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
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
KAISER FOUNDATION HOSPITALS
 
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

94-1105628
E Telephone number

G Gross receipts $ 24,188,927,784
F Name and address of principal officer:
GEORGE C HALVORSON
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: 1948
M State of legal domicile: CA
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 2011 (Part V, line 2a) ... 5 64,395
6 Total number of volunteers (estimate if necessary) .... 6 7,442
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 7,781,566
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -1,263,603
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 133,521,152 192,069,957
9 Program service revenue (Part VIII, line 2g) ......... 15,903,379,451 17,159,566,467
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 494,874,341 547,748,427
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 60,462,846 80,645,504
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 16,592,237,790 17,980,030,355
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 88,566,500 78,199,348
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) 6,249,584,279 6,922,486,670
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).... 8,882,396,666 9,443,226,511
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 15,220,547,445 16,443,912,529
19 Revenue less expenses. Subtract line 18 from line 12....... 1,371,690,345 1,536,117,826
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 25,745,696,667 28,948,439,297
21 Total liabilities (Part X, line 26)............. 16,666,321,040 19,765,732,734
22 Net assets or fund balances. Subtract line 21 from line 20..... 9,079,375,627 9,182,706,563
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 use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
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 organization’s program service accomplishments for each of its three largest program services, as measured 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 $ 15,321,874,751 including grants of $ 37,405,060 ) (Revenue $ 16,814,723,449 )
Provides Hospital and Medical Care, Training and charity care Kaiser Foundation Hospitals (KFH) provides hospital, medical and surgical care, including emergency services, extended care and home health care without regards to age, sex, race, religion or national origin or the ability to pay. KFH educates and trains medical students, physicians and other health care professionals and promotes scientific research and medical and nursing education in order to improve care for our members and our community. KFH directly invests in improvements in community health by working to increase access for the underserved, disseminating care improvements, altering the social determinants of health and educating to improve health. KFH provides charity care to low-income vulnerable patients through the Medical Financial Assistance (MFA) and Charitable Health Coverage (CHC) Programs. MFA - KFH 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 a Kaiser Permanente facility. CHC - these programs are available to low income adults and children who are not eligible for other public or privately sponsored coverage. More than 88,000 patients received comprehensive care for up to four years through this program.
4b (Code:   ) (Expenses $ 646,508,479 including grants of $ 0 ) (Revenue $ 320,193,965 )
Medicaid and Other Government Sponsored Programs KFH is committed to improving the way Medicaid beneficiaries receive care, not only in our facilities, but also in the communities we serve. In 2011, KFH participated in a number of government programs. Medicaid Managed Care - provided comprehensive care for more than 218,940 managed care members; Medicaid Fee for Service - California and Hawaii participated in the State Children's Health Initiative - providing comprehensive health care, to more than 194,536 members.
4c (Code:   ) (Expenses $ 162,980,181 including grants of $ 0 ) (Revenue $ 0 )
Medical Research Programs For more than 40 years, Kaiser Permanente researchers have leveraged modest grants financed through the Federal Government, KFH's Community Benefit Programs and other private foundations into major discoveries that have served our communities, influenced national policy, and informed medical practice throughout the nation and the world. Many of the research studies address current health issues and improve care for common conditions where treatment is often linked to community-based efforts, and are broadly disseminated through articles and professional presentations. Kaiser Permanente investigators in California, Hawaii, Oregon, and Washington participated in research and evaluation studies, partnering with several prominent academic research institutions, including Harvard University, Oregon Health & Sciences University, Stanford University, University of California (Los Angeles, Berkeley, and San Francisco), University of Southern California, University of Washington, National Institutes of Health, Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention.
(Code:   ) (Expenses $ 172,088,660 including grants of $ 40,794,288 ) (Revenue $ 17,240,525 )
SEE part iii, line 4a-d description
4d Other program services (Describe in Schedule O.)
(Expenses $ 172,088,660 including grants of $ 40,794,288 ) (Revenue $ 17,240,525 )
4e Total program service expensesMediumBullet$ 16,303,452,071
Form 990 (2011)
Form 990 (2011)
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? Click to see attachment........
2
Yes
 
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 I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
No
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 for which 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 temporarily restricted endowments, permanent endowments, 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
Yes
 
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
 
No
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, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
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.. Click to see attachment
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.. Click to see attachment
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
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization 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
Yes
 
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................ Click to see list of attachments
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
Yes
 
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
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
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......
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................
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.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
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 .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
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..
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
Yes
 
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
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, 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
35b
Yes
 
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 (2011)
Form 990 (2011)
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
1,996
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
64,395
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
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletID
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 (2011)
Form 990 (2011)
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
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
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
 
