 1,939,546,503 2,001,419,294 2,072,424,301 2,167,352,747 10,014,203,203
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 10,407,879 16,063,854 16,584,560 13,960,781 11,014,664 68,031,738
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 10,407,879 16,063,854 16,584,560 13,960,781 11,014,664 68,031,738
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.). 1,843,868,237 1,955,610,357 2,018,003,854 2,086,385,082 2,178,367,411 10,082,234,941
14
Section C. Computation of Public Support Percentage
15
15
99.325 %
16
16
99.337 %
Section D. Computation of Investment Income Percentage
17
17
0.675 %
18
18
0.663 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities ....................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2010

Schedule C (Form 990 or 990-EZ) 2010
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
Organization's
Totals 		(b) Affiliated Group
Totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots non-taxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2010


Schedule C (Form 990 or 990-EZ) 2010
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
18,000
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
318,128
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? If "Yes," describe in Part IV ..........................
Yes
 
239,064
j
Total. lines 1c through 1i ...................................
575,192
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING ACTIVITY BY NONELECTING PUBLIC CHARITIES SCHEDULE C, PART II-B, LINE 1A THROUGH 1I The Organization is a member of the Kaiser Permanente Medical Care Program and participated and benefited from lobbying activities conducted at the regional and national level for the benefit of its enrolled members and for the health care industry as a whole. As an organization generally exempt from income tax under Internal Revenue Code Section 501(c)(3), Health Plan has a policy prohibiting internal involvement in any political campaigns. This policy is closely monitored for compliance. During the year this Organization may have made comments or statements concerning legislation which may affect the health care industry. Health Plan may have engaged in telephone conversations and/or written letters to various federal, state, and local officials regarding matters which affected the healthcare industry as a whole. The amount of time and money involved in the activities is detailed on lines a through i. Health Plan has several employees and/or may retain a professional consultant to represent Health Plan's interests in various legislative and regulatory bodies and from time-to-time to keep informed of Federal and State legislation having an impact on Health Plan's charitable activities as an exempt Health Maintenance Organization. These individuals attempt to ensure that proposed legislation and enacted laws are compatible with the Interest of Health Plan and its members by performing the following activities: - Collecting, analyzing and distributing within the Organization, public and private policy recommendations regarding proposed legislation that affect the operation of Health Plan and its ability to provide quality health and medical care services to its members in a cost effective environment. - Providing appropriate informational materials to legislators and to their staffs that pertain to matters of common interest in the health care community and in the not-for-profit community. - Also by preparing written and oral testimony, these individuals appear at legislative hearings, monitor legislative proceedings and meet with legislators and/or their staffs regarding issues pertinent to the mission of Health Plan. Those individuals appearing at such hearings and meetings for and on behalf of Health Plan often are representing the interests of common interest groups as well as the interests of the members of Health Plan. - Other employees and officers perform services by delivering speeches at various public and private functions and in serving as faculty in healthcare related educational programs throughout the community.
Schedule C (Form 990 or 990EZ) 2010

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06 ........ 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....      
b Contributions ........      
c Investment earnings or losses ...      
d Grants or scholarships .....      
e Other expenditures for facilities
and programs ........ 		     
f Administrative expenses ....      
g End of year balance ......      
2
Provide the estimated percentage of the year end balance held as:
a
Board designated or quasi-endowment: SchDMd Bullet  
b
Permanent endowment: SchDMd Bullet  
c
Term endowment: SchDMd Bullet  
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Investments—Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of investment (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   67,793,066 67,793,066
b Buildings ................   330,193,139 185,352,173 144,840,966
c Leasehold improvements ............   110,531,880 46,252,188 64,279,692
d Equipment ................   164,957,879 121,116,858 43,841,021
e Other .................   137,188,503 23,957,756 113,230,747
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........SchDMdBullet 433,985,492
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Amount
Federal Income Taxes 0
DUE TO RELATED ENTITIES 134,924,545
SELF-INSURED RISK - PROF & PUB 0
MEDICARE COST REPORT RESERVE 24,948,679
PENSION & POST-RETIREMENT BENE 206,824,754
OTHER CURRENT LIABILITIES 6,386,273
LONG-TERM DEFERRED RENT LIABILITY 33,186,165
OTHER LONG-TERM LIABILITIES 4,879,491


Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)Small Bullet 411,149,907
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2010

Schedule D (Form 990) 2010
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 2,182,414,597
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 2,216,406,016
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 -33,991,419
4 Net unrealized gains (losses) on investments .......................... 4 -4,996,045
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV) ................................. 8 -11,329,120
9 Total adjustments (net). Add lines 4 - 8 ............................. 9 -16,325,165
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 -50,316,584
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 2,176,018,655
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -4,996,045
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV): ............ 2d 6,827,945
e Add lines 2a through 2d ..................... 2e 1,831,900
3 Subtract line 2e from line 1..................... 3 2,174,186,755
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV): ........... 4b 8,227,842
c Add lines 4a and 4b....................... 4c 8,227,842
5 Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ...... 5 2,182,414,597
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 2,226,335,239
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV): ............ 2d 13,339,200
e Add lines 2a through 2d...................... 2e 13,339,200
3 Subtract line 2e from line 1..................... 3 2,212,996,039
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV): ............ 4b 3,409,977
c Add lines 4a and 4b....................... 4c 3,409,977
5 Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ...... 5 2,216,406,016
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
RECONCILIATION OF REVENUE PER AUDITED FIN. STMT. WITH REVENUE PER RETURN SCHEDULE D, PART XII LINE 2D: Gain on sale of investments - book $ 4,543,206 CAPITAL TRANSFER OUT - CURRENT YEAR 1,506,152 INTEREST EXPENSE - RECLASS 560,760 FIXED ASSET LOSS - RECLASS 217,827 TOTAL $ 6,827,945 LINE 4B: BAD DEBT EXPENSES - RECLASS $ 3,075,680 INVESTMENT MANAGEMENT EXPENSES - RECLASS 334,297 Gain on sale of investments - tax 4,076,282 SEE PART XI, LINE 8, NOTE 1 741,583 TOTAL $ 8,227,842
RECONCILIATION OF EXPENSES PER AUDITED FIN. STMT. WITH EXPENSES PER RETURN SCHEDULE D, PART XIII LINE 2D: CHANGE IN OTHER COMPREHENSIVE INCOME $ 12,560,613 INTEREST EXPENSE - RECLASS 560,760 FIXED ASSET LOSS - RECLASS 217,827 TOTAL $ 13,339,200 LINE 4B: BAD DEBT EXPENSES - RECLASS $ 3,075,680 INVESTMENT MANAGEMENT EXPENSES - RECLASS 334,297 TOTAL $ 3,409,977
RECONCILIATION OF CHANGE IN NET ASSETS FROM FORM 990 TO FINANCIAL STMT SCHEDULE D, PART XI, LINE 8 CHANGE IN OTHER COMPREHENSIVE INCOME $ (12,560,613) CAPITAL TRANSFER OUT - CURRENT YEAR 1,506,152 Gain on sale of investments - book 4,543,206 Gain on sale of investments - tax (4,076,282) SEE "NOTE 1" (741,583) TOTAL $ (11,329,120) NOTE 1: OTHER THAN TEMPORARY IMPAIRMENT OF INVESTMENT RECOGNIZED FOR FINANCIAL STATEMENT PURPOSES, WHICH WILL BE TAX REPORTED WHEN REALIZED
FIN 48 FOOTNOTE SCHEDULE D, PART X, QUESTION 2 NOT REQUIRED
Schedule D (Form 990) 2010

Additional Data


Software ID:  
Software Version:  




Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number
52-0954463
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Access to Wholistic & Prdctive Lvg Inst Inc7114 Cipriano Springs Dr
LANHAM,MD207063835 		26-2296724 501(c)(3) 70,000       Salvation Army In-treatment Center - Embracing Hea Access Coordinator and Medication Coordinator
(2) Achieve Kids Tri Inc2000 M St NW
520
WASHINGTON,DC20036 		26-2073899 501(c)(3) 10,000       Achieve Kids Triathlon
(3) Adventist HealthCare Inc1801 Research Blvd
ROCKVILLE,MD20850 		52-1532556 501(c)(3) 39,129       Qualified Bilingual Staff Train-the-Trainer Confer
(4) Alternative HousePO Box 694
Dunn Loring,VA22027 		54-0899463 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(5) American Diabetes Association2002 Clipper Park Rd
Baltimore,MD21211 		13-1623888 501(c)(3) 45,000       2010 Reverse the Trend Grant
(6) Annapolis Area Ministries Inc10 Hudson St
Annapolis,MD21401 		52-1671388 501(c)(3) 74,500       Health Assistance for Vulnerable Populations Special Health Care Needs
(7) Arlington Free Clinic2921 11th St
Arlington,VA22204 		54-1671883 501(c)(3) 90,000       2010 Grant for general operating support table
(8) Arlington Pediatric Center Inc601 S Carlin Springs Rd
Arlington,VA22204 		54-1998631 501(c)(3) 75,000       2010 Grant for Operational Support Collaborative
(9) Ascensions Community Services Inc1526 Howard Rd SE
Washington,DC20018 		51-0519629 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(10) Associated Black Charities1114 Cathedral St
Baltimore,MD21201 		52-1427774 501(c)(3) 264,800       BMore Healthy Media Campaign
(11) Associated Catholic Charities2015 20th St
Ft Meade,MD207551301 		52-0591538 501(c)(3) 49,000       End of Year Donation
(12) Baltimore Community College Foundation Inc2901 Liberty Heights Ave
Harper Hall 101
Baltimore,MD212157893 		52-1361023 501(c)(3) 200,000       BCCC Kaiser Permanente Scholarships Project
(13) Bethany Christian Services of Maryland2130 Priest Bridge Dr
9
Crofton,MD21114 		31-1282580 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(14) Bikes Belong FoundationPO Box 2359
Boulder,CO80306 		20-4306888 501(c)(3) 161,250       Safe Passages for School Children
(15) Black Lesbian and Gay Pride Day Inc1325 Mass Ave
600
Washington,DC20005 		52-2021396 501(c)(3) 20,000       2010 Health and Wellness Convention
(16) Boat People SOS Inc6066 Leesburg Pike
100
Falls Church,VA22041 		54-1563619 501(c)(3) 125,000       Health Awareness and Prevention Program (HAPP)
(17) Bread for the City Inc1525 Seventh St NW
Washington,DC20001 		52-1138207 501(c)(3) 99,000       2010 grant for nutrition initiative
(18) Calvary Women's Services110 Maryland Ave NE
103
Washington,DC20002 		52-1307706 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(19) Capital Area Food Bank645 Taylor St NE
Washington,DC20017 		52-1167581 501(c)(3) 252,000       Employee Giving Campaign Match
(20) Carpenter's Shelter Inc930 North Henry St
Alexandria,VA22314 		54-1571849 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(21) CASA of Maryland8151 15th Ave
Langley Park,MD20783 		52-1372972 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(22) Catoctin Foundation Inc The224B Cornwell St NW
Leesburg,VA20175 		54-1921059 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(23) Cesar Chavez Public Policy Charter HS709 12th St SE
Washington,DC20003 		52-2088566 501(c)(3) 20,000       District of Columbia Promise Neighborhood Initiati
(24) Children's Hospital Foundation111 Michigan Ave NW
Washington,DC200102970 		52-1640402 501(c)(3) 60,000       Mobile Health Program
(25) Christ House1717 Columbia Rd NW
Washington,DC20009 		52-1362103 501(c)(3) 99,000       2010 Grant for Operational Support
(26) Comm Health Charities of the Nat Cap ARea1240 N Pitt St
3RD Fl
Alexandria,VA22314 		52-1089036 501(c)(3) 28,500       Matching funds for 2009 Employee Giving Campaign
(27) CommnHealth ACTION1025 Connecticut Ave NW
1000
Washington,DC20036 		83-0398572 501(c)(3) 300,743       Grant for Technical Assistance to support the Port Nation's Capital
(28) Common Good City Farm3318 19th St NW
Washington,DC20010 		80-0365344 501(c)(3) 80,000       Fresh Food Beyond LeDroit Park
(29) Community Clinic Inc15850 Crabbs Branch Way
350
Rockville,MD20855 		52-0988386 501(c)(3) 200,000       Dental Health Program
(30) Community Ministries of Rockville1010 Grandin Ave
A-1
Rockville,MD20851 		52-0910334 501(c)(3) 95,300       2010 Gala Sponsorship
(31) DC Appleseed Center for Law and Justice1111 Fourteenth St NW
510
Washington,DC20005 		52-1891162 501(c)(3) 29,575       2010 Awards Dinner
(32) DC Central Kitchen Inc425 2nd St NW
Washington,DC20001 		52-1584936 501(c)(3) 174,000       2010 Capital Food Fight school based healthcare
(33) Dialogue on Diversity1629 K St NW
300
Washington,DC20006 		52-1761217 501(c)(3) 17,500       2010 Health Care Symposium
(34) District of Columbia Primary Care Assoc1411 K St NW
300
Washington,DC200053404 		52-1999196 501(c)(3) 20,000       2010 Annual Meeting
(35) Domestic Violence Center of Howard Cty Inc5457 Twin Knolls Rd
310
Columbia,MD21045 		52-1115111 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(36) Doorways for Women and FamiliesPO Box 100185
Arlington,VA22210 		54-1087829 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(37) ECO-Farm3901 Livingston St
Hyattsville,MD20781 		26-4196401 501(c)(3) 107,500       2010 Sowing Seeds Here and Now Conference Gala
(38) Elton John AIDS Foundation Inc584 Broadway
906
New York,NY10012 		58-2033460 501(c)(3) 15,000       Smash Hits Tennis Tournament
(39) End Time Harvest Ministries In5808 Harland St
New Carrollton,MD20784 		52-1379809 501(c)(3) 27,000       2010 Port Towns Graduation Celebration
(40) FACETS Cares Inc10640 Page Ave
300
Fairfax,VA22030 		54-1516266 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(41) Fairfax County Office of Partnerships12000 Government Center Pkwy
432
Fairfax,VA22035 		54-0787833 501(c)(3) 8,912       Dress Up With Grown Ups Gala Career Success Program graduates
(42) Family Services Inc610 E Diamond Ave
Gaithersburg,MD20877 		52-0730225 501(c)(3) 150,000       2010 SafetyNet Grant
(43) Food & Friends Inc219 Riggs Rd NE
Washington,DC20011 		52-1648941 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(44) Food For Others Inc2938 Prosperity Ave
Fairfax,VA22031 		54-1777157 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(45) Food Research and Action Center1875 Connecticut Ave NW
540
Washington,DC20009 		23-7200739 501(c)(3) 150,000       Reducing Obesity Among District Students through H children to medical homes
(46) Frederick Union Rescue Mission IncPO Box 3389
Frederick,MD21705 		52-0813371 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(47) Fredericksburg Area Food Bank3631 Lee Hill Dr
Fredericksburg,VA22408 		54-1255013 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(48) George Mason University Foundation Inc4400 University Dr
Fairfax,VA22030 		54-1603842 501(c)(3) 13,000       2010 Health & Fitness Expo
(49) Good Shepherd Housing & Family Services8305 Richmond Hwy
17B
Alexandria,VA22309 		23-7447962 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(50) Greater Prince William Community Health Ctr4379 Ridgewood Center Dr
102
Woodbridge,VA22192 		83-0435138 501(c)(3) 150,000       Healthy Kids for a Healthy Community
(51) Guide Program Inc8643 Cherry Lane
Laurel,MD20707 		52-0950208 501(c)(3) 99,527       GUIDE Strategic IT Initiative Sciences Students
(52) Healthy Howard IncPO Box 2275
Columbia,MD21045 		61-1549388 501(c)(3) 144,110       The Impacts of Health and Wellness Coaching on the Health Care Directory
(53) Heartly House IncPO Box 857
Frederick,MD21705 		52-1186250 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET patients
(54) Hispanic College Fund Inc1301 K St NW
450-A
Washington,DC20005 		52-1809680 501(c)(3) 58,800       17th annual HCF Gala
(55) Holy Cross Hospital11801 Tech Rd
Silver Spring,MD20904 		20-8428450 501(c)(3) 7,495       Sponsorship
(56) Holy Cross Hospital Foundation11801 Tech Rd
Silver Spring,MD20904 		52-0738041 501(c)(3) 22,260       2010 Gala
(57) Holy Cross Hospital Silver Spring Maryland1500 Forest Glen Rd
Silver Spring,MD20910 		52-0738041 501(c)(3) 161,040       Senior Fit Program Program
(58) Inquiring Systems Inc150 South Park
San Francisco,CA94107 		94-2524840 501(c)(3) 141,000       D.C. Schools on the Move Phase 2
(59) Jeanie Schmidt Free ClinicPO Box 5143
Herndon,VA20172 		71-0877944 501(c)(3) 107,000       Community Connections Program County
(60) Joseph's House Inc1730 Lanier Place NW
Washington,DC20009 		52-1693018 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(61) Jubilee Foundation Inc10408 Montgomery Ave
Kensington,MD20895 		52-1698505 501(c)(3) 14,400       Sponsorship
(62) Junior Achievement of the Natl Capital Area1725 I St NW
200
Washington,DC20006 		54-0788947 501(c)(3) 15,000       Junior Achievement Finance Park
(63) Junior League of Baltimore Inc The5902 York Rd
Baltimore,MD21212 		52-0591620 501(c)(3) 50,000       Kids in the Kitchen - Curriculum Development
(64) La Clinica del Pueblo2831 15th St NW
Washington,DC200094607 		52-1942551 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(65) Latin American Youth Center Inc1419 Columbia Rd NW
Washington,DC20009 		52-1023074 501(c)(3) 23,500       Fiesta 2010
(66) Loudoun Community Health Center224 A Cornwall St NW
Leesburg,VA20176 		20-2379419 501(c)(3) 254,000       Loudoun Community Health Center Kids Clinic
(67) Lupus Foundation of Greater Washington2000 L St NW
732
Washington,DC20036 		23-7448063 501(c)(3) 60,000       Patient Navigation Program
(68) Manna Food Center Inc9311 Gaither Rd
Gaithersburg,MD20877 		52-1289203 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET and Festival
(69) Marian House949 Gorsuch Ave
Baltimore,MD21218 		52-1243849 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(70) Martha's Table Inc2114 14th St NW
Washington,DC20009 		52-1186071 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(71) Maryland Assoc of Nonprofit Org Inc190 West Ostend St
201
Baltimore,MD21230 		52-1749231 501(c)(3) 98,475       Health Advocates Leadership Institute
(72) Maryland Food Bank Inc2200 Halethorpe Farms Rd
Baltimore,MD21227 		52-1135690 501(c)(3) 28,500       Blue Jeans Ball
(73) Maryland Healthcare Education Institute6820 Deerpath Rd
Elkridge,MD21075 		52-0901664 501(c)(3) 150,000       Nursing Grants STI/HIV/AIDS Transmission in At-Risk Youth
(74) MARY'S CENTER FOR MATERNAL & CHILD CARE2333 Ontario Rd NW
Washington,DC20009 		52-1594116 501(c)(3) 119,500       Year-End Direct Services Donation for Safety NET
(75) Medical Society of Virginia Foundation2924 Emerywood Pkwy
300
Richmond,VA23294 		52-1394768 501(c)(3) 8,920       2010 Physician's Gala
(76) Micah Ecumenical MinistriesPO Box 3277