No
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
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
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
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete 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
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did 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 15a or 15b, 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,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take 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
CA , CO , DC , GA , HI , MD , OH , OR , VA , WA
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 made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
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 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) Christine Cassel
Director
 2.5 X           0 184,500 0
(2) Thomas Chapman
Director
 3.0 X           0 191,695 89,109
(3) Daniel Garcia
SVP, Chief Compliance Officer
 20.0 X   X       0 1,228,765 73,604
(4) William Graber
Director
 2.25 X           0 208,269 0
(5) J Eugene Grigsby III
Director
 2.25 X           0 210,900 0
(6) George Halvorson
Chairman and CEO
 12.0 X   X       0 7,861,915 74,595
(7) Judith Johansen
Director
 2.1 X           0 200,075 0
(8) Kim J Kaiser
Director
 3.0 X           0 124,500 0
(9) Philip Marineau
Director
 2.0 X           0 200,769 0
(10) Jenny Ming
Director
 2.0 X           0 179,269 0
(11) Edward Pei
Director
 3.0 X           0 173,000 16,500
(12) Margaret Porfido
Director
 2.0 X           0 35,013 0
(13) J Neal Purcell
Director
 3.0 X           0 234,858 0
(14) Cynthia Telles
Director
 2.3 X           0 204,613 0
(15) Sandra Thompkins
Director
 2.0 X           0 39,031 0
(16) Gregory Adams
Group & Region President NCAL
 22.0     X       0 2,064,333 292,548
(17) Peter Andruszkiewicz
Region President - Georgia
 0.0     X       0 634,729 138,008
Form 990 (2011)
Form 990 (2011)
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 (do not check more than one box, unless person is both an officer and a director/trustee) 		(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) Anthony Barrueta
SVP, Government Relations
 25.0     X       0 879,329 154,182
(19) Raymond Baxter
SVP, CB, Research & Health Pol
 25.0     X       0 1,266,965 74,302
(20) Benjamin Chu
Group & Region President SCAL
 25.0     X       0 1,932,486 290,010
(21) Charles Columbus
SVP, Chief HR Officer
 25.0     X       0 856,137 204,567
(22) Steven Doshay
Senior Counsel
 22.0     X       0 259,457 54,404
(23) Philip Fasano
EVP & CIO
 25.0     X       0 2,144,366 326,587
(24) Jerry Fleming
SVP, Health Reform Implement.
 20.0     X       0 1,078,443 148,447
(25) Diane Gage-Lofgren
SVP, Brand Mgmt & Comm.
 25.0     X       0 1,030,003 160,696
(26) Sandra Golze
VP, Regional Counsel - NCAL
 25.0     X       0 410,409 97,916
(27) Mitchell Goodstein
SVP, Actuarial, U/W & Pricing
 1.0     X       0 1,443,129 164,851
(28) Marilyn Kawamura
Region President - MAS
 10.0     X       0 1,042,189 213,395
(29) Patricia Kennedy-Scott
Region President - Ohio
 5.0     X       0 924,039 153,668
(30) Kerry Kohnen
Region President - Georgia
 10.0     X       0 695,379 141,557
(31) Kathryn Lancaster
EVP & CFO
 12.0     X       0 2,109,102 289,626
(32) Janet Liang
Region President - Hawaii
 25.0     X       0 764,862 180,174
(33) Donna Lynne
Group & Region President CO
 18.0     X       0 1,314,917 222,947
(34) Andrew McCulloch
Region President - Northwest
 25.0     X       0 818,911 219,483
(35) Judith Mears
VP & Asst Gen Counsel
 3.0     X       0 407,138 92,160
(36) Thomas Meier
SVP, Corporate Treasurer
 15.0     X       0 802,247 110,802
(37) Indrajit Obeysekere
Expert Counsel
 21.0     X       0 321,292 56,621
(38) Donald Orndoff
SVP, NFS
 13.0     X       0 634,274 137,999
(39) Frank Richardson
VP, Regional Counsel - HI
 25.0     X       0 278,508 43,372
(40) ROCHELLE ROTH
SENIOR DIRECTOR,QRM
 18.0     X       0 196,984 42,093
(41) Jacqueline Sellers
Senior Counsel
 25.0     X       0 250,674 57,187
(42) Arthur Southam
EVP, Health Plan Operations
 4.9     X       0 2,649,224 348,687
(43) Deborah Stokes
SVP, CC & CAO
 14.4     X       0 720,302 118,018
(44) Bernard Tyson
President & COO
 12.0     X       0 2,800,296 482,152
(45) Herman Weil
SVP, Federal & State Programs
 10.0     X       0 865,328 95,908
(46) Jed Weissberg
SVP, Quality & Care Delivery
 25.0     X       0 930,822 245,344
(47) Carlos Zaragoza
VP, Practice Leader-Labor &Emp
 25.0     X       0 457,472 130,861
(48) Victoria Zatkin
VP, Off of Brd & Corp Gov Svcs
 14.0     X       0 314,768 84,531
(49) Mark Zemelman
SVP, Gen. Counsel & Secretary
 15.9     X       0 778,576 191,923
(50) Mary Ann Barnes
SVP, Exec Dir - San Diego
 30.0       X     0 672,016 125,296
(51) Christopher L Boyd
SVP, Area Mgr - Santa Clara
 30.0       X     0 524,094 96,500
(52) Michael Brady
SVP, Infrastructure Mgmt Group
 30.0       X     0 679,051 117,179
(53) Virginia Campbell
SVP & Area Mgr - Diablo
 30.0       X     0 510,161 112,472
(54) William Caswell
SVP, Operations
 30.0       X     0 835,873 123,061
(55) Greg K Christian
Exec Dir - Fontana
 30.0       X     0 481,119 96,985
(56) Judith Coffey
SVP & Area Mgr - Marin/Sonoma
 30.0       X     0 543,069 91,637
(57) Jeffrey A Collins
SVP & Area Manager - Fresno
 30.0       X     0 487,825 94,714
(58) Mark Costa
Exec Dir - Los Angeles
 30.0       X     0 490,534 94,833
(59) Richard Daniels
SVP, Shared Services
 30.0       X     0 1,155,638 134,687
(60) Elizabeth Finley
SVP & Exec Dir - Downey
 30.0       X     0 609,783 106,198
(61) Edward Glavis
SVP & Area Mgr - Roseville
 30.0       X     0 573,372 117,150
(62) Corwin Harper
SVP & Area Mgr -Central Valley
 30.0       X     0 518,464 87,164
(63) Gerald McCall
SVP Operations
 30.0       X     0 773,091 136,409
(64) Colleen McKeown
SVP & Area Mgr - Greater So. A
 30.0       X     0 588,118 105,952
(65) Julie Miller-Phipps
SVP & Exec Dir - Orange
 30.0       X     0 643,344 108,871
(66) Nathaniel Oubre
SVP & Area Mgr - East Bay
 30.0       X     0 633,185 102,433
(67) Christine Robisch
SVP & Area Manager - SF
 30.0       X     0 505,923 96,480
(68) Max Villalobos
SVP & Area Manager - Napa/Sola
 30.0       X     0 575,430 97,909
(69) Vita Willett
Exec Dir - Riverside
 30.0       X     0 482,408 106,276
(70) Diane Comer
SVP, Bus. Info Officer - HP
 30.0         X   0 613,479 103,142
(71) James Goff Crawford
VP, Group Bus. Info Officer
 30.0         X   0 593,369 89,774
(72) Lazaro Garcia
VP, Data Center Svcs
 30.0         X   0 651,961 96,365
(73) Wendy L Lee
VP, Strategic Initiatives & Op
 30.0         X   0 567,880 108,136
(74) Chadwick Henry Nestman
VP, Chief Architect
 30.0         X   0 597,828 110,249
(75) Paul Records
SVP, Human Resources
 0.0           X 0 502,499 33,787
(76) Steven Zatkin
Consultant
 0.0           X 0 574,121 76,925
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 61,737,897 8,789,418
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet20,547
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. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
PROVIDENCE HEALTH SERVICES - OR
PO BOX 3396
PORTLAND,OR97208 		MEDICAL SERVICES 45,657,837
PEACEHEALTH SOUTHWEST WASHINGTON ME
400 NE MOTHER JOSEPH PL
VANCOUVER,WA98664 		MEDICAL SERVICES 43,895,293
SALEM HOSPITAL
890 OAK ST SE
SALEM,OR97301 		MEDICAL SERVICES 40,270,808
OREGON HEALTH SCIENCE UNIVERSITY
3181 SW SAM JACKSON PARK RD
PORTLAND,OR97201 		MEDICAL SERVICES 31,253,754
MAUI MEMORIAL MEDICAL CENTER
221 MAHALANI ST
WAILUKU,HI96793 		MEDICAL SERVICES 29,419,656
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet140
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 766,000
e Government grants (contributions)1e 155,127,973
f All other contributions, gifts, grants, and
similar amounts not included above1f 		36,175,984
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet 192,069,957
Program Service Revenue Business Code
2a HOSPITAL SERV REV 900,099 15,083,925,760 15,083,925,760    
b NON-PLAN & IND REV 900,099 188,687,113 188,687,113    
c OTHR PRGM SERV REV 900,099 1,829,023,197 1,821,614,669 7,408,528  
d MEDICARE PAYMENTS 900,099 57,930,397 57,930,397    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 17,159,566,467
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 119,369,794     119,369,794
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 1,709,616  
b Less: rental expenses    
c Rental income or (loss) 1,709,616  
d Net rental income or (loss).......MediumBullet 1,709,616     1,709,616
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 6,634,116,325 3,159,737
b Less: cost or other basis and sales expenses 6,199,905,734 8,991,695
c Gain or (loss) 434,210,591 -5,831,958
d Net gain or (loss)..........MediumBullet 428,378,633     428,378,633
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 CAFETERIA 722,210 18,136,301     18,136,301
b PARKING GARAGES 812,930 8,497,523   204,019 8,293,504
c KP ONCALL 900,099 40,728,612   4,549,274 36,179,338
d All other revenue .... 11,573,452   -4,380,255 15,953,707
e Total. Add lines 11a–11d ......MediumBullet 78,935,888
12 Total revenue. See Instructions....MediumBullet 17,980,030,355 17,152,157,939 7,781,566 628,020,893
Form 990 (2011)
Form 990 (2011)
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).
Check if Schedule O contains a response to any question in this Part IX. .........
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 United States. See Part IV, line 21 77,792,348 77,792,348
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 407,000 407,000
3 Grants and other assistance to governments, organizations, and individuals outside the United States. 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 .... 0      
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 4,606,081,041 4,549,578,135 56,502,906 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 649,954,766 641,981,755 7,973,011  
9 Other employee benefits ....... 1,324,997,111 1,308,743,340 16,253,771  
10 Payroll taxes ........... 341,453,752 337,265,131 4,188,621  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 73,423   73,423  
c Accounting ........... 2,404,382   2,404,382  
d Lobbying ........... 0      
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 38,508,491 38,036,106 472,385  
g Other .......... 0      
12 Advertising and promotion .... 4,037,844   4,037,844  
13 Office expenses ....... 1,609,149,607 1,589,410,130 19,739,477  
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 202,830,417 200,342,291 2,488,126  
17 Travel ............ 20,716,821 20,462,687 254,134  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 9,775,963   9,775,963  
20 Interest ........... 74,862,101 73,943,766 918,335  
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 705,197,889 696,547,210 8,650,679  
23 Insurance .............. 66,348,287 65,534,391 813,896  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a BASIC CONTRACTUAL PAYMENTS 2,846,777,705 2,846,777,705    
b PURCHASED MEDICAL SERVICES 2,751,912,088 2,751,912,088    
c PURCHASED NON-MEDICAL SVC 370,689,433 366,142,177 4,547,256  
d BAD DEBT EXPENSE 125,906,152 125,906,152    
e
f All other expenses 614,035,908 612,669,659 1,366,249  
25 Total functional expenses. Add lines 1 through 24f 16,443,912,529 16,303,452,071 140,460,458 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 37,015,352 1 84,285,675
2 Savings and temporary cash investments ....... 0 2 0
3 Pledges and grants receivable, net ......... 0 3 0
4 Accounts receivable, net ......... 264,067,372 4 322,831,094
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
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 .......... 0 6 0
7 Notes and loans receivable, net ............. 215,356,692 7 315,851,331
8 Inventories for sale or use .............. 357,691,588 8 417,934,461
9 Prepaid expenses and deferred charges ............ 246,189,527 9 121,769,695
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 25,112,153,447
b Less: accumulated depreciation. ..... 10b 10,669,625,466 13,177,788,565 10c 14,442,527,981
11 Investments—publicly traded securities .......... 9,738,877,605 11 10,594,862,345
12 Investments—other securities. See Part IV, line 11 ...... 1,588,745,055 12 2,265,720,383
13 Investments—program-related. See Part IV, line 11 .. 0 13 0
14 Intangible assets ......... 7,366,237 14 1,800,000
15 Other assets. See Part IV, line 11 ........... 112,598,674 15 380,856,332
16 Total assets. Add lines 1 through 15 (must equal line 34)... 25,745,696,667 16 28,948,439,297
Liabilities 17 Accounts payable and accrued expenses . 2,255,184,139 17 2,522,746,649
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 31,147,451 19 11,781
20 Tax-exempt bond liabilities .......... 5,490,197,030 20 5,697,624,165
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 1,289,691,972 23 1,328,143,905
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 7,600,100,448 25 10,217,206,234
26 Total liabilities. Add lines 17 through 25..... 16,666,321,040 26 19,765,732,734
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 ..... 0 30 0
31 Paid-in or capital surplus, or land, building or equipment fund ..... 11,778,805 31 -19,013,528
32 Retained earnings, endowment, accumulated income, or other funds 9,067,596,822 32 9,201,720,091
33 Total net assets or fund balances ..... 9,079,375,627 33 9,182,706,563
34 Total liabilities and net assets/fund balances ..... 25,745,696,667 34 28,948,439,297
Form 990 (2011)
Form 990 (2011)
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
17,980,030,355
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
16,443,912,529
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
1,536,117,826
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
9,079,375,627
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-1,432,786,890
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
9,182,706,563
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 (2011)
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
2011
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number

94-1105628
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
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......            
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.            
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.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
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.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number

94-1105628
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
KAISER FOUNDATION HOSPITALS
  		Employer identification number

94-1105628
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
KAISER FOUNDATION HOSPITALS
  		Employer identification number

94-1105628
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
KAISER FOUNDATION HOSPITALS
  		Employer identification number

94-1105628
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

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, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number

94-1105628
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 can 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 through 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, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax 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 (ASC 958), 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 (ASC 958), 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 (ASC 958), 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) 2011

Schedule D (Form 990) 2011
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 Net investment earnings, gains, and 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 (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
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
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   875,623,058 875,623,058
b Buildings ................   15,604,168,457 6,632,964,385 8,971,204,072
c Leasehold improvements ............   178,166,354 139,535,226 38,631,128
d Equipment ................   2,292,585,534 1,641,547,520 651,038,014
e Other .................   6,161,610,044 2,255,578,335 3,906,031,709
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 14,442,527,981
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
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    
(3)Other
(A) ABSOLUTE RETURN FUNDS 		1,648,657,587 F

(B) PRIVATE EQUITY FUNDS 		617,062,796 F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 2,265,720,383
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) must 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) must 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) Book value
Federal Income Taxes 0
DUE TO RELATED ENTITIES 1,446,050,882
RESERVE FOR UNCLAIMED PROPERTY 785,806
RESERVE FOR WORKERS COMP RISKS 319,932,796
RESERVE FOR PROF/PUBLIC LIAB 184,507,551
RESERVE FOR SELF-INS RISK AUTO 200,000
RESERVE FOR MEDICARE 10,291,277
RESERVE FOR RESTRUCTURING CHGS 7,520,926
POST RETIREMENT LIABILITIES 7,639,955,067
OTHER LONG-TERM LIABILITIES 388,296,742
OTHER CURRENT LIABILITIES 132,260,421
BROKER PAYABLES 87,404,766
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 10,217,206,234
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) 2011

Schedule D (Form 990) 2011
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 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2  
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3  
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9  
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10  
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 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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  
c Add lines 4a and 4b....................... 4c  
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1  
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  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
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
FIN 48 FOOTNOTE SCHEDULE D, PART X NOT REQUIRED
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number

94-1105628
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
South America     Investments   25,227,574
East Asia and the Pacific     Investments   81,791,135
Europe (Including Iceland and Greenland)     Investments   209,515,877
Middle East and North Africa     Investments   10,870,889
South Asia     Investments   414,456
Central America and the Caribbean     Investments   2,379,717,179
           
           
           
           
           
           
           
           
           
           
           
3a Sub-total .....     2,707,537,110
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     2,707,537,110
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number