Fredericksburg,VA22402 		20-4044884 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(77) Miriam's Kitchen2401 Virginia Ave NW
WASHINGTON,DC20037 		52-1331552 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(78) Mission Life Center10721 Main St
1200
fairfax,VA22030 		75-2999280 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(79) Mission of Mercy Inc22 South Market St
6D
Frederick,MD21701 		86-0704883 501(c)(3) 100,000       Mission of Mercy's Access to Care Program
(80) Montgomery College Foundation Inc900 Hungerford Dr
200
Rockville,MD20850 		52-1267008 501(c)(3) 200,000       Kaiser Permanente of the Mid-Atlantic States Healt
(81) Montgomery County Department of Health101 Monroe St
Rockville,MD20850 		52-6000980 GOVT ENTITY 100,000       The Montgomery Cares 'Next Steps' Program: Expandi
(82) Montgomery Cty Coalition for the homeless600-B East Gude Dr
Rockville,MD20850 		52-1735674 501(c)(3) 9,250       2010 Celebrating Partnerships Gala
(83) Montgomery Hospice1355 Piccard Dr
100
Rockville,MD20850 		52-1664426 501(c)(3) 9,120       Bereavement Conference
(84) Mosaica Inc1522 K St NW
1130
Washington,DC20005 		52-1872115 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(85) Mt Washington Pediatric Hospital Inc1708 West Rogers Ave
Baltimore,MD21209 		52-0591483 501(c)(3) 150,000       Healthy Living Academy (HLA)
(86) Muslim Community Center Medical Clinic15200 New Hampshire Ave
Silver Spring,MD20905 		52-1072792 501(c)(3) 95,000       Women Wellness Program
(87) My Sister's Place IncPO Box 29596
Washington,DC20017 		52-1263256 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(88) NAMI Montgomery County (MD) Inc11718 Parklawn Dr
Rockville,MD20852 		52-1150412 501(c)(3) 70,000       Improving the lives of individuals affected by men
(89) National Assoc of Commissions for Women401 N Washington St
100
Rockville,MD20850 		20-5110222 501(c)(3) 12,000       Capital Opportunities for America's Women and Girl
(90) National Children's Museum955 LEnfant Plaza N SW
Washington,DC20024 		23-7423491 501(c)(3) 8,950       2010 National Children's Museum Gala
(91) National Hispana Leadership Institute1601 N Kent St
803
Arlington,VA22209 		74-2544980 501(c)(3) 12,500       2010 Leadership Institute for Healthy Eating and Active Living (PG HEAL)
(92) Natl Kidney Fdn of the Natl Capital Area5335 Wisconsin Ave NW
300
Washington,DC20015 		52-1001444 501(c)(3) 8,900       2010 Kidney Ball
(93) Network2000PO Box 22765
Baltimore,MD21203 		52-1814260 501(c)(3) 5,660       Women of Excellence Sponsorship
(94) Northern Virginia Community College Edu Fdn4001 Wakefield Chapel Dr
Annandale,VA22003 		51-0249730 501(c)(3) 200,000       NOVA Kaiser Permanente Scholarship Program for Nur
(95) Northern Virginia Dental Clinic Inc5827 Columbia Pike
405
Falls Church,VA22041 		54-1646071 501(c)(3) 265,000       Northern Virginia Dental Clinic / NVDC - Loudoun and supplies
(96) Northern Virginia Family Service10455 White Granite Dr
100
Oakton,VA22124 		54-0791977 501(c)(3) 135,545       2010 Road to Independence Gala Program opening
(97) NOVA Scripts Central Inc6400 Arlington Blvd
120
Falls Church,VA22042 		65-1275162 501(c)(3) 150,000       Medication and Pharmaceutical Services for Norther
(98) Park Heights Renaissance Inc4151 Park Heights Ave
Baltimore,MD21215 		77-0673126 501(c)(3) 100,000       Healthy Eating, Healthy Living Community Greening
(99) Pediatric Primary Care Project15941 Donald Curtis Dr
180
Woodbridge,VA22191 		54-1796203 501(c)(3) 60,000       SNEAG Grant from 2009 - to add additional provider
(100) People Encouraging People Inc2002 Clipper Park Rd
105
Baltimore,MD21211 		52-1168285 501(c)(3) 150,000       Project OPEN (Outreach, Prevention, and Enrollment
(101) Port Towns Community Development Corp4217 Edmonston Rd
Bladensburg,MD20710 		52-1998685 501(c)(3) 25,000       2010 Grant for Capacity building
(102) Pregnancy Aid Centers Inc4809 Greenbelt Rd
College Park,MD207402001 		23-7418649 501(c)(3) 72,000       Expanding Safety Net Services: Health Care/Nutriti
(103) Primary Care Coalition of Montgomery Cty8757 Georgia Ave
10th Fl
Silver Spring,MD20910 		52-1847976 501(c)(3) 112,486       2010 Grant for electronic medical records conversi
(104) Prince George's Community College Fdn301 Largo Rd
Largo,MD20774 		52-1429938 501(c)(3) 200,000       Professional Education Scholarship for Health Scie
(105) Prince William Area Free Clinic Inc4001 Prince William Pkwy
101
Woodbridge,VA22192 		54-1619202 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(106) Prince William Health Partners Inc2296 Opitz Blvd
320
Woodbridge,VA22191 		03-0444689 501(c)(3) 92,000       Healthy Eating and Active Living (HEAL) for High S
(107) Protect Yourself 1 Inc2938 Kidds Schoolhouse Rd
Parkton,MD21120 		81-0644880 501(c)(3) 36,500       Sponsorship of Safe2Live website development in the Virginia Health Care Foundation
(108) Providence Health Foundation1150 Varnum St NE
Washington,DC20017 		52-1275583 501(c)(3) 49,898       Fort Lincoln Health Navigator Project
(109) Rails-to-Trails Conservancy2121 Ward Court NW
5TH FL
Washington,DC20037 		52-1437006 501(c)(3) 24,000       Meet the Metropolitan Branch Trail - opening day '
(110) Rappahannock Council Against Sexual Assault2601 Princess Anne St
Fredericksburg,VA22401 		54-1443112 501(c)(3) 50,000       Violence and Vulnerable Populations -- Culturally
(111) Rappahannock Refuge Inc902 Lafayette Blvd
Fredericksburg,VA22401 		52-1419314 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(112) Red Wiggler Foundation IncPO Box 968
Clarksburg,MD208710968 		52-1973795 501(c)(3) 50,000       Red Wiggler Community Farm's Active People and Hea
(113) Samaritan Inns Inc2523 14th St NW
WASHINGTON,DC20009 		52-1474935 501(c)(3) 74,500       Building Capacity of the Safety Net: Nutrition and
(114) Shady Grove Adventist Hospital Foundation14955 Shady Grove Rd
165
Rockville,MD20850 		52-1216429 501(c)(3) 10,000       For Expansion of Diabetes Self Management Educatio
(115) Share Our Strength Inc1730 M St NW
700
WASHINGTON,DC20036 		52-1367538 501(c)(3) 198,000       First Class Breakfast: Helping Maryland Students C
(116) So Others Might Eat71 O St NW
WASHINGTON,DC20001 		23-7098123 501(c)(3) 99,500       2010 Grant for Operational Support
(117) Spanish Catholic Ctr of Catholic Charities1618 Monroe St NW
WASHINGTON,DC20010 		52-0980905 501(c)(3) 29,500       2010 Gala
(118) Suitland Family and Life Development Corp14416 Old Mill Rd
101
Upper Marlboro,MD20772 		52-2052386 501(c)(3) 90,000       PG Youth-Adult Partnership for Healthy Eating and
(119) Summit Health Institute for Research & Edu1313 L St NW
111
Washington,DC20005 		52-1936403 501(c)(3) 94,629       TA for Ward 8 Early Childhood Obesity Project
(120) The Comm Fdn for the Natl Capital Region1201 15th St NW
420
Washington,DC20005 		23-7343119 501(c)(3) 3,274,240       Sponsorship of Prince George's Community Foundatio
(121) The Friends of Natl Arboretum's DC Yth Gdn3501 New York Ave NE
Washington,DC20002 		52-1257712 501(c)(3) 144,737       The Washington Youth Garden Schoolyard Garden Well
(122) The Fuel Fund of Maryland Inc305 W Chesapeake Ave
Towson,MD21204 		52-1204629 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(123) The Gaston & Porter Health Improv Ctr Inc8612 Timber Hill Ln
Potomac,MD20854 		03-0455203 501(c)(3) 150,000       Prime Time Sister Circles(R) (PTSC)
(124) The Lloyd F Moss Free Clinic1301 Sam Perry Blvd
Fredericksburg,VA22401 		54-1677934 501(c)(3) 90,000       2010 Grant for Operational Support
(125) The Montgomery Cty Family Justice Ctr Fdn600 Jefferson St
Rockville,MD20852 		94-3444962 501(c)(3) 9,750       1st annual MC Family Justice Center Benefit Dinner
(126) The Pship for a Healthier Carroll Cty Inc535 Old Westminster Pike
102
Westminster,MD211576269 		52-2156892 501(c)(3) 143,000       L.E.A.N. Carroll-Healthy Eating
(127) The Religious Coalition for Emergency Human Needs27 DeGrange St
Frederick,MD21701 		52-1449375 501(c)(3) 85,000       Access to Dental Care and Prescription Medications
(128) The Universities at Shady Grove9630 Gudelsky Dr
Rockville,MD20850 		52-1125883 501(c)(3) 15,000       Community Events Sponsoring
(129) Through The Kitchen Door International Inc3305 Pauline Dr
Chevy Chase,MD208153919 		31-1677181 501(c)(3) 95,700       Public School Replication; Teens Get Cooking
(130) Towson University Foundation8000 York Rd
Towson,MD21252 		52-0939453 501(c)(3) 77,700       2010 Grant
(131) Ulman Cancer Fund for Young Adults10440 Little Patuxent Pkwy
G1
Columbia,MD21044 		52-2057636 501(c)(3) 83,400       Upgraded sponsorship of Half-Full Triathlon
(132) United Way of Central Maryland Inc100 South Charles St
5th Fl
Baltimore,MD21203 		52-0591543 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(133) United Way of the National Capital Area8391 Old Courthouse Rd
200
Vienna,VA22182 		53-0234290 501(c)(3) 24,500       Year-End Direct Services Donation for Safety NET
(134) University of Maryland Baltimore Fdn Inc655 W Lomard St
Baltimore,MD21201 		31-1678679 501(c)(3) 10,000       Our Environment, Our Health: A Nurses Call to Acti
(135) University of the District of Columbia899 North Capitol St NE
Washington,DC20002 		53-6001131 501(c)(3) 200,000       CCDC Healthcare Education Initiative
(136) Us Helping Us-People Into Living INC3636 Georgia Ave NW
Washington,DC20010 		52-1628279 501(c)(3) 79,439       2010 Autumn Reception
(137) Virginia Department of Health418 S Washington St
Alexandria,VA22314 		54-6001775 501(c)(3) 82,711       Playspaces & Gardening: Making the Healthy Choice
(138) Virginia Health Care Foundation707 East Main St
1350
Richmond,VA23219 		54-1639924 501(c)(3) 50,000       Health Safety Grant
(139) Virginia Hosp Ctr-Arlington Health Works1701 N George Mason Dr
Arlington,VA22205 		20-4129901 501(c)(3) 25,000       2010 Family Fun Day
(140) Washington Area Consortium on HIV Infection in You651 Pennsylvania Ave SE
Washington,DC20003 		52-1610088 501(c)(3) 28,875       17th Annual Auction
(141) Washington Regional Assoc of Grantmakers1400 16th St NW
740
Washington,DC20036 		52-1756853 501(c)(3) 114,250       2010 Grant for Washington AIDS Partnership Project
(142) Whitman Walker ClinicPO Box 73768
Washington,DC20056 		52-1122122 501(c)(3) 91,000       2010 AIDS Walk
(143) Workforce Solution of Montgomery County Inc11002 Veirs Mill Rd
510
Wheaton,MD20902 		52-2250602 501(c)(3) 155,000       Healthcare Navigator
(144) Year Up Inc1560 Wilson Blvd
350
Arlington,VA22209 		04-3534407 501(c)(3) 50,000       Year Up Health & Wellness Initiative
2
Enter total number of section 501(c)(3) and government organizations ......................... Bullet Image
144
3
Enter total number of other organizations ................................ . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2010

Schedule I (Form 990) 2010
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I, PART I, LINE 2 Grantees are required to sign a memorandum of understanding with Health plan prior to grant funds disbursal. grantees are required to submit a final report which delineates accomplishments, relates to stated objectives, and describes the evaluation method used to assess accomplishments.
Schedule I (Form 990) 2010


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported in prior
Form 990 or
Form 990-EZ
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Anthony Barrueta (i)
(ii)		 0
354,645 		0
196,875 		0
19,936 		0
103,343 		0
13,068 		0
687,867 		0
0
(2) Russell Bradley (i)
(ii)		 175,402
0 		16,300
0 		61,941
0 		36,452
0 		12,603
0 		302,698
0 		0
0
(3) JUDITH L BRITTAIN (i)
(ii)		 215,249
0 		77,131
0 		10,151
0 		67,375
0 		12,761
0 		382,667
0 		0
0
(4) RUBEN J BURNETT (i)
(ii)		 0
229,737 		0
150,972 		0
17,974 		0
81,852 		0
12,436 		0
492,971 		0
0
(5) CHRISTINE K CASSEL (i)
(ii)		 0
172,625 		0
0 		0
0 		0
0 		0
0 		0
172,625 		0
0
(6) THOMAS W CHAPMAN EDD (i)
(ii)		 11,000
174,427 		0
0 		0
0 		0
59,810 		0
0 		11,000
234,237 		0
0
(7) DANIEL P GARCIA (i)
(ii)		 0
517,930 		0
585,000 		0
177,308 		0
62,481 		0
11,306 		0
1,354,025 		0
151,518
(8) WILLIAM R GRABER (i)
(ii)		 0
232,123 		0
0 		0
0 		0
0 		0
0 		0
232,123 		0
0
(9) J EUGENE GRIGSBY III PHD (i)
(ii)		 11,643
182,100 		0
0 		0
0 		0
0 		0
0 		11,643
182,100 		0
0
(10) GEORGE C HALVORSON (i)
(ii)		 0
1,177,487 		0
5,155,125 		0
1,334,723 		0
62,481 		0
13,611 		0
7,743,427 		0
0
(11) Carrie Harris-Muller (i)
(ii)		 0
251,873 		0
153,997 		0
15,912 		0
69,437 		0
12,436 		0
503,655 		0
0
(12) KENDALL D HUNTER (i)
(ii)		 0
266,341 		0
212,586 		0
20,309 		0
92,082 		0
12,436 		0
603,754 		0
0
(13) MARY E JAEGER (i)
(ii)		 0
189,817 		0
81,709 		0
16,741 		0
65,514 		0
12,436 		0
366,217 		0
0
(14) JUDITH JOHANSEN (i)
(ii)		 0
184,560 		0
0 		0
0 		0
0 		0
0 		0
184,560 		0
0
(15) Marilyn Kawamura (i)
(ii)		 0
390,260 		0
438,827 		0
132,118 		0
194,439 		0
12,893 		0
1,168,537 		0
90,440
(16) Kathryn Lancaster (i)
(ii)		 0
615,090 		0
919,900 		0
23,086 		0
283,406 		0
13,068 		0
1,854,550 		0
0
(17) KAY W LEWIS (i)
(ii)		 0
187,972 		0
90,999 		0
76,870 		0
105,335 		0
11,052 		0
472,228 		0
56,775
(18) Christine Malcolm (i)
(ii)		 0
0 		0
0 		0
568,721 		0
0 		0
12,021 		0
580,742 		0
0
(19) PHILIP MARINEAU (i)
(ii)		 0
193,623 		0
0 		0
0 		0
0 		0
0 		0
193,623 		0
0
(20) THOMAS R MEIER (i)
(ii)		 0
316,076 		0
297,094 		0
34,615 		0
94,371 		0
13,068 		0
755,224 		0
0
(21) JENNY J MING (i)
(ii)		 0
182,748 		0
0 		0
0 		0
0 		0
0 		0
182,748 		0
0
(22) Donald Orndoff (i)
(ii)		 0
333,479 		0
0 		0
174,579 		0
57,212 		0
13,720 		0
578,990 		0
0
(23) EDWARD PEI (i)
(ii)		 0
168,250 		0
0 		0
0 		0
16,500 		0
0 		0
184,750 		0
0
(24) DeAnne Petersen (i)
(ii)		 0
215,614 		0
133,030 		0
15,633 		0
68,996 		0
12,436 		0
445,709 		0
0
(25) J NEAL PURCELL (i)
(ii)		 0
219,738 		0
0 		0
0 		0
0 		0
0 		0
219,738 		0
0
(26) ROCHELLE M ROTH (i)
(ii)		 0
156,416 		0
23,838 		0
2,385 		0
38,895 		0
12,680 		0
234,214 		0
0
(27) ARTHUR M SOUTHAM MD (i)
(ii)		 0
735,252 		0
1,241,861 		0
43,186 		0
342,622 		0
11,306 		0
2,374,227 		0
0
(28) Susan Spurlark (i)
(ii)		 0
224,511 		0
132,617 		0
19,763 		0
90,491 		0
12,893 		0
480,275 		0
0
(29) Deborah Stokes (i)
(ii)		 0
313,713 		0
249,552 		0
59,377 		0
110,792 		0
13,068 		0
746,502 		0
40,338
(30) CYNTHIA TELLES (i)
(ii)		 0
182,647 		0
0 		0
0 		0
0 		0
0 		0
182,647 		0
0
(31) SANDRA THOMPKINS (i)
(ii)		 0
166,951 		0
0 		0
0 		0
0 		0
0 		0
166,951 		0
0
(32) BERNARD J TYSON (i)
(ii)		 0
737,887 		0
1,180,500 		0
24,127 		0
346,893 		0
13,068 		0
2,302,475 		0
0
(33) TAMSEN L WESTMORELAND (i)
(ii)		 0
169,242 		0
62,477 		0
3,890 		0
28,298 		0
12,436 		0
276,343 		0
0
(34) Steven Zatkin (i)
(ii)		 0
283,028 		0
932,500 		0
31,725 		0
86,239 		0
11,477 		0
1,344,969 		0
0
(35) VICTORIA B ZATKIN (i)
(ii)		 0
196,570 		0
80,174 		0
34,625 		0
81,763 		0
1,884 		0
395,016 		0
0
(36) Mark Zemelman (i)
(ii)		 0
342,852 		0
224,105 		0
239,242 		0
137,956 		0
12,680 		0
956,835 		0
57,187
Schedule J (Form 990) 2010