94-1105628
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    256,490,101 12,635,671 243,854,430 1.490 %
b Medicaid (from Worksheet 3, column a) .....     358,394,073 108,629,796 249,764,277 1.530 %
c Costs of other means-tested government programs (from Worksheet 3, column b) .     142,471,850 69,749,702 72,722,148 0.450 %
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    757,356,024 191,015,169 566,340,855 3.470 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    37,691,804   37,691,804 0.230 %
f Health professions education
(from Worksheet 5) .. 		    97,074,590 17,240,525 79,834,065 0.490 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     160,876,868 39,007,121 121,869,747 0.750 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     39,231,459   39,231,459 0.240 %
jTotal Other Benefits ...     334,874,721 56,247,646 278,627,075 1.710 %
kTotal. Add lines 7d and 7j. ..     1,092,230,745 247,262,815 844,967,930 5.180 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total            
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
112,470,198
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
0
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
174,247,078
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
269,643,764
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
-95,396,686
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?38
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 KAISER FOUNDATION HOSPITAL - SUNSET
4867 SUNSET BLVD
LOS ANGELES,CA90027 		X X   X   X X    
2 KAISER FOUNDATION HOSPITAL - SAN DIEGO
4647 ZION AVE
SAN DIEGO,CA92120 		X X   X   X X    
3 KAISER FOUNDATION HOSPITAL - SANTA CLARA
700 LAWRENCE EXPRESSWAY
SANTA CLARA,CA95051 		X X   X   X X    
4 KAISER FOUNDATION HOSPITAL - FONTANA
9961 SIERRA AVE
FONTANA,CA92335 		X X   X     X    
5 KAISER FOUNDATION HOSPITAL - ROSEVILLE
1600 EUREKA RD
ROSEVILLE,CA95661 		X X   X   X X    
6 KAISER FOUNDATION HOSPITAL - DOWNEY
9333 IMPERIAL HIGHWAY
DOWNEY,CA90242 		X X   X   X X    
7 KAISER FOUNDATION HOSPITAL - OAKLAND
280 W MACARTHUR BLVD
OAKLAND,CA94611 		X X   X   X X    
8 KAISER FDN HOSP - SUNNYSIDE MEDICAL CTR
10180 SOUTHEAST SUNNYSIDE RD
CLACKAMAS,OR97105 		X X   X     X    
9 KAISER FOUNDATION HOSPITAL -WALNUT CREEK
1425 S MAIN ST
WALNUT CREEK,CA94596 		X X   X   X X    
10 KAISER FOUNDATION HOSPITAL - HONOLULU
3288 MOANALUA RD
HONOLULU,HI96819 		X X   X     X    
11 KAISER FDN HOSPITAL - SAN FRANCISCO
2425 GEARY BLVD
SAN FRANCISCO,CA94115 		X X   X   X X    
12 KAISER FOUNDATION HOSPITAL - VALLEJO
975 SERENO DR
VALLEJO,CA94589 		X X   X   X X    
13 KAISER FOUNDATION HOSPITAL - HARBOR CITY
25825 S VERMONT AVE
HARBOR CITY,CA90710 		X X   X   X X    
14 KAISER FOUNDATION HOSPITAL - SACRAMENTO
2025 MORSE AVENUE
SACRAMENTO,CA95825 		X X   X   X X    
15 KAISER FOUNDATION HOSPITAL - RIVERSIDE
10800 MAGNOLIA AVE
RIVERSIDE,CA92505 		X X   X     X    
16 KAISER FDN HOSPITAL - WOODLAND HILLS
5601 DE SOTO AVE
WOODLAND HILLS,CA91367 		X X   X   X X    
17 KAISER FOUNDATION HOSPITAL - SAN JOSE
250 HOSPITAL PARKWAY
SAN JOSE,CA95119 		X X   X   X X    
18 KAISER FOUNDATION HOSPITAL -BALDWIN PARK
1011 BALDWIN PARK BLVD
BALDWIN PARK,CA91706 		X X   X     X    
19 KAISER FDN HOSPITAL - W LOS ANGELES
6041 CADILLAC AVE
W LOS ANGELES,CA90034 		X X   X   X X    
20 KAISER FDN HOSPITAL - SOUTH SACRAMENTO
6600 BRUCEVILLE RD
SOUTH SACRAMENTO,CA95823 		X X   X   X X    
21 KAISER FOUNDATION HOSPITAL - ANAHEIM
441 N LAKEVIEW AVE
ANAHEIM,CA92807 		X X   X   X X    
22 KAISER FDN HOSPITAL - PANORAMA CITY
13652 CANTARA ST
PANORAMA CITY,CA91402 		X X         X    
23 KAISER FOUNDATION HOSPITAL - IRVINE
6640 ALTON PARKWAY
IRVINE,CA92618 		X X   X     X    
24 KAISER FOUNDATION HOSPITAL - HAYWARD
27400 HESPERIAN BLVD
HAYWARD,CA94545 		X X   X   X X    
25 KAISER FOUNDATION HOSPITAL -REDWOOD CITY
1150 VETERANS BLVD
REDWOOD CITY,CA94063 		X X   X   X X    
26 KAISER FOUNDATION HOSPITAL - SANTA ROSA
401 BICENTENNIAL WAY
SANTA ROSA,CA95403 		X X   X   X X    
27 KAISER FOUNDATION HOSPITAL - FRESNO
7300 N FRESNO ST
FRESNO,CA93720 		X X   X   X X    
28 KAISER FOUNDATION HOSPITAL - ANTIOCH
4501 SAND CREEK RD
ANTIOCH,CA94531 		X X   X   X X    
29 KAISER FDN HOSPITAL -SOUTH SAN FRANCISCO
1200 EL CAMINO REAL
SOUTH SAN FRANCISCO,CA94080 		X X   X   X X    
30 KAISER FOUNDATION HOSPITAL - SAN RAFAEL
90 MONTECILLO RD
SAN RAFAEL,CA94903 		X X   X   X X    
31 KAISER FOUNDATION HOSPITAL - MODESTO
4601 DALE RD
MODESTO,CA95356 		X X   X     X    
32 KAISER FOUNDATION HOSPITAL - FREMONT
39400 PASEO PADRE PARKWAY
FREMONT,CA94538 		X X   X   X X    
33 KAISER FOUNDATION HOSPITAL - MANTECA
1777 W YOSEMITE AVE
MANTECA,CA95336 		X X   X     X    
34 KAISER FOUNDATION HOSPITAL - VACAVILLE
1 QUALITY DR
VACAVILLE,CA95688 		X X   X   X X    
35 KAISER FDN HOSPITAL - MORENO VALLEY
27300 IRIS AVE
MORENO VALLEY,CA92555 		X X         X    
36 KAISER FOUNDATION HOSPITAL - RICHMOND
901 NEVIN ST
RICHMOND,CA94804 		X X   X   X X    
37 KAISER FDN HOSPITAL - SANTA CLARA PHF
3840 HOMESTEAD ROAD
SANTA CLARA,CA95051 		X X   X   X X    
38 KAISER FOUNDATION HOSPITAL - ONTARIO
2295 S VINEYARD AVE
ONTARIO,CA91761 		X X   X     X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - SUNSET
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - SAN DIEGO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - SANTA CLARA
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - FONTANA
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - ROSEVILLE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - DOWNEY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - OAKLAND
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSP - SUNNYSIDE MEDICAL CTR
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):8

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21 Yes  
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL -WALNUT CREEK
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):9

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - HONOLULU
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):10

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSPITAL - SAN FRANCISCO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):11

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - VALLEJO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):12

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - HARBOR CITY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):13

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - SACRAMENTO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):14

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - RIVERSIDE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):15

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSPITAL - WOODLAND HILLS
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):16

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - SAN JOSE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):17

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL -BALDWIN PARK
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):18

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSPITAL - W LOS ANGELES
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):19

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSPITAL - SOUTH SACRAMENTO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):20

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - ANAHEIM
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):21

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSPITAL - PANORAMA CITY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):22

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - IRVINE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):23

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - HAYWARD
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):24

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL -REDWOOD CITY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):25

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - SANTA ROSA
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):26

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - FRESNO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):27

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - ANTIOCH
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):28

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSPITAL -SOUTH SAN FRANCISCO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):29

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18   No
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - SAN RAFAEL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):30

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - MODESTO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):31

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - FREMONT
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):32

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - MANTECA
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):33

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - VACAVILLE
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):34

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSPITAL - MORENO VALLEY
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):35

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - RICHMOND
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):36

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FDN HOSPITAL - SANTA CLARA PHF
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):37

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
KAISER FOUNDATION HOSPITAL - ONTARIO
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):38

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 350.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 400.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14 Yes  
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address Type of Facility (describe)
1 BROOKSIDE RESIDENTIAL TREATMENT CENTER
10180 SOUTHEAST SUNNYSIDE RD
CLACKAMAS,OR97015 		IMPATIENT MENTAL HEALTH SERVICES
2 KAISER PERMANENTE POST ACUTE CARE CENTER
1440 168TH AVE
SAN LEANDRO,CA94578 		SKILLED NURSING
3 INTERSTATE SURGICAL CENTER
3500 N INTERSTATE AVE
PORTLAND,OR97227 		AMBULATORY SURGERY
4 SUNNYBROOK SURGICAL CENTER
10180 SOUTHEAST SUNNYSIDE RD
CLACKAMAS,OR97015 		AMBULATORY SURGERY
5 SKYLINE SURGICAL CENTER
5135 SKYLINE ROAD SOUTH
SALEM,OR97306 		AMBULATORY SURGERY
6 CENTER FOR HEALTH RESEARCH
3800 N INTERSTATE AVE
PORTLAND,OR97227 		RESEARCH CENTER
7 MENTAL HEALTH CENTER
765 W COLLEGE ST
LOS ANGELES,CA90012 		MENTAL HEALTH
8 CHEMICAL DEPENDENCY PROGRAM
17046 MARYGOLD AVE
FONTANA,CA92335 		CHEMICAL DEPENDENCY PROGRAM
9
10
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
Part I Line 7   The losses attributed to providing charity care (medical financial assistance and charitable health coverage) and participation in select government or community sponsored health coverage programs are calculated using a cost-based methodology for patients in those programs. The cost-based loss is generated through the standard systems used to report on market segments for KFHP/H's commercial business lines. In order to calculate the percentages reported in column (f) bad debt was excluded from total expenses. Bad debt of $125,906,152 was excluded from total expenses of $16,443,912,529 reported in part ix, line 25, column (a)
Part III Line 4   The organization's financial statement is part of a combined report, The combined statement does not have a footnote related to bad debt. The organization reports Accounts Receivable - net. The calculation begins with gross revenue and multiplies that value by a bad debt percentage which is based on a look back period that is aligned with our reserve model timelines. For specific revenue types within Account Receivable, we applied that bad debt percentage to the general ledger self pay gross charges to determine the bad debt amount. Copay charge codes (less POS payments) we apply a bad debt ratio based on a lag model to give us our estimated copay bad debt. DHMO and HDHP is also based on a report that pulls their respective gross charges and applies a ratio based on a lag model for those lines of business to calculate our estimated bad debt.
Part III Line 8   None of the amounts reported on Part III, line 7 has been treated as community benefit. The cost accounting system takes inputs from the General Ledger, utilization and other statistics, products from the chargemasters, and Relative Value Units (RVUs) to cost the individual products. These costs are then aggregated to form an encounter cost. Revenues received are applied to reduce the cost to a net loss, which is the reported value. Our systems aggregate these costs into the patient's assigned line of business to create our standard line of reporting.
Part III Line 9b   When a patient/guarantor indicates an inability to pay (charity care), the patient/guarantor will be evaluated for charity care in accordance with established criteria outlined in the Medical Financial Assistance (MFA) Program. In addition, outside collection agencies will cancel and return on a retrospective basis any accounts that either would have qualified or now qualify for charity care according to the criteria outlined in the MFA Program.
needs assessment   In California, Hawaii and Oregon each KFH medical center is required to conduct a community needs assessment every three years. The assessments may be conducted individually by each hospital or in collaboration with other hospitals, community-based agencies and public service organizations. Each needs assessment provides a summary of the needs assessment process undertaken including the methodologies and data sources utilized, individuals and organizations consulted, a complete listing of the needs identified and description of the method used to prioritize needs for inclusion in the individual community benefit plans. The most recent needs assessments were completed in 2010.
patient education of eligibility for assistance   In California, Hawaii, Oregon and Washington, information regarding assistance is widely available to patients and the general public as well as Health Plan members throughout the facility. Kaiser Permanente physicians and staff are also a source of information for patients requesting medical financial assistance. The availability and contact information about Kaiser Permanente's Medical Financial Assistance Program (MFAP) are posted in the emergency departments, billing and admitting offices and hospital-based outpatient departments. Information is also publicly posted on our websites and in public entrances of hospitals, medical office buildings, urgent care and outpatient pharmacies. In addition, a special MFAP 800# hotline (in several languages) has been established. This number is included on all bill correspondence, brochures and signage. MFAP information can also be found on the publicly accessible KP web site. All patients identified as "self pay" and who have received care in a Kaiser Permanente emergency department or hospital-based outpatient department are required to receive a Medical Financial Assistance brochure which contains eligibility information on the charity care programs and self pay discounts. All brochures and applications are provided in English or other appropriate languages such as Spanish, Chinese, Armenian, Russian and Farsi.
community information   KFH owns and operates 38 licensed hospitals, including five licensed hospitals with multiple campuses in California, Hawaii and Oregon. In California, KFH medical centers are located in the cities of Anaheim, Antioch, Baldwin Park, Clackamas, Downey, Fontana, Fremont, Fresno, Harbor City, Hayward, Irvine, Los Angeles, Manteca, Modesto, Moreno Valley, Oakland, Ontario, Panorama City, Redwood City, Richmond, Riverside, Roseville, Sacramento, San Diego, San Francisco, San Jose, San Rafael, Santa Clara, Santa Rosa, South Sacramento, South San Francisco, Vacaville, Vallejo, Walnut Creek, West Los Angeles, and Woodland Hills. In Hawaii, the Moanalua Medical Center is located in the City of Honolulu on the island of Oahu. In Oregon, the Sunnyside Medical Center is located in the City of Clackamas. Kaiser Permanente members are representative of the various ages and income groups as well as the social, ethnic, and culture distinction of each community located within KFH service areas. ncal scal Hawaii nw Total population in area (mil) 11.6 21.6 1.3 2.2 Average family income $98,459 $85,050 $90,072 $78,278 % below fpl 14 16 11 14 % w/o public or private health ins 14 21 8 16 (SOURCE: US CENSUS 2010 AMERICAN COMMUNITY SURVEY S2701, CPO3, AND DP03 LIMITED TO APPROXIMATE KAISER SERVICE AREAS (MSA) IN EACH OF the 4 REGIONS. (INCLUDES the ENTIRE STATE OF HAWAII))
other information   promotion of community health KFH's principal purpose is to provide hospital, medical, and surgical care, including emergency services, extended care and home health care to members of the public without regard to age, sex, race, religion or national origin, or to the individual's ability to pay. KFH's general community benefits are: Emergency departments - KFH operates full-time emergency departments in each of its 38 licensed hospitals, including five licensed hospitals with multiple campuses in California, Hawaii and Oregon. Emergency medical services are available to all individuals regardless of their ability to pay. Care provided to all patients - Hospital care is provided to individuals with health care coverage from any private or government-sponsored health plan, insured and uninsured referrals from safety net and other public health partnerships, and uninsured patients admitted through the emergency department. Open Medical Staff Privileges - Staff privileges in the hospitals are available to community practitioners who are not affiliated with a Permanente Medical Group. Reinvestment of Surplus Revenues - KFHP pays KFH for hospital services and surplus revenues are reinvested for capital replacement or expansion of facilities and equipment, debt amortization, improvement in patient care and services, and other community benefit services including charity care, medical education and research.
affiliated health care system   Kaiser Foundation Hospitals (KFH) and Kaiser Foundation Health Plan, Inc. (KFHP), with its five principal operating tax-exempt subsidiary health plans-Kaiser Foundation Health Plan of Colorado; Kaiser Foundation Health Plan of Georgia, Inc.; Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.; Kaiser Foundation Health Plan of the Northwest; and Kaiser Foundation Health Plan of Ohio, are nonprofit corporations that are part of the integrated health care delivery system known as the Kaiser Permanente Medical Care Program or "Kaiser Permanente." Kaiser Permanente is an integrated health care delivery system that combines the provision and financing of health care services. People who elect to enroll in a Kaiser Permanente health plan receive a full range of prepaid health care services, including hospital care, professional care in hospitals and physicians' offices, x-ray and laboratory services, physical therapy, emergency, ambulance transportation, preventive services, health education and certain prescribed drugs. More comprehensive drug coverage is also provided through a separate coverage rider. In the hospital-based regions-California, Hawaii, Oregon and Washington, Kaiser Permanente is comprised of several separate legal organizations: KFH - a California nonprofit public benefit corporation exempt from federal income tax under Internal Revenue Code 501(c)(3); KFHP - a California nonprofit public benefit corporation exempt from federal income tax under Internal Revenue Code 501(c)(3); Northwest Health Plan - an Oregon nonprofit corporation. Kaiser Permanente contracts with various medical groups in each respective region to provide services to members. Persons enroll in Kaiser Permanente through KFHP or one of the Health Plan subsidiaries ("Health Plan"). 