Schedule J (Form 990) 2010
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
SCHEDULE J, PART I, LINE 3 Top Management Officials' Compensation Kaiser Foundation Health Plan of the Mid-Atlantic States relied on Kaiser Foundation Health Plan, Inc that used one or more of the methods described below to establish the top management officials' compensation: - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Written employment contract - Compensation survey or study, and - Approval by the board or compensation committee
SCHEDULE J, PART I, LINE 4a SEVERANCE CHRISTINE MALCOLM $ 568,515 LISTED PERSONS PARTICIPATED IN ARRANGEMENTS ENTITLING THEM TO SEVERANCE BENEFITS IN THE EVENT OF TERMINATION BY THE ORGANIZATION WITHOUT CAUSE OR DUE TO JOB ELIMINATION. DEPENDING ON POSITION LEVEL, TENURE, AND TERMINATION REASON, SEVERANCE BENEFITS PAYABLE UNDER THESE ARRANGEMENTS PROVIDE FOR PAY AND HEALTH BENEFITS CONTINUATION PLUS PAYMENT OF ACCRUED OBLIGATIONS. IN ADDITION, FOR SOME OF THE LISTED PERSONS, SEVERANCE BENEFITS PAYABLE INCLUDE PRORATED INCENTIVE AWARDS FOR PERFORMANCE PERIODS NOT YET ENDED. NONE OF THE LISTED PERSONS PARTICIPATED IN ARRANGEMENTS ENTITLING THEM TO CHANGE-OF-CONTROL PAYMENTS.
SCHEDULE J, PART I, LINE 4b SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS George Halvorson $ 1,237,500 Mark Zemelman 218,741 Daniel Garcia 151,518 Marilyn Kawamura 92,729 Kay Lewis 56,775 Deborah Stokes 40,338 Steven Zatkin 5,463 Thomas Meier 609 Kendall Hunter 569 Kathryn Lancaster 368 Total $ 1,804,610 Some of the listed persons participated in nonqualified supplemental retirement plans. Under these plans, the organization makes annual contributions to accounts held in the name of individual participants. Contributions vary by position level and pay, and vest over time based on age and/or service. Participant accounts are credited with actual investment returns from up to four mutual funds and/or with a fixed rate of interest or a combination thereof. Unvested amounts are subject to risk of forfeiture.
SCHEDULE J, PART I, LINE 7   The organization provided non-fixed payments to some of the persons listed. Payments were made under incentive plans, based on attainment of organizational performance goals and individual performance, designed to support the organization's mission to provide high-quality, affordable care and improve the health of its members and the communities it serves.
Schedule J (Form 990) 2010

Additional Data


Software ID:  
Software Version:  
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2010
Schedule L (Form 990 or 990-EZ) 2010
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) MARK MALCOLM KFHP INC EMPLOYEE 96,476 COMPENSATION   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  




SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Identifier Return Reference Explanation
form 990, PART I, LINE 7B   TOTAL UBI (FORM 990-T, LINE 30) $ 1,969 NET OPERATING LOSS (NOL) APPLIED (1,969) UBTI WITH NOL (FORM 990-T, LINE 34) NONE
form 990, PART III, LINE 4A-D   2010 COMMUNITY BENEFIT REPORT KAISER FOUNDATION HEALTH PLAN OF MID-ATLANTIC STATES, INC. Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. or "Mid-Atlantic Health Plan" is a tax-exempt subsidiary health plan of Kaiser Foundation Health Plan, Inc. (KFHP). Mid Atlantic Health Plan as well as Kaiser Foundation Hospitals (KFH) are nonprofit corporations that are part of the integrated health care delivery system known as the Kaiser Permanente Medical Care Program or "Kaiser Permanente." In 2010, the Mid-Atlantic Health Plan served more than 488,171 members, and had 5,193 full-time administrative, clerical and technical employees as well as 895 full-time Permanente physicians. Mid-Atlantic Health Plan provides and arranges comprehensive health care services for members on a predominantly prepaid basis and fulfills its contractual obligations to group and individual members by contracting with KFH and a Permanente Medical Group to provide the required health care services. Membership in KFHP and its health plan subsidiaries is available without regard to sex, race, religion, ethnic background, sexual orientation, and occupational status, or income level. Health Plan members are broadly representative of the various ages, social, and income groups within the areas it serves. Once enrolled, a member is free to maintain membership regardless of age, health status or employment. KAISER PERMANENTE'S COMMITMENT TO THE COMMUNITY Kaiser Permanente believes its Direct Community Benefit Investment (DCBI), is fundamental to being a nonprofit organization. It embodies the organization's commitment to improve the health of communities beyond services to Health Plan members. It is more than traditional corporate citizenship or corporate philanthropy. It is an intentional, planned, budgeted, measurable, accountable creation for better health in our communities. It is done in collaboration with, not in isolation from, the community. DCBI serves to fulfill Kaiser Permanente's social purpose, justify its tax-exempt status, and differentiate it from other health care organizations. This tradition of community benefit dates from the earliest days of the Program, when charitable care to non-employees, and later, nonmembers, was initiated. That heritage has continued through the years in Kaiser Permanente's early participation in publicly financed programs such as Medicaid and Medicare, establishment of residency training and medical research programs, and later, in the development of the Educational Theatre Programs, Safety Net Partnerships, Community Health Initiatives and Charitable Health Coverage Programs. In 2007, the KFHP/H Board of Directors refined the focus of the organization's Community Benefit Program and established the following four priority areas which have come to be known as "streams of work": - Care and Coverage for Low-Income People - Creates and supports programs that lower the financial barriers for the under- and uninsured. - Community Health Initiatives - Designs, delivers, and sustains long-term programs that engage communities in work to improve conditions in their neighborhoods. - Safety Net Partnerships - Builds partnerships with community clinics, local health departments, and public hospitals. Provides funding, technical assistance, dissemination of care management and quality improvements technology to help improve care and expand treatment capacity for vulnerable populations. - Developing and Disseminating Knowledge - Improves health care by sharing our knowledge- educating practitioners, advancing research, empowering consumers and informing policymakers about the evidence base for care and health. The Board elaborated that at least 75% of total community benefit funding will be directed to program priorities within the four streams of work and the remaining 25% of funding will be directed by local regions to respond to local community benefit needs and opportunities that may or may not be within the four key focus areas.
.   THE COMMUNITY BENEFIT PROGRAMS IN THE MID-ATLANTIC REGION The Mid-Atlantic Health Plan expended approximately $56.5 million to support community benefit activities. A breakdown of the 2010 Community Benefit dollars attributable to the Mid-Atlantic Health Plan is included in Attachment A. The following identifies many of the signature community benefit programs and services grouped according to the national streams of work funded by the Mid-Atlantic Health Plan. CARE AND COVERAGE FOR LOW-INCOME PEOPLE There are roughly 46 million Americans without health care coverage. Uninsured, low-income individuals and families who are not eligible for public programs often have to rely on traditional charity care. Frequently, individuals in this situation may wait to seek medical care until their conditions become critical, and end up in hospital emergency rooms for treatment of conditions that are preventable or easily treated in earlier stages. In 2010, the Mid-Atlantic Health Plan expended $39.6 million to address the financing and delivery of health care for populations vulnerable due to socio-economic status, illness, ethnicity, age, or other factors. Program beneficiaries (under and uninsured) received free or discounted care in a Kaiser Permanente facility or by a Permanente provider. Charitable Care (Medical Financial Assistance and Charitable Health Coverage Programs) In the Mid-Atlantic States, Health Plan provides charity care to low-income vulnerable populations through the Medical Financial Assistance and Charitable Health Coverage Programs. In 2010, the Mid-Atlantic States Health Plan spent $29.3 million on under- and uninsured residents in Maryland, Virginia and the District of Columbia to serve more than 8,548 children and adults. - Medical Financial Assistance The Medical Financial Assistance (MFA) Program provides temporary financial assistance to individuals who are in both medical and financial need and ensures that collection practices do not further burden an individual or family in financial distress. The program is available to assist Health Plan members in reducing out-of-pocket costs such as co-payments, co-insurance, medical services and/or pharmacy. Nonmembers are offered assistance for specified medically necessary services related to an episode of care. In order to receive financial assistance, members and nonmembers must not be eligible to receive assistance under any other public or private program. MFA awards are only for services provided in Health Plan facilities. Kaiser Permanente's charity care program also includes discounted charges for uninsured patients below 400% of the federal poverty guidelines. - Charitable Health Coverage Charitable Health Coverage (CHC) is a unique approach to caring for low-income uninsured persons in the community. Participants receive a regular Kaiser Permanente membership card and access to the full range of service and providers-a much better alternative to a brief and costly emergency room visit or hospitalization. This allows the Mid-Atlantic Health Plan to invest in the longer term health of patients and the communities. Since inception in the early 1980s, CHC programs have made a real difference in the lives of persons who might otherwise have no other source of care. The following describes two CHC programs in the Mid-Atlantic region. Bridge Program - This program enables participants to have comprehensive health care coverage at significantly reduced costs at a time when they are experiencing financial difficulties due to job loss, involuntary reduction in work hours, death, divorce, or legal separation from a spouse. Typically, these individuals are not eligible for any other public or private health care coverage and whose income is less than 250% of the federal poverty guidelines. Health Plan subsidizes either 90% or 95% of their monthly health care premium relative to the member's income. At the end of 2010, nearly 6,168 individuals were enrolled through community partners located in 12 local jurisdictions. Medical Care for Children Programs - In 2010, more than 2,300 children were enrolled in the program in six jurisdictions throughout the Mid-Atlantic Health Plan region. Children in these programs may not be eligible for public or private health care programs and must have family incomes of below 250% of the federal poverty guidelines. The program operated in partnership with local governments, hospitals and/or nonprofit community groups. Referrals to specialists not available from the Permanente Medical Group and inpatient hospitalizations are covered by the program's partners. This program targets children of "working poor" families.
.   Participation in Government-Sponsored Programs In 2010, Mid-Atlantic Health Plan contributed $9.7 million to support the provision of medical care services to individuals in the following government-sponsored program. - The Maryland Medical Assistance Program provides funds to allow the state to increase rates that Medicaid pays to fee-for-service health care providers and managed care health care providers. The program helps increase the number of practitioners willing to serve Medicaid patients, and without such practitioners, access to care could be seriously curtailed for vulnerable populations in Maryland. - Medicaid - Kaiser Permanente contracted with Priority Partners, a Medicaid Managed Care Organization to provide primary health care services in Montgomery, Prince George's and Frederick counties in Maryland. COMMUNITY HEALTH INITIATIVES As an innovator in health, Kaiser Permanente designs, delivers, and sustains long-term programs that engage communities in work to improve conditions in their neighborhoods, workplaces, and schools to support good health, particularly Healthy Eating, Active Living (HEAL). The Mid-Atlantic Health Plan spent $3.3 million on community health initiatives during 2010. Health Eating Active Living Programs The Mid-Atlantic HEAL program provides a variety of community outreach activities and services to address the environmental factors that effect childhood and adult obesity. The focus is on increasing access to healthy foods, fun and safe places for children and adults to engage in physical activity as well as raise awareness and educate the consumer about ways to lead a healthier lifestyle through healthy eating and active living. Grants and Donations for Community Health Initiatives The Mid-Atlantic Health Plan donated $3.3 million to 35 nonprofit community organizations to support a variety of community health initiatives. The following are examples of programs and services funded in 2010: - The Capital Area Food Bank in Washington, DC received $200,000 to increase the amount, consistency, and variety of fresh produce available to partner organizations that work with the Capital Area Food Bank and community outreach programs through a coordinated model that integrates access with outreach services that educate and inform healthy eating habits and food choices. - Friends of the National Arboretum - Washington Youth Garden received $144,000 to support the Garden Science eight-week classroom program and three- to five-week outdoor program focusing on natural science principles, nutrition, and school garden projects. The program targets low and very low income elementary students and families in Ward 5 of Washington, DC with the goal of reconnecting residents to food and healthy food sources. SAFETY NET PARTNERSHIPS Through funding, technical assistance, public policy advocacy, training and volunteering, dissemination of care-management and quality improvement technologies, Kaiser Permanente helps these vital health care providers improve care and expand treatment capacity for the communities and vulnerable people they serve. Grants and Donations for Safety Net Partnerships The Mid-Atlantic Health Plan spent $5.3 million to support 89 organizations that deliver medical or dental care services to uninsured people in community settings, primarily safety net clinics in the District of Columbia, Maryland, and Virginia. In May 2010, a special request for proposals was issued to safety net providers for the purpose of funding services that address health needs of the uninsured. The following are examples of programs and services funded: - Greater Prince William Community Health Center received $150,000 for operational support as a key safety net provider in Prince William County, VA. Funds will go towards providing prenatal care for expectant mothers and primary (including immunizations) and dental care required for newborns through 18 years old. - The Community Clinic Inc. received $200,000 to construct and equip its first comprehensive dental health program located in Gaithersburg, MD. The program expects to serve 10,000 Community Clinic patients in 2011, serving the Montgomery and Prince George's Counties.