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. KFHP and KFH are separate corporations governed by identical boards of directors. KFH accepts responsibility to provide or arrange necessary hospital services and facilities for Health Plan members. KFH owns and operates 38 licensed hospitals, including five licensed hospitals with multiple campuses in California, Hawaii and Oregon, which provide emergency and in-patient services to all persons in the community regardless of membership or ability to pay. Staff privileges are available on a nondiscriminatory basis to physicians in the communities served. KFH also contracts with other community hospitals to provide hospital services to members for specialized care and other services. KAISER PERMANENTE'S COMMITMENT TO THE COMMUNITY Through the Kaiser Permanente mission, the organization contributes to the health of the communities in two related ways. First, Kaiser Permanente strives for excellence in serving its 8.9 million members through market-leading performance in quality, service and affordability. By doing so, Kaiser Permanente provides a discipline in the marketplace by demonstrating meaningful value and affordability, and generating resources to reinvest in the community's health. Second, Kaiser Permanente directly invests in improvements to community health by working to increase access for the underserved, disseminating care improvements, altering the social determinants of health, educating healthcare workers and consumers, and informing public policy. This latter approach, which Kaiser Permanente calls the 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, Safety Net Partnerships, Community Health Initiatives and Charitable Coverage Programs. The KFHP/H Board has a standing Community Benefit Committee of the Board of Directors to oversee the program-wide Community Benefit program. Kaiser Permanente also has a national executive of KFHP and KFH to lead Kaiser Permanente's Community Benefit Program as a full-time assignment. Raymond J. Baxter, PhD is the Senior Vice President for Community Benefit, Research and Health Care Policy reporting to the CEO and Chairman of the Board.
state filing of community benefit report   KFH annually prepares and submits a Consolidated Community Benefit Plan to the California Office of Statewide Health Planning and Development in compliance with Health and Safety Code Section 127340 et seq. The consolidated plan includes a hospital-specific community benefit plan for each individual medical center campus in California. KFH also annually prepares and submits a comprehensive Community benefit report to the Department of Human Services, Office for Oregon Health Policy and Research for the Sunnyside Medical Center located in the City of Clackamas.
Part V, Line 19D Other   The maximum amounts that could be charged are based upon the current fee schedule for non Kaiser member patients. For the majority of our charges, the amount is based on the medicare fee schedule. FAP is offered for a period of one year, with the option to re-apply. FAP is not limited to a dollar amounts.
Kaiser Sunnyside Medical Center   Part V, line 21: Until an individual has been qualified as FAP, the gross charge is applicable.
Kaiser Permanente - Hawaii   Part V, line 13g Other: KP- Hawaii will assist patients who express an inability to pay with financial counseling that includes assisting patients with determining whether or not they are potentially eligible for a broad range of services. Part V, line 15e Other: Internal collection activity Part V, line 16e Other: Internal collections (payment plan; offer of discounted payoffs) Part V, line 17e Other: Personal Financial assistance at point of entry and service
Schedule H (Form 990) 2011
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
2011
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number
94-1105628
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) 100 Black Men of America141 Auburn Ave
Atlanta,CA30303 		58-1974429 501(c)(3) 32,378       Annual Conference
(2) 2B Successful Youth1500 Oliver Rd - K 167
Fairfield,CA94534 		26-3309863 501(c)(3) 7,500       The STEMulate Project
(3) A More Excellent Way Health Org215 Lighthouse Dr
Vallejo,CA94590 		14-2011697 501(c)(3) 20,000       MEW African-American Breastfeeding Project
(4) A Safe Place2864 Telegraph Ave
Oakland,CA94609 		94-2491881 501(c)(3) 20,000       Domestic Violence Community Counseling Program
(5) A World Fit For Kids678 S La Fayette Pk Pl
Los Angeles,CA90057 		33-0550994 501(c)(3) 50,000       Fit for Success
(6) A Milton Miller Memorial Fund Inc800 S Figueroa St
Suite 1120
Los Angeles,CA90017 		95-2960607 501(c)(3) 25,000       Cancer Legal Center
(7) ABC Unified School District16700 Norwalk Blvd
Cerritos,CA90703 		95-2380644 Government 15,000       ABC Youth Leadership
(8) Access Inc2612 Daniel Ave
San Diego,CA92111 		95-2422704 501(c)(3) 15,000       Healthcare Project
(9) AccessOC25283 Cabot Rd-101
Laguna Hills,CA92653 		95-2021700 501(c)(3) 10,000       Service Award Grant
(10) Afghan Elderly Assoc (AEA)3300 Capitol Ave Bldg B
Fremont,CA94536 		94-3290111 501(c)(3) 12,000       Health Access and Prevention Program
(11) African American Prostate Cancer Initiative9521 Folsom Blvd-R
Sacramento,CA95827 		94-3387471 501(c)(3) 7,500       Healthy Men Healthy Families Health Fair and Cance
(12) AIDS Community Care Team4348 Waialae Ave-420
Honolulu,HI96816 		99-0285135 501(c)(3) 45,210       Utilizing a Patient Navigator to Increase Access t
(13) AIDS Project Los Angeles Inc611 S Kingsley Dr
Los Angeles,CA90005 		95-3842506 501(c)(3) 13,000       Southland Artists Event
(14) AIDS Research Alliance of America1400 S Grand Ave-701
Los Angeles,CA90015 		95-4264845 501(c)(3) 10,000       HIV/AIDS Clinical Trials
(15) AIDS Services Center Inc909 S Fair Oaks Ave
Pasadena,CA91105 		95-4165358 501(c)(3) 42,500       HIV/AIDS Prevention
(16) AIDS Services Fdn of Orange County17982 Skypark Circle-J
Irvine,CA92614 		33-0126481 501(c)(3) 25,000       HIV Management Program
(17) Airport Marina Counseling Service7891 La Tijera Blvd
Los Angeles,CA90045 		95-2224149 501(c)(3) 8,000       Adults and At-Risk
(18) Alameda County Deputy Sheriff's Assoc6689 Owens Dr 100
Pleasanton,CA94588 		83-0410537 Government 10,000       Exercise as Preventative Health Care
(19) Alameda County Health Care Fdn2001 Broadway-M
Oakland,CA94612 		94-3103136 501(c)(3) 15,000       Youth Violence Prevention Program
(20) Alameda County Public Health Dept7200 Bancroft Ave 202
Oakland,CA94605 		94-6000501 Government 40,000       Diabetes in Control
(21) Alameda Health Consortium101 Callan Ave-300
San Leandro,CA94577 		51-0189590 501(c)(3) 318,950       Clinic Appreciation Dinner, August 10, 2011
(22) Alliance for Housing and Healing825 Colorado Blvd-100
Los Angeles,CA90041 		95-4147364 501(c)(3) 25,000       Persons w/HIV/AIDS
(23) Alliance Medical Center1381 University Ave
Healdsburg,CA95448 		94-2308748 501(c)(3) 19,255       Good Start Dental Screenings
(24) Al-Shifa Clinic Inc2034-B Mallory St
San Bernardino,CA92407 		33-0855769 501(c)(3) 25,000       Live Well' Education
(25) AltaMed Health Services Corp2040 Camfield Ave
Los Angeles,CA90040 		95-2810095 501(c)(3) 14,400       East LA Meets Napa
(26) Alternatives for Better Living701 School St
Napa,CA94559 		94-3306094 501(c)(3) 7,500       Teen Anger Management/Violence Prevention
(27) Alum Rock Counseling Center1245 E Santa Clara St
San Jose,CA95116 		23-7367637 501(c)(3) 25,000       Ocala Middle School Mentoring & Support Services P
(28) Always Knocking Inc7741 Amherst St
Sacramento,CA95832 		26-4635991 501(c)(3) 25,000       Youth/Gang Violence Prevention Program
(29) Alzheimer's Disease & Disorders Assoc5900 Wilshire Blvd
1100
Los Angeles,CA90036 		95-3718119 501(c)(3) 9,500       Faith and Health Prog
(30) Alzheimer's Disease & Related Disorders Assoc17771 Cowan-200
Irvine,CA92614 		95-3702013 501(c)(3) 19,150       Safari Event
(31) Amanecer Community Counseling Svc1200 Wilshire Bl 510
510
Los Angeles,CA90017 		95-3076578 501(c)(3) 7,000       Project Connect
(32) Ambulatory Surgery Access Coalition115 Sansome St-1205
San Francisco,CA94104 		94-3180356 501(c)(3) 24,000       Strategic Planning for Operation Access
(33) American Canyon Family Resource Center3431 Broadway-A5
American Canyon,CA94503 		36-4612853 501(c)(3) 7,500       Healthy Living Project
(34) American Diabetes Assoc1701 N Beauregard St
Alexandria,VA22331 		13-1623888 501(c)(3) 43,170       Diabetes Forum
(35) American Heart Assoc Inc426 17th St 3rd Flr
Oakland,CA94612 		13-5613797 501(c)(3) 193,700       Healthy Holiday Celebrity Cooking Class, November
(36) American Heart Assoc Inc1700 Iowa Ave 240
Riverside,CA92507 		13-5613797 501(c)(3) 30,000       (Educational Workshops)
(37) American Lung Assoc in California202 Fashion Lane-219
Tustin,CA92780 		94-0362650 501(c)(3) 10,000       Asthma Management in Schools
(38) American Lung Assoc in California202 Fashion Lane-219
Tustin,CA92780 		94-0362650 501(c)(3) 20,000       SCAMP Camp
(39) American National Red Cross2025 E St NW
Washington,DC20006 		53-0196605 501(c)(3) 39,000       CPR Saturday Capital Region
(40) Antelope Valley College Fdn3041 West Ave K
Lancaster,CA93536 		95-4398700 501(c)(3) 17,000       Mental Health Grant
(41) Antelope Valley Domestic Violence Council1150 West Ave I
Lancaster,CA93539 		95-3582588 501(c)(3) 15,000       Health Care for Homeless
(42) Antelope Valley Partners for Health45104 10TH St W
Lancaster,CA93534 		47-0957404 501(c)(3) 104,670       Annual Fundraising Gala
(43) API Wellness Center730 Polk St-4 Flr
San Francisco,CA94109 		94-3096109 501(c)(3) 20,000       Wellness Clinic and Hepatitis B&C screening servic
(44) Arden Manor Recreation & Park District1415 Rushden Dr
Sacramento,CA95864 		94-6000529 Government 32,000       Thomas Edison Afterschool Program
(45) Area Agency on Aging400 Contra Costa St
Vallejo,CA94590 		94-2742309 501(c)(3) 20,000       Latino Outreach Napa and Solano
(46) Arrowhead United Way646 North D St
San Bernardino,CA92402 		95-1934586 501(c)(3) 15,000       Health Awareness Prog
(47) Arroyo Vista Family Health Fdn6000 N Figueroa St
Los Angeles,CA90042 		95-3514918 501(c)(3) 9,011       30th Anniversary Gala
(48) Artists for a New South Africa2999 Overland Ave-102
Los Angeles,CA90064 		95-4544830 501(c)(3) 6,750       Speakers' Donation - Remember Them on behalf of Mi
(49) Ashland Free Medical Clinic1757 Clemens Rd
Oakland,CA94602 		68-0554276 501(c)(3) 9,500       AFMC Diabetes Education Program
(50) Asian Americans for Community Involvement2400 Moorpark Ave-300
San Jose,CA95128 		94-2292491 501(c)(3) 38,720       Fundraising Luncheon
(51) Asian Am-Pacific Islanders in Philanthropy211 Sutter St-600
San Francisco,CA94108 		94-3150064 501(c)(3) 10,000       Comm Philanthropy
(52) Asian Pacific American Legal Center of SC1145 Wilshire Bl 2 Fl
2nd Flr
Los Angeles,CA90017 		95-3854152 501(c)(3) 209,400       28th Anniversary Gala
(53) Asian Pacific Community Counseling7273 14th Ave-120-B
Sacramento,CA95820 		94-2489666 501(c)(3) 80,330       Annual Dragon Reception
(54) Asian Pacific Islander Amer Public Affairs4000 Truxl Rd
Sacramento,CA95834 		55-0849384 501(c)(3) 10,000       State Capitol Internship Award and Installation (A