.   DEVELOPING AND DISSEMINATING KNOWLEDGE Kaiser Permanente aims to improve health care by sharing its knowledge, educating practitioners, advancing research, empowering consumers, and informing policymakers about the evidence base for care and health. The Educational Theatre Programs is a potent strategy for disseminating clinically-honed prevention messages to students, families, and their broader communities. In 2010, the Mid-Atlantic Health Plan spent $736,887 to support this program. Educational Theatre Programs (ETP) The Educational Theatre Programs in Mid-Atlantic States has provided professional, award-winning health education plays for grades K-12 for 20 years in Maryland, Virginia and the District of Columbia. In 2010, ETP performed for approximately 49,000 children and adults in the Greater Baltimore-Washington metro area. They completed 193 performances. Each program presents current age-appropriate health information. Actor-educators are extensively trained in related health issues and workshop facilitation. Resources material for students, teachers and parents reinforce the educational messages in each performance. OTHER COMMUNITY BENEFITS The Mid-Atlantic Health Plan spent $5.4 million on other community benefits beyond the national streams of work. Regional Community Benefit Operations The Mid-Atlantic Health Plan has a dedicated Community Benefit Department with 8 full time employees to support regional community benefit programs and services and coordinate CB initiatives. 2010 COMMUNITY BENEFIT INVESTMENT - MID-ATLANTIC STATES The following chart summarizes the 2010 Community Benefit investments in Maryland, Virginia and Washington, DC. The investments in the community reflected in the chart are unaudited. CARE AND COVERAGE Charitable Care and Coverage Programs $ 29,253,322 Government Sponsored Programs 9,686,427 CB Operations for Care and Coverage 707,318 Subtotal $ 39,647,067 COMMUNITY HEALTH INITIATIVES Community Health Initiatives Programs and Services $ 21,786 Grants & Donations for Community Health Initiatives 3,259,276 CB Operations for Community Health Initiatives 46,161 Subtotal $ 3,327,223 SAFETY NET PARTNERSHIPS Grants & Donations for Safety Net Partnerships $ 5,338,095 CB Operations for Safety Net 33,257 Subtotal $ 5,371,352 KNOWLEDGE DISSEMINATION Medical Research $ 318,808 Educational Theatre Programs 1,082,351 Grants & Donations for Knowledge Dissemination 1,206,629 Subtotal $ 2,607,788 OTHER COMMUNITY BENEFITS Other CB Grants & Donations $ 3,807,869 CB Operations 1,696,861 Subtotal $ 5,504,730 TOTAL $ 56,458,160
form 990, part vi, question 4   On June 24, 2010, Article E., Officers, of the Bylaws of the Corporation was amended to (a) provide for a Chief Executive Officer as an officer of the Corporation to be elected by member (Sections E-1, Officers; E-2, Election and Term of Office; and E-4, Removal and Resignation); and (b) to provide for the title of Ambulatory Surgery Center ("ASC") Administrator (Section E-1) and add a new Section E-11 to provide for the appointment of an ASC Administrator at each ASC operated by the Corporation and to set forth the authority and responsibilities of an ASC Administrator. On March 3, 2011, Article E., Officers, of the Bylaws of the Corporation was amended to (a) provide that the officers of the Corporation may include one or more Group Presidents (Section E-1, Officers); (b) add a new Section E-8, Group President and/or Regional President, to describe the duties and responsibilities of those positions; (c) provide that the President shall be the Chief Operating Officer of the Corporation (Section E-7, President); and (d) ) provide clarification regarding leadership in the event of the absence or disability of the President (Section D-9, Executive Vice President or National Senior Vice President); and (e) to change the reference to "the President" in Sections E-3, E-4 and E-11 to "any President"
form 990, part vi, question 6   kaiser foundation health plan, INC is the sole member.
form 990, part vi, LINE 7A   KFHP appoints the directors (and fills vacancies and has authority to remove directors). The same 14 individuals who comprise the board of directors of KFHP also serve as the 14 directors of KFHP-CO, OH, NW, MAS
form 990, PART VI, LINE 7B   The following actions of the corporation require approval of the sole member. a) removal of the chairman of the board or the regional president; b) amendments to the bylaws that pertain to the member, the board of directors, or procedures for amending the bylaws (articles c, d, and h of the bylaws); c) amendment of the articles of incorporation
form 990, PART VI, LINE 11B   1. Key information necessary for the preparation of the tax return is obtained and/or confirmed with internal sources including regional finance, executive compensation, community benefits, treasury, government relations, and legal. 2. Community benefits details are presented to the community benefit committee of the board for review. 3. Executive compensation details are presented to the compensation committee of the board for review. 4. The complete tax return is reviewed and signed by a KPMG tax advisor. 5. The complete tax return is reviewed and signed by an officer or a member of management designated by an officer. 6. The tax return is discussed with the full board of directors. A copy of the return is provided to each board member in electronic format prior to filing.
form 990, PART VI, LINE 12C   Regularly and Consistently Monitors Compliance with the Conflicts of Interest Policy Kaiser Permanente regularly monitors compliance with the Conflicts of Interest Policy in 3 key ways: 1.The Kaiser Permanente Compliance Hotline is available to all employees and vendors to report actual or potential conflicts of interest. All calls are answered by a third party and provided to Kaiser Permanente's National Compliance office for review and appropriate action. Employees can report anonymously and without fear of retaliation. Reports of actual or potential Conflicts of Interest are generated and investigations are conducted as required and information is tracked and trended to determine if additional guidance is required to avoid conflicts of interest. Compliance Hotline Reports are provided for review and action to the Kaiser Foundation Health Plan/ Hospitals Boards of Directors annually. 2.The Senior Vice President & Chief Compliance Officer and the Vice President of Internal Audit Services annually review the directors', officers', key employees', and executives' Annual Conflicts of Interest Questionnaire disclosures and provide direction on any investigations required. Investigations are documented, tracked and trended to determine if additional controls or education is required; In addition, Conflicts of Interest Questionnaire Reports are provided for review and action to the Kaiser Foundation Health Plan/ Hospitals Boards of Directors annually; and 3. Annually, as a component of the external audit, KPMG reviews the Annual Conflicts of Interest Questionnaires completed by Directors, Officers, Key Employees, and Executives, and actions taken as a result of the disclosures. The results of the annual audit, including any findings in this area are presented to the Kaiser Foundation Health Plan/ Hospitals Audit and Compliance Committee. Regularly and Consistently Enforces Compliance with the Conflicts of Interest Policy To ensure consistency in the enforcement of the policy Kaiser Permanente uses the following steps as a general guideline: A. Represented employees are subject to any corrective/disciplinary action provisions described in specific regional/national collective bargaining agreements and/or organizational policies and practices. B. Kaiser Permanente notifies employees of the National Human Resources Policy No. 14. Corrective/Disciplinary Action Policy during new employee orientation and in annual compliance training. C. In the event that it is necessary to discipline any employee because of, but not limited to, failure to comply with applicable legal/regulatory requirements, Kaiser Permanente policies and procedures, or the Principles of Responsibility, or for unsatisfactory performance or misconduct, coaching/counseling and/or corrective/disciplinary action may include, but is not limited to: (I) Oral discussion and/or warning by the employee's immediate supervisor or higher level manager to correct the problem (II) Written notice, with or without final warning (III) Paid or unpaid suspension, with or without final warning (IV) Termination of employment
form 990, PART VI, LINE 15A/B   The executive compensation program is designed to recruit, retain and motivate qualified senior management personnel. Senior management personnel have a significant impact on the strategic and policy direction and results of the organization. Therefore, the executive compensation program is, to a significant degree, performance-based. The compensation program is reviewed annually by the Compensation Committee of the Board of Directors which evaluates and approves, prior to payment, all programs and payments to CEO, Executive Director and top management officials (executives). Base pay for executive positions is established at a level comparable to the relevant market. In addition, other components of the compensation program bear 'at-risk' features designed to focus on strategically important performance goals and to assist in attracting and retaining top performers. The executive compensation program is targeted at the median of the comparable external market in which the organization competes for executive leadership. Evaluation of comparable pay data is performed by an Independent Compensation, Benefit & Human Resource Consulting firm. The compensation program focuses on objectives in the areas of quality of member care and service, financial soundness, and the community and social mission of the organization.
Form 990, Part VI, Line 19   Governing documents - are available as provided to state Dept. of Insurance and maintained on state agency website or upon request. Conflict of Interest is available on KP website under vendor Principles of Responsibility or upon request. Financial Statements are on file with state insurance agency on a statutory basis (stand alone entity) Combined data is published for Kaiser Foundation Health Plan Inc. and subsidiaries and Kaiser Foundation Hospitals and Subsidiaries with audit opinion by KPMG and is available upon request. To request copies contact: VP - NATIONAL Tax COMPLIANCE Kaiser Foundation Health Plan and Hospitals One Kaiser Plaza, 15L Oakland, CA 94612
form 990, Part VII, section A, column B   Individuals who are both officers and members of Boards of Directors work full time as employees as well as fulfill their board assignment. All officers work full time in their employee capacity. Full time work may require in excess of the traditional 40 hour week. Given the integrated nature of our organization, employees may provide support for various Kaiser Permanente companies. The average hours per week reported for the filing organization and related organizations was estimated.
Form 990, Part XI, Line 5   CHANGE IN OTHER COMPREHENSIVE INCOME $ (12,560,613) CHANGE IN UNREALIZED GAIN (4,996,045) CAPITAL TRANSFER OUT - CURRENT YEAR 1,506,152 OTHER THAN TEMPORARY IMPAIRMENTS (741,583) TAX GAIN ON SALE OF INVESTMENTS (4,076,282) BOOK GAIN ON SALE OF INVESTMENTS 4,543,206 TOTAL $ (16,325,165)
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Anthony Barrueta TITLE:SVP, Government Relations HOURS:45
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHRISTINE K CASSEL TITLE:DIRECTOR HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS W. CHAPMAN, EDD TITLE:DIRECTOR HOURS:8
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL P GARCIA TITLE:SVP, Chief Compliance Officer HOURS:48
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:WILLIAM R GRABER TITLE:DIRECTOR HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:J. EUGENE GRIGSBY, III, PHD TITLE:DIRECTOR HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GEORGE C. HALVORSON TITLE:Chairman, CEO, President HOURS:45
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JUDITH JOHANSEN TITLE:DIRECTOR HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KIM J KAISER TITLE:DIRECTOR HOURS:8
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:PHILIP MARINEAU TITLE:DIRECTOR HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JENNY J MING TITLE:DIRECTOR HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:EDWARD PEI TITLE:DIRECTOR HOURS:8
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:J NEAL PURCELL TITLE:DIRECTOR HOURS:9
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CYNTHIA TELLES TITLE:DIRECTOR HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SANDRA THOMPKINS TITLE:DIRECTOR HOURS:6
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Marilyn Kawamura TITLE:Region President - MAS HOURS:15
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Kathryn Lancaster TITLE:EVP & CFO HOURS:46
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS R. MEIER TITLE:SVP, Corporate Treasurer HOURS:47
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Donald Orndoff TITLE:SVP, NFS HOURS:45
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DeAnne Petersen TITLE:VP, CFO - MAS HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROCHELLE M. ROTH TITLE:SENIOR DIRECTOR, QRM HOURS:45
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARTHUR M. SOUTHAM, MD TITLE:EVP, Health Plan Operations HOURS:45
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Susan Spurlark TITLE:VP, Regional Counsel - MAS HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Deborah Stokes TITLE:SVP, CORP CONTROLLER & CAO HOURS:46
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BERNARD J. TYSON TITLE:President & COO HOURS:45
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Steven Zatkin TITLE:SVP, Gen Counsel & Secretary HOURS:45
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:VICTORIA B. ZATKIN TITLE:VP, Off of Brd & Corp Gov Svcs HOURS:46
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mark Zemelman TITLE:SVP, Gen Counsel & Secretary HOURS:46
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RUBEN J. BURNETT TITLE:VP, SALES, MARKETING & BUS. HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carrie Harris-Muller TITLE:VP, Chief Admin Officer HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KENDALL D. HUNTER TITLE:VP, Chief Operating Officer HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Russell Bradley TITLE:VP, HP Services & Admin HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JUDITH L. BRITTAIN TITLE:VP, DELIVERY SYS OPERATIONS HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARY E JAEGER TITLE:VP, HR - MAS HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KAY W. LEWIS TITLE:VP, UM, Risk Mgmt & Quality HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TAMSEN L WESTMORELAND TITLE:Exec Dir Regional Comp - MAS HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Christine Malcolm TITLE:FORMER SVP HOURS:
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) KAISER FOUNDATION HEALTH PLAN INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-1340523 		HEALTH CARE CA 501(C)(3) 9 NA
 