(55) Asian Resources Inc5709 Stockton Blvd
Sacramento,CA95824 		94-2658135 501(c)(3) 19,320       Lunar New Year Dinner
(56) Aspiranet400 Oyster Point
Blvd 501
S San Francisco,CA94080 		94-2442955 501(c)(3) 20,000       Empathic Empowerment
(57) Assistance League of Redlands700 E Redland-U-290
Redlands,CA92373 		95-2131653 501(c)(3) 20,000       Dental Center
(58) Assistance League of San Bernardino580 W 6th St
San Bernardino,CA92410 		95-6065105 501(c)(3) 10,000       Urgent Dental Conditions
(59) Assistance League of Southern California1370 N St Andrews Place
Hollywood,CA90028 		95-1641960 501(c)(3) 6,000       Child Abuse Prevention
(60) Asthma Resource Center of San Francisco527 Baker St
San Francisco,CA94117 		94-3320216 501(c)(3) 15,000       Controlling Asthma Risks to Promote Reduced Teen O
(61) Axis Community Health Inc4361 Railroad Ave
Pleasanton,CA94566 		94-2232394 501(c)(3) 35,000       Leadership Grant Staff and Board Development
(62) Azusa Pacific Univ901 E Alosta Ave
Azusa,CA91702 		95-1744369 501(c)(3) 16,000       Homeless Healthcare
(63) Bakersfield Assoc for Retarded Citizens2240 S Union Ave
Bakersfield,CA93561 		95-1805520 501(c)(3) 20,000       Dental Care for Adults
(64) Baldwin Park Unified School District4640 Maine Ave
Baldwin Park,CA91706 		95-6000213 Government 42,885       COMMUNITY GARDEN
(65) Bay Area Bicycle Coalition10 Meadowbrook Court
Novato,CA94947 		94-3023347 501(c)(3) 35,000       Bike to Work Day
(66) Bay Area Black United Fund Inc1212 Broadway-730
Oakland,CA94612 		94-2602958 501(c)(3) 65,000       Core Operating Support
(67) Bay Area Community Resources171 Carlos Dr
San Rafael,CA94903 		94-2346815 501(c)(3) 45,000       Marin Smoke-free Cities Project
(68) Bay Area Legal Aid1735 Telegraph Ave
Oakland,CA94612 		94-1631316 501(c)(3) 25,000       Richmond Reentry Project
(69) Bay Area Womens Sports Initiative1922 The Alameda St-100
San Jose,CA95126 		55-0897084 501(c)(3) 45,000       Game on! A BAWSI Sportsapalooza
(70) Being Alive-San Diego4070 Centre St
San Diego,CA92103 		33-0439092 501(c)(3) 12,000       Peer/Client Advocacy
(71) Benicia Community Action Council480 Military E
Benicia,CA94510 		68-0294153 501(c)(3) 7,500       Home Delivered Meals Program
(72) Benicia Unified School District350 E K St
Benicia,CA94510 		30-0385724 Government 20,000       BUSD Elementary Nutrition Education Program
(73) Benton County by and through the Community Health530 NW 27th St
Corvallis,OR97330 		93-6002285 Government 49,571       Benton County Oral Health Initiative General Opera
(74) Berkeley Organizing Congregations1950 Addison St 108
Berkeley,CA94704 		91-2010060 501(c)(3) 75,000       Lifelines to Healing Campaign
(75) Bethany Services1600 E Truxton Ave
Bakersfield,CA93305 		95-2858936 501(c)(3) 20,000       Bakersfield Homeless Ctr
(76) Big Brothers Big Sisters Greater Sacramento1451 River Park Dr-241
Sacramento,CA95815 		94-1559853 501(c)(3) 7,500       Community Giving Award on behalf of Sacramento (So
(77) Big Brothers Big Sisters of the Bay Area731 Market St-6 Fl
San Francisco,CA94103 		23-7108045 501(c)(3) 71,250       The BIG Event
(78) Big Brothers Big Sisters Of the North Bay1652 W Texas St 201
Fairfield,CA94553 		94-2502278 501(c)(3) 20,000       Operation Thrive Mentoring Program
(79) Bikes Belong Fdn207 Canyon Blvd-202
Boulder,CO80302 		20-4306888 501(c)(3) 63,875       Safe Routes
(80) Bikes Belong Fdn1928 Pearl St
Boulder,CO80302 		20-4306888 501(c)(3) 28,750       Safe Routes to School State Network Project 2010 -
(81) Bikes Belong Fdn207 Canyon Blvd-202
Boulder,CO80302 		20-4306888 501(c)(3) 200,000       Safe Routes Project
(82) Black Voice Fdn1590 Waterman Ave
San Bernardino,CA92404 		33-0470176 501(c)(3) 9,411       Chronic Illness Prevention
(83) Borrego Community Health Fdn4343 Yaqui Pass
Rd
Borrego Springs,CA92004 		33-0440021 501(c)(3) 89,910       BCHF Patient Program
(84) BOSTON Univ85 E Newton St
Boston,MA02118 		04-2103547 501(c)(3) 146,814       Pass Through from Northern California region for v
(85) Boys & Girls Club of Fontana7723 Almeria Ave
Fontana,CA92336 		33-0443344 501(c)(3) 10,000       Healthy Habits
(86) Boys & Girls Club of Redlands Inc1251 Clay St
Redlands,CA92374 		95-6187083 501(c)(3) 10,000       RBI Triple Play
(87) Boys & Girls Club of the West Valley7245 Remmet St
Canoga Park,CA91303 		95-4419365 501(c)(3) 10,000       Healthy Habits
(88) Boys & Girls Club of Tracy753 W Lowell Ave
Tracy,CA95376 		68-0028682 501(c)(3) 50,000       Triple Play Healthy Youth
(89) Boys & Girls Club of Whittier Inc7905 S Greenleaf Ave
Whittier,CA90602 		95-6151763 501(c)(3) 10,450       Healthy Habits Program
(90) Boys & Girls Club West San Gabriel Valley328 S Ramona Ave
Monterey Park,CA91754 		95-2782501 501(c)(3) 20,000       HEALTHY CHOICES'
(91) Boys & Girls Clubs North San Mateo County201 W Orange Ave
S San Francisco,CA94080 		94-1497000 501(c)(3) 30,000       Triple Play Mind, Body, Soul
(92) Boys & Girls Clubs of Fresno County540 N Augusta St
Fresno,CA93701 		94-1149171 501(c)(3) 34,500       Kids Connection to Community Health
(93) Boys & Girls Clubs of Greater San Diego4635 Clairemont Mesa Bl
San Diego,CA92117 		95-1865988 501(c)(3) 10,000       Planet Health
(94) Boys & Girls Clubs of Kern County801 Niles St
Bakersifeld,CA93305 		95-2462246 501(c)(3) 20,000       RBI Triple Play
(95) Boys & Girls Clubs of San Francisco55 Hawthorne St-600
San Francisco,CA94105 		94-1156608 501(c)(3) 10,000       Power Snack & Play
(96) Boys 2 Men Fdn7170 N San Pablo Ave
Fresno,CA93650 		77-0549776 501(c)(3) 6,012       ZumbAtomic Fitness for Kids
(97) Boys and Girls Club of Greater Sacramento5212 Lemon Hill Ave
Sacramento,CA95824 		68-0338324 501(c)(3) 59,569       Sponsor a Kid
(98) Boys and Girls Club of Santa Clara ValleyPO Box 152
Santa Paula,CA93061 		95-2497853 501(c)(3) 20,000       One Step Adelante!
(99) Boys and Girls Club of the Coastside600 Church St
Half Moon Bay,CA94019 		94-3193725 501(c)(3) 9,500       Healthy Eating Active Training, H.E.A.T
(100) Boys and Girls Clubs of Anaheim Inc311 E Broadway
Anaheim,CA92805 		33-0356284 501(c)(3) 35,000       Motel Outreach Program
(101) Boys and Girls Clubs of Carson1950 E 220th St-102
Carson,CA90810 		33-0475452 501(c)(3) 10,000       Achieve In Middle Sch
(102) BRANDEIS Univ415 South St
Waltham,MA02454 		04-2103552 501(c)(3) 16,226       Pass Through from Northern California region for v
(103) Breaking Barriers2210 21st St
Sacramento,CA95818 		68-0456738 501(c)(3) 8,000       HIV/STD Field Based Testing
(104) Breast Cancer Connections390 Cambridge Ave
Palo Alto,CA94306 		77-0417605 501(c)(3) 25,000       The Gabriella Patser Program
(105) Breast Cancer Emergency Fund12 Grace St-300
San Francisco,CA94103 		20-3203899 501(c)(3) 18,750       This Old Bag
(106) Breathe Calif of Sacramento-Emigrant Trails909 12th St-100
Sacramento,CA95814 		94-1641240 501(c)(3) 20,000       Asthma Education and iPhone Application
(107) Breathe California of the Bay Area1469 Park Ave
San Jose,CA95126 		94-1156307 501(c)(3) 18,600       Smoking Cessation Resource Network & Trainings
(108) Buddhist Tzu Chi Medical Fdn7421 N Maple Ave
Fresno,CA93720 		95-4457939 501(c)(3) 70,000       Tzu Chi Medical Outreach/Mobile Clinic
(109) Buddhist Tzu Chi Medical Fdn1000 S Garfield Ave
Alhambra,CA91801 		95-4457939 501(c)(3) 15,000       Oral Health Access Prog
(110) Building a Generation932 W Cypress St
Redlands,CA92373 		54-2104001 501(c)(3) 15,000       Family Mental Health
(111) CSULA Auxiliary Services Inc5151 State University
Dr
Los Angeles,CA90032 		95-4016653 501(c)(3) 28,160       Annual Awards
(112) CA Academy of Family Physicians Fdn1520 Pacific Ave
San Francisco,CA94109 		94-2938597 501(c)(3) 25,000       Family Medicine Summit
(113) CA Center For Public Health Advocacy1947 Galileo Ct-101
Davis,CA95618 		95-4723901 501(c)(3) 129,359       Annual Awards
(114) CA Institute for Nursing and Health Care663 13th St-300
Oakland,CA94612 		82-0570413 501(c)(3) 125,000       ADN to BSN Education
(115) Cal State Bakersfield Fdn9001 Stockdale Hwy
Bakersfield,CA93311 		95-2643086 501(c)(3) 20,000       Preventive Health
(116) California Academy Family Physicians Fdtn1520 Pacific Ave
San Francisco,CA94109 		94-2938597 501(c)(3) 25,000       Family Medicine Summer and Student Conference (Sta
(117) California Assoc of Food Banks1624 Franklin St-722
Oakland,CA94612 		68-0392816 501(c)(3) 100,000       Better Nutrition through Food Banking: Healthy Ea
(118) California Assoc of Food Banks1624 Franklin St-722
Oakland,CA94612 		68-0392816 501(c)(3) 200,000       Better Nutrition
(119) California Black Health Network1112 I St-110
Sacramento,CA95814 		95-3794688 501(c)(3) 150,000       Capacity Building & Core Operating Funding For Adv
(120) California Black Women's Health Project101 N La Brea Ave-610
Inglewood,CA90301 		95-4702923 501(c)(3) 16,800       Awards Gala
(121) California Center1220 H St-102
Sacramento,CA95814 		23-7182049 501(c)(3) 50,000       Youth for Healthy Comm
(122) California Ctr For Public Health Advocacy1947 Galileo Ct-101 Bx2309
Davis,CA95618 		95-4723901 501(c)(3) 41,667       Ca Convergence
(123) California Family Health Council Inc3600 Wilshire Bl 600
Los Angeles,CA90010 		95-2564024 501(c)(3) 230,000       Core Support
(124) California Food Policy Advocates436 14th St-1220
Oakland,CA94612 		94-3163142 501(c)(3) 225,000       Child Nutrition Campaign
(125) California Institute of Integral Studies1453 Mission St
San Francisco,CA94103 		94-2254303 501(c)(3) 7,950       ConverZations that Matter Series
(126) California Pan-Ethnic Health Network654 13th St
Oakland,CA94612 		94-3306223 501(c)(3) 100,000       Achieving Health Equity
(127) California Parenting Institute3650 Standish Ave
Santa Rosa,CA95407 		94-2541640 501(c)(3) 6,600       4-a-Child Benefit
(128) California Primary Care Assoc1231 I St-400
Sacramento,CA95814 		94-3215565 501(c)(3) 321,175       Annual Conference
(129) California School Health Centers Assoc1203 Preservation Park Wy
302
Oakland,CA94612 		94-3201896 501(c)(3) 194,780       Regional Conferences (Oakland and Fresno)
(130) California Teaching Fellows Fdn1177 E Shaw-108
Fresno,CA93710 		20-0359353 501(c)(3) 35,000       Salud es Vida
(131) California WIC Assoc1490 Drew Ave-175
Davis,CA95618 		68-0271696 501(c)(3) 45,000       WIC Reach Partnering for Better Health
(132) California WIC Assoc1490 Drew Ave-175
Davis,CA95618 		68-0271696 501(c)(3) 45,000       WIC REACH Project
(133) Calistoga Family Center Inc1500 Cedar St
Calistoga,CA94515 		80-0023012 501(c)(3) 9,500       Calistoga Student Assistance Program
(134) Camarillo Hospice Corp400 Rosewood Ave 102
Camarillo,CA93010 		95-3347061 501(c)(3) 15,000       Services for Seniors
(135) Camp Laurel Fdn75 S Grand Ave
Pasadena,CA91105 		95-4429260 501(c)(3) 13,000       HIV/AIDS Youth Program
(136) Canal Alliance91 Larkspur St
San Rafael,CA94901 		94-2832648 501(c)(3) 12,500       Community Giving Award on behalf of Marin Sonoma S
(137) CANCER PREVENTION INSTITUTE OF CALIFORNIA2201 Walnut Ave
Fremont,CA94538 		23-7427232 501(c)(3) 62,795       Pass Through from Northern California region for v
(138) Cancer Support Community Pasadena200 E Del Mar Blvd 118
Pasadena,CA91105 		95-4201985 501(c)(3) 25,000       Esperanza Gala
(139) Cangress530 S Main St
Los Angeles,CA90013 		02-0661629 501(c)(3) 6,000       Education Project
(140) Carousel Ranch Inc34289 Rockinghorse
Rd
Santa Clarita,CA91390 		95-4646461 501(c)(3) 9,375       Special Needs Children
(141) Catalyst Fdtn for Aids Awareness and Care44758 Elm Ave
Lancaster,CA93534 		77-0357456 501(c)(3) 275,000       ACE Medical Care
(142) Catholic Charities CYO Archiocese SFO180 Howard St-100
San Francisco,CA94105 		94-1498472 501(c)(3) 5,250       Loaves & Fishes Event
(143) Catholic Charities of Diocese of Stockton400 12th St-4
Modesto,CA95354 		94-1629114 501(c)(3) 50,000       Children's Health Initiative
(144) Catholic Charities of the Diocese of OAK433 Jefferson St
Oakland,CA94607 		94-2677202 501(c)(3) 19,719       Men's Pillar Project
(145) Catholic Charities SBRiverside1450 N D St
San Bernardino,CA92405 		95-3516461 501(c)(3) 17,000       HOPE in the City Project
(146) Center for Community Health & Well-Being1900 T St
Sacramento,CA95811 		68-0248303 501(c)(3) 15,000       The Birthing Project Clinic
(147) Center for Community Solutions4508 Mission Bay Dr
San Diego,CA92109 		95-6379598 501(c)(3) 17,500       Healthy Education
(148) Center for Domestic Peace734 A St
San Rafael,CA94901 		94-2415856 501(c)(3) 10,000       Domestic Violence Safety Net Services
(149) Center for Health Policy Development10 Free St 2nd Flr
Portland,ME04101 		52-1576801 501(c)(3) 75,411       Symposium on Policy
(150) Center for Human Development391 Taylor Blvd-120
Pleasant Hill,CA94523 		94-2520840 501(c)(3) 17,200       Bay Point Partnership's Eighth Annual 'Unity in Co
(151) Center for Multicultural Cooperation1331 Garden Hwy
Sacramento,CA95833 		77-0305544 501(c)(3) 7,500       Hmong Cultural Talent Program
(152) Center For The Partially Sighted6101 W Centinela Ave
150
Culver City,CA90027 		95-3771974 501(c)(3) 27,000       Visually Impaired Adults
(153) Centinela Youth Services Inc11539 Hawthorne Blvd 5
FL
Hawthorne,CA90250 		95-3821576 501(c)(3) 15,000       STARS Club
(154) Central City Community Health Center5233 E Beverly Blvd
Los Angeles,CA90022 		95-4492570 501(c)(3) 90,000       Health Care Services
(155) Central City Concern Inc232 NW Sixth Ave
Portland,OR97209 		93-0728816 501(c)(3) 20,000       Self-sufficiency through employment. EMPLOYEE SPON
(156) Central Coast Alliance United2021 Sperry Ave-18
Ventura,CA93003 		77-0578864 501(c)(3) 25,000       Growing Poder Project
(157) Central Valley Health Network Inc2000 O St-100
Sacramento,CA95811 		68-0429643 501(c)(3) 300,000       Consortia Core Operations
(158) Centro Binacional para Desarrollo Indigena744 N Abby St
Fresno,CA93701 		77-0337939 501(c)(3) 35,000       Promotores Health Network
(159) Centro de Salud La Comunidad4004 Beyer Blvd
San Ysidro,CA92173 		95-2801772 501(c)(3) 25,000       Uninsured Patient Fund'
(160) Cesar Chavez Fdn316 W 2nd St-600
Los Angeles,CA90012 		95-2466747 501(c)(3) 9,150       'Yes We Can' Awards
(161) Chabot College Fdn249 W Jackson St-455
Hayward,CA94545 		20-0027721 501(c)(3) 25,000       SouLeadership
(162) Child & Family Center21545 Centre Pointe
Parkway
Santa Clarita,CA91350 		95-3941342 501(c)(3) 20,000       Health Prevention
(163) Child Care Coordin Council-San Mateo Co2121 S El Camino Real-A-100
A-100
San Mateo,CA94403 		94-2226587 501(c)(3) 15,000       AmeriCorps Healthy Habits Program
(164) Childhood Matters221 Oak St-B
Oakland,CA94607 		26-0098527 501(c)(3) 42,500       Annual Gala
(165) Children Now1212 Broadway 5th Fl
Oakland,CA94612 		94-3059243 501(c)(3) 25,000       Core operating support
(166) Children's Cancer Assoc433 NW 4th Ave-100
Portland,OR97209 		93-1181662 501(c)(3) 15,000       LifeSupport and Family Enrichment Program EMPLOYEE
(167) Childrens Dental Fdn455 E Columbia St
Long Beach,CA90806 		95-2111124 501(c)(3) 25,000       Dental Treatment
(168) Childrens Garden Fdn208 W Bluff Ave
Fresno,CA93711 		77-0550161 501(c)(3) 10,000       Service Award Grant
(169) Children's Hospital & Research Center Fdtn2201 Broadway-600
Oakland,CA94612 		94-1657474 501(c)(3) 15,000       Healthy Hearts: Childhood Obesity Prevention
(170) Children's Nurturing Project490 Chadbourne Road-A
Fairfield,CA94534 		72-1553818 501(c)(3) 15,000       Solano Baby Coach Program
(171) Chinatown Service Center767 N Hills St-400
Los Angeles,CA90012 		95-2918844 501(c)(3) 9,387       40th Gala Celebration
(172) Christie's Place Inc2440 Third Ave
San Diego,CA92101 		91-1878632 501(c)(3) 10,000       Women Project
(173) CHT Resource Group614 Grand Ave 400
Oakland,CA94610 		93-1220473 501(c)(3) 10,000       Parents for Teen Sexual Health
(174) Citrus Heights Womens Center6060 Sunrise Vista
Drive 2340
Citrus Heights,CA95610 		68-0457704 501(c)(3) 10,000       Family Care Center
(175) City of Chula Vista276 Fourth Ave
Chula Vista,CA91911 		95-6000690 Government 50,000       Swim Program
(176) City of Damascus19920 SE Hwy 212
Damascus,OR97089 		20-1886926 Government 52,500       Edible Community: The Healthy Damascus Food Plan
(177) City of Fontana16860 Valencia Ave
Fontana,CA92335 		95-6004770 Government 10,000       Healthy Fontana Nights
(178) City of Fremont3300 Capitol Ave-B
Fremont,CA94538 		94-6027361 Government 40,000       Parent Project Outeach
(179) City of Fresno2326 Fresno St-101
Fresno,CA93721 		94-6000338 Government 13,500       Af-School Programming at Quigley Park
(180) City of LA Dept of Recreation and Parks221 N Figueroa St
1550
Los Angeles,CA90012 		95-6000735 Government 265,000       Operation Splash Program
(181) City of LB Dept of Human Svcs2525 Grand Ave
Long Beach,CA90815 		95-6000733 Government 20,000       Store Partnership Project
(182) City of Livermore1052 S Livermore Ave
Livermore,CA94568 		94-6000359 Government 15,000       Cooking Together
(183) City of Montclair5111 Benito St
Montclair,CA91763 		95-6005731 Government 10,000       Gateway to Coverage
(184) City of Oakland250 Frank Ogawa Plaza
3315
Oakland,CA94612 		94-6000384 Government 25,000       Oakland Mayor's Summer Jobs Program
(185) City of Pasadena - Public Health Dept1845 N Fair Oaks Ave
2408
Pasadena,CA91103 		95-6000759 Government 200,000       underserved community
(186) City of Portland1120 SW Fifth Ave
Portland,OR97204 		93-6002236 Government 47,000       Ten Toes
(187) City of Rancho Cucamonga10500 Civic Ctr
Dr
Rancho Cucamonga,CA91730 		95-3213002 Government 15,000       Fun on the Run
(188) City of Riverside3900 Main St
Riverside,CA92522 		95-6000769 Government 55,000       Splash Program
(189) City of San Bernardino1350 S E St
San Bernardino,CA92408 		95-6000772 Government 40,000       Learn-to-Swim
(190) City of San Diego202 C St MF 37C
San Diego,CA92101 		95-6000776 Government 11,000       Therapeutic Services
(191) City of San Fernando117 Macneil St
San Fernando,CA91340 		95-6000779 Government 20,000       HEALTHY FAMILIES
(192) City of Union City34009 Alvarado-Niles
Rd
Union City,CA94587 		94-6036941 Government 12,500       Teen & Kid Fit Camps
(193) City of Ventura501 Poli St
Ventura,CA93002 		95-6000807 Government 30,000       Operation Splash Program
(194) City of Victorville14343 Civic Dr
Victorville,CA92392 		95-2235918 Government 10,000       Prescription Play Prog
(195) City of Whittier13230 Penn St
Whittier,CA90602 		95-6000812 Government 15,250       Ca Healthy Cities
(196) Clara's House3319 J St
Sacramento,CA95816 		61-1591265 501(c)(3) 15,000       Safety Net Clinic
(197) Clark County Public HealthPO Box 9825
Vancouver,WA98666 		91-6001290 Government 60,000       Increasing, Supporting and Promoting Healthy Food
(198) Clinica Sierra Vista1430 Truxtun Ave-4 Fl
Bakersfield,CA93302 		95-2707101 501(c)(3) 39,500       Homeless Access Proj
(199) Clinicas de Salud Del Pueblo Inc1166 K St
Brawley,CA92227 		95-2657324 501(c)(3) 25,000       Clinicas ACCESS Proj
(200) Coachella Valley Volunteers in Medicine81-880 Dr Carreon Bl B-103
Indio,CA92201 		26-3312826 501(c)(3) 20,000       Staff Development
(201) Coalition for a Livable Future107 SE Washington St-239
Portland,OR97214 		93-1278845 501(c)(3) 9,000       Climate Justice: Healthy People, Healthy Places,
(202) Coalition for Humane Immigrant Rights of LA2533 W Third St-101
Los Angeles,CA90057 		95-4421521 501(c)(3) 10,158       25th Anniversary Gala
(203) Coalition of Community Health Clinics619 SW 11th Ave
Portland,OR97205 		91-1829239 501(c)(3) 9,750       Strengthening Community Sponsored Clinics to Prepa
(204) Coalition of OC Community Clinics17701 Cowan Ave-220
Irvine,CA92614 		95-2900725 501(c)(3) 165,000       OC Health Centers
(205) Coastal Health Alliance65 3rd St-22910
Pt Reyes Station,CA94956 		68-0172541 501(c)(3) 20,000       Expanding Access Thru Application Assistance
(206) Coastside Adult Day Health Center645 Correas St
Half Moon Bay,CA94019 		94-2935784 501(c)(3) 10,000       Aging with Love and Support'
(207) Collective Roots Garden Project1785 Woodland Av
East Palo Alto,CA94303 		71-0901459 501(c)(3) 10,000       Nutrition Education Initiative
(208) Comm Action Partnership of San Bern Cty696 S Tippecanoe
Ave
San Bernardino,CA92415 		95-2376882 501(c)(3) 40,000       Healthy Eating
(209) CommuniCare Health Centers2051 John Jones Rd
Davis,CA95616 		94-2188574 501(c)(3) 30,000       Pediatric Immunization Program
(210) Community Action Organization1001 SW Baseline St
Hillsboro,OR97123 		93-0554941 501(c)(3) 20,000       Opening Doors - program support to low-income preg
(211) Community Action Partnership of Kern300 19th St
Bakersfield,CA93301 		95-2402760 501(c)(3) 85,000       Teen Pregnancy Program
(212) Community Agencies for Caring Connections16703 S Clark Ave
Bellflower,CA90706 		33-0953881 501(c)(3) 9,500       Caring Connections
(213) Community Alliance with Family Farmers Fdtn36355 Russell Blvd
Davis,CA95616 		94-2914745 501(c)(3) 89,417       Farm to School in Gilroy Unified School District
(214) Community Chaplaincy7812 El Reno Ave
Elverta,CA95626 		20-0241444 501(c)(3) 15,000       Volunteer academies
(215) Community Child Care Coord Council Alameda22351 City Center Dr-100
Hayward,CA94541 		23-7218859 501(c)(3) 41,500       Children's Fair
(216) Community Clinic Assoc of LA County1055 Wilshire Bl-1400
Los Angeles,CA90017 		95-4576023 501(c)(3) 437,388       Policy Cafe Quarterly
(217) Community Clinic Consortium3720 Barrett Ave
Richmond,CA94805 		20-0782029 501(c)(3) 162,000       National Health Center Week Community Clinic Staff