 
 
(2) KAISER FOUNDATION HOSPITALS

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-1105628 		HEALTH CARE CA 501(C)(3) 3 KFHP INC
 
 
 
(3) KAISER FDN HEALTH PLAN OF COLORADO

ONE KAISER PLAZA 15L

OAKLAND,CA94612
84-0591617 		HEALTH CARE CO 501(C)(3) 9 KFHP INC
 
 
 
(4) KAISER FDN HEALTH PLAN OF GEORGIA INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
58-1592076 		HEALTH CARE GA 501(C)(3) 9 KFHP INC
 
 
 
(5) KAISER FDN HEALTH PLAN OF THE NORTHWEST

ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0798039 		HEALTH CARE OR 501(C)(3) 9 KFHP INC
 
 
 
(6) KAISER FDN HEALTH PLAN OF OHIO

ONE KAISER PLAZA 15L

OAKLAND,CA94612
34-0922268 		HEALTH CARE OH 501(C)(3) 9 KFHP INC
 
 
 
(7) KAISER HEALTH PLAN ASSET MANAGEMENT INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299124 		ASSET MGMT CA 501(C)(3) 11 KFHP INC
 
 
 
(8) LOKAHI ASSURANCE LTD

ONE KAISER PLAZA 15L

OAKLAND,CA94612
91-2171891 		RISK MGMT HI 501(C)(3) 11 KFHP INC
 
 
 
(9) KAISER HOSPITAL ASSET MANAGEMENT INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299125 		ASSET MGMT CA 501(C)(3) 11 KFH
 
 
 
(10) CAMP BOWIE SERVICE CENTER

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299123 		HEALTH CARE CA 501(C)(3) 11 KFHP INC
 
 
 
(11) OHP

ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0480268 		LEASING WA 501(C)(3) 11 KFHP INC
 
 
 
(12) KAISER HEALTH ALTERNATIVES

ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0954562 		HEALTH CARE WA 501(C)(3) 11 KFHP INC
 
 
 
(13) 1800 HARRISON FOUNDATION

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3317484 		FINANCING CA 501(C)(3) 11 KFHP INC
 
 
 
(14) KAISER HOSPITAL ASSISTANCE CORPORATION

ONE KAISER PLAZA

OAKLAND,CA94612
31-1779500 		FINANCING CA 501(C)(3) 11 KFH
 
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) HCMS LLC

ONE KAISER PLAZA 15L
OAKLAND,CA94612
20-3924985 		CASE MGMT CA NA
  		NONE 0 0   No 0   No 0 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) OAK TREE ASSURANCE LTD
ONE KAISER PLAZA 15L
OAKLAND,CA94612
03-0329760 		INSURANCE VT NA
  		C CORP 0 0 0 %
(2) KAISER PERMANENTE INSURANCE COMPANY
ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3203402 		INSURANCE CA NA
  		C CORP 0 0 0 %
(3) KAISER PROPERTY SERVICES INC
ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3259432 		REAL ESTATE CA NA
  		C CORP 0 0 0 %
(4) ARCHIMEDES INC
ONE KAISER PLAZA 15L
OAKLAND,CA94612
20-3774729 		CONSULTING CA NA
  		C CORP 0 0 0 %
(5) KAISER PERMANENTE INTERNATIONAL
ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3245176 		CONSULTING CA NA
  		C CORP 0 0 0 %




Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) KAISER FOUNDATION HOSPITALS

 C 94,473  
(2) KAISER FOUNDATION HEALTH PLAN INC

 K 6,373,208  
(3) KAISER FOUNDATION HOSPITALS

 K 13,656,462  
(4) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 K 399,593  
(5) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 K 867,693  
(6) KAISER FOUNDATION HEALTH PLAN OF THE NW

 K 212,198  
(7) KAISER FOUNDATION HEALTH PLAN OF OHIO

 K 106,984  
(8) KAISER PERMANENTE INSURANCE COMPANY

 K 1,727,993  
(9) KAISER FOUNDATION HEALTH PLAN INC

 L 60,632,409  
(10) KAISER FOUNDATION HOSPITALS

 L 810,427,280  
(11) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 L 213,028  
(12) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 L 1,313,178  
(13) KAISER FOUNDATION HEALTH PLAN OF THE NW

 L 269  
(14) KAISER FOUNDATION HEALTH PLAN OF OHIO

 L 323,033  
(15) KAISER PERMANENTE INSURANCE COMPANY

 L 7,789,507  
(16) LOKAHI ASSURANCE LTD

 L 47,098,373  
(17) OAK TREE ASSURANCE LTD

 L 4,243  
(18) KAISER FOUNDATION HEALTH PLAN INC

 N 9,284  
(19) KAISER FOUNDATION HEALTH PLAN INC

 O 20,074,918  
(20) KAISER FOUNDATION HOSPITALS

 O 33,706,176  
(21) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 O 1,041,535  
(22) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 O 142,186  
(23) KAISER FOUNDATION HEALTH PLAN OF THE NW

 O 4,815  
(24) KAISER FOUNDATION HEALTH PLAN OF OHIO

 O 15,374  
(25) KAISER PERMANENTE INSURANCE COMPANY

 O 35,590,176  
(26) KAISER FOUNDATION HEALTH PLAN INC

 P 4,375,440  
(27) KAISER FOUNDATION HOSPITALS

 P 704,686,805  
(28) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 P 25,521  
(29) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 P 57,488  
(30) KAISER FOUNDATION HEALTH PLAN OF THE NW

 P 15,038  
(31) KAISER FOUNDATION HEALTH PLAN OF OHIO

 P 4,988  
(32) LOKAHI ASSURANCE LTD

 P 7,754,669  
(33) KAISER FOUNDATION HEALTH PLAN INC

 Q 231  
(34) KAISER FOUNDATION HOSPITALS

 Q 1,868,604,796  
Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Are all
partners
section
501(c)(3)
organizations? 		(e)
Share of
end-of-year
assets 		(f)
Disproprtionate allocations? 		(g)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(h)
General or
managing
partner?
Yes No Yes No Yes No






























Schedule R (Form 990) 2010
Schedule R (Form 990) 2010
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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