(218) Community Clinics Health Network7535 Metropolitan Dr
San Diego,CA92108 		33-0759107 501(c)(3) 240,000       2009 KP QI Initiative
(219) Community Coalition For Substance Abuse8101 S Vermont Ave
Los Angeles,CA90044 		95-4298811 501(c)(3) 10,000       12th Annual Gala
(220) Community Connect2060 University Ave-212
Riverside,CA92507 		95-2287250 501(c)(3) 95,000       Nonprofit Capacity Proj
(221) Community Development Commission2 Coral Circle
Monterey Park,CA91755 		95-3777596 Government 10,500       The Heart Education
(222) Community Family Guidance Center10929 South St-208B
Cerritos,CA90703 		95-3083776 501(c)(3) 17,500       Positive Parenting
(223) Community Health Alliance of Pasadena1855 N Fair Oaks Ave-200
Pasadena,CA91103 		95-4536824 501(c)(3) 9,100       2011 Annual Gala
(224) Community Health Clinic Ole1370 Trancas St 524
Napa,CA94558 		23-7221695 501(c)(3) 30,000       Bi-National Health Fair
(225) Community Health Councils Inc3731 Stocker St-201
Los Angeles,CA90008 		95-4487664 501(c)(3) 340,533       Heroes Celebration
(226) Community Health Improvement Partners9370 Chesapeake Dr-220
San Diego,CA92123 		33-0496092 501(c)(3) 110,500       Empowering Seniors
(227) Community Health Partnership Santa Clara Co100 N Winchester Blvd
250
Santa Clara,CA95050 		77-0352645 501(c)(3) 157,000       Consortia Enrollment and Retention Project
(228) Community Health Systems Inc22675 Alessandro Bl
Moreno Valley,CA92553 		33-0056551 501(c)(3) 35,000       Health Center
(229) Community Initiatives354 Pine St-700
San Francisco,CA94104 		94-3255070 501(c)(3) 17,500       Youth Voice: Obesity/Overweight Prevention
(230) Community Medical Centers Inc7210 Murray Dr
Stockton,CA95210 		94-2437106 501(c)(3) 174,801       Commit to Be Fit
(231) Community Partners1000 N Alameda St-240
Los Angeles,CA90012 		95-4302067 501(c)(3) 49,931       Specialty Care Initiative Technical Assistance Family effectiveness
(232) Community Partners1000 N Alameda St-240
Los Angeles,CA90012 		95-4302067 501(c)(3) 1,390,000       Growing Up Healthy
(233) Community Partnership Families San Joaquin4707 Kentfield Road-C
Stockton,CA95207 		68-0475602 501(c)(3) 62,464       Family Stability, Engagement and Involvement
(234) Community Pride Project3101 1st Ave
Sacramento,CA95817 		20-0364162 501(c)(3) 26,740       Healthcare Access and Education Program
(235) Community Resources for Independent Living439 A St
Hayward,CA94541 		94-2598873 501(c)(3) 12,000       Health Cooking for Healthy Living
(236) Community Settlement Assoc of Riverside4366 Bermuda Ave
Riverside,CA92507 		95-0642985 501(c)(3) 25,000       Family Effectiveness
(237) Comprehensive Options for Drug Abusers Inc1027 E Burnside
Portland,OR97214 		93-0716860 501(c)(3) 15,000       Stepping Stones Community Outreach Project General
(238) Comprehensive Youth Svcs of Fresno3795 E Shields Ave
Fresno,CA93726 		94-2219412 501(c)(3) 35,000       Steinbeck Elementary Student Assistance Program
(239) Concord Comm Economic Development Org2699 Monument Blvd-G
Concord,CA94520 		94-3370919 501(c)(3) 18,499       Sponsorship of Merger Consultation (Phase 1)
(240) Conejo Free Clinic80 E Hillcre Dr-102
Thousand Oaks,CA91360 		95-3177953 501(c)(3) 20,000       Free Clinic Services
(241) Congregations Organizing for Renewal22634 Second St-209
Hayward,CA94541 		94-3282881 501(c)(3) 50,000       School and Neighbor hood Based Violence Prevention
(242) Continuing Development Inc111 N Market St 500
San Jose,CA95113 		94-2376637 501(c)(3) 35,000       5 Keys-Obesity Prevention Behaviors
(243) Contra Costa Child Care Council1035 Detroit Ave 200
Concord,CA94518 		94-2383037 501(c)(3) 80,000       Healthy & Active Before 5
(244) Contra Costa County597 Center Ave 125
Martinez,CA94553 		94-6000509 Government 140,000       Project Hope Phase 2
(245) Contra Costa County Office of Education77 Santa Barbara Rd
Pleasant Hill,CA94523 		94-2675635 Government 20,000       Community Challenge
(246) Contra Costa Crisis CenterPO BOX 3364
Walnut Creek,CA94598 		94-1747227 501(c)(3) 50,000       211 Contra Costa
(247) Contra Costa InterFaith Sponsor Committee684 Juliga Woods St
Richmond,CA94804 		68-0361176 501(c)(3) 12,050       Community health and wellness project programs
(248) Cope Family Center1340 Fourth St
Napa,CA94559 		94-2322399 501(c)(3) 20,000       Home Visitation Program
(249) CORA Comm Overcoming Relationship Abuse1633 Bayshore Hwy-280
Burlingame,CA94010 		94-2481188 501(c)(3) 45,190       Spring Awakening Event
(250) CORO Northern California Inc601 Montgomery St
800
San Francisco,CA94111 		94-3117758 501(c)(3) 39,250       Leadership Luncheon and Board Involvement (J Nudel
(251) Coro Southern California Inc1000 N Alameda St-240
Los Angeles,CA90012 		95-4274561 501(c)(3) 9,870       Crystal Eagle Awards
(252) Corona-Norco Unified School District2820 Clark Ave-E
Norco,CA92860 		33-0277305 Government 25,000       Project INSURE
(253) Council of Community Clinics7535 Metropolitan Dr
San Diego,CA92108 		95-3008850 501(c)(3) 300,000       Specialty Care Initiative
(254) Council Of OC Society Of St Vincent De Paul8014 Marine Way
Irvine,CA92618 		95-3033494 501(c)(3) 95,000       Healthy Homes Initiative
(255) Council on Aging Svcs for Seniors30 Kawana Springs Road
Santa Rosa,CA95404 		94-6138714 501(c)(3) 27,500       Meals on Wheels
(256) County of Kern1700 Mount Vernon Ave
Bakersfield,CA93305 		95-6000925 Government 300,000       Specialty Care Initiative
(257) County of Los Angeles313 N Figueroa St-806
Los Angeles,CA90012 		95-6000927 Government 102,726       Child Obesity Prog
(258) County of Madera14215 Road 28
Madera,CA93638 		94-6000518 Government 35,000       Managing Asthma Triggers at Home
(259) County of Orange - Social Services Agency888 N Main St
Santa Ana,CA92701 		95-6000928 Government 75,000       Healthy Eating
(260) County of Riverside26520 Cactus Ave
Moreno Valley,CA92555 		95-6000930 Government 125,000       Project ALL Program
(261) County of San Mateo701 Gateway Blvd
400
S San Francisco,CA94080 		94-6000532 Government 20,000       Children's Health Initiative
(262) County of Solano355 Tuolumne St MS 20-210
Vallejo,CA94590 		94-6000538 Government 20,000       Napa/Solano HIV Mobile Testing Project
(263) County of Solano355 Tuolumne St MS 20-210
Vallejo,CA94590 		94-6000538 Government 20,000       Solano County Dental Van
(264) County of Sonoma Dept of Health Svcs490 Mendocino Ave-202
Santa Rosa,CA95404 		94-6000539 Government 20,000       Sonoma Safe Routes to School
(265) County of Ventura2323 Knoll Dr
Ventura,CA93003 		95-6000944 Government 300,000       Specialty Care Initiative
(266) County of Yolo226 Buckeye St
Woodland,CA95695 		94-6000548 Government 50,000       211 Yolo
(267) Court Appointed Special Advocate1615 E 17th St-100
Santa Ana,CA92705 		33-0069334 501(c)(3) 15,850       Holiday Gala
(268) Court Appointed Special Advocate Assoc660 13th St-300
Oakland,CA94612 		68-0163010 501(c)(3) 65,000       CASA Youth Wellness Initiative
(269) Court Appointed Special Advocates1252 Fulton Mall
Fresno,CA93721 		77-0401361 501(c)(3) 15,000       Advocating for Healthy Foster Youth
(270) Cover The Homeless Ministry1332 S Orange Dr
Los Angeles,CA90019 		91-2094255 501(c)(3) 6,000       Medical Fair
(271) Crystal Stairs Inc5110 W Goldleaf Cir
150
Los Angeles,CA90056 		95-3510046 501(c)(3) 15,000       Access to Health
(272) CSU Northridge Fdn18111 Nordhoff St
Northridge,CA91330 		95-6196006 501(c)(3) 38,500       Parcourse at CSUN
(273) Daly City Peninsula Partnership Collabor111 Lake Merced Blvd
Daly City,CA94015 		06-1734338 501(c)(3) 30,500       Healthy Aging Response Team
(274) Darin M Camarena Health Centers Inc344 E Sixth St
Madera,CA93638 		94-2503904 501(c)(3) 35,000       Scholarship Fundraiser
(275) Desarollo Familiar205 39th St
Richmond,CA94806 		94-2751073 501(c)(3) 32,000       Familias' Wellness Program
(276) Desert AIDS Project1695 N Sunrise Way
Palm Springs,CA92262 		33-0068583 501(c)(3) 20,000       Mental Health Services
(277) Desert Recreation District45-305 Oasis St
Indio,CA92201 		33-0076473 Government 50,000       Operation Splash Program
(278) Destiny Arts Center1000 42nd St
Oakland,CA94608 		94-3176726 501(c)(3) 12,250       Annual Friendraiser
(279) Dixon Family Services155 N Second St
Dixon,CA95620 		68-0041829 501(c)(3) 20,000       Mental Health Continuum of Care
(280) Dixon Unified School District180 S First St 6
Dixon,CA95620 		32-0183755 Government 18,000       Health Access /Oral Health Improvement
(281) Doctors Without Borders Usa Inc333 7th Ave 2nd Flr
New York,NY10001 		13-3433452 501(c)(3) 100,000       Medical Relief
(282) Donald P McCullum Youth Court285 Seventeenth St
Oakland,CA94612 		94-3187729 501(c)(3) 5,500       The Law & Justice Summer Leadership Program
(283) Downey Unified School District13220 Bellflower Blvd
Downey,CA90242 		95-6006586 Government 25,000       TLC Open House
(284) Dr Ernest And Arthella Hunter FdnPO Box 3431
Rancho Cordova,CA95741 		27-0718721 501(c)(3) 10,000       Service Award Grant
(285) Dunwoody United Methodist Church Inc1548 Mt Vernon Rd
Dunwoody,GA30338 		58-1994231 501(c)(3) 6,250       Charitable donation - Board matching gift program
(286) E San Gabriel Vly Coalition for Homeless1345 Turnbull Cyn
Rd
Hacienda Hghts,CA91745 		95-4508436 501(c)(3) 16,000       Homeless Assistance
(287) Early Childhood Mental Health Program4101 Macdonald Ave
Richmond,CA94805 		94-2883469 501(c)(3) 20,000       Los Buenos Padres (Good Parents)
(288) East Bay Agency for Children303 Van Buren Ave
Oakland,CA94610 		94-1358309 501(c)(3) 132,200       Heart & Soul event
(289) East Bay Community Fdn200 Frank H Ogawa Plaza
Oakland,CA94612 		94-6070996 501(c)(3) 113,000       New Beginnings Fresh Start Caf Business Plan
(290) East Bay Spanish Speaking Citizens' Fdtn1470 Fruitvale Ave
Oakland,CA94601 		94-1628221 501(c)(3) 20,000       LIBRE
(291) East Bay Zoological Society9777 Golf Links Road
Oakland,CA94605 		94-1687847 501(c)(3) 10,000       Celebration and Career Fair
(292) East County Faith Based Subcommittee4549 Delta Fair Blvd
Antioch,CA94509 		20-8682635 501(c)(3) 10,000       Kitchen Starters and Food Boxes
(293) East County Kids-N-Motion3444 Chandler Circle
Bay Point,CA94565 		41-2207708 501(c)(3) 6,000       East County Kids N Motion
(294) East Los Angeles Women's Center1255 S Atlantic Blvd
Los Angeles,CA90022 		51-0204577 501(c)(3) 7,000       Promotoras en Accion
(295) East Valley Community Health Center420 S Glendora Ave
West Covina,CA91790 		23-7068586 501(c)(3) 434,000       Annual Fundraising Gala
(296) Ecotrust721 NW Ninth Ave-200
Portland,OR97209 		93-1050144 501(c)(3) 57,020       Healthy Food for Northwestern Oregon and Southwest
(297) Ecumenical Ministries of Oregon0245 SW Bancroft St-B
Portland,OR97239 		93-0625359 501(c)(3) 20,000       Support collaborative community actions to increas
(298) Eden I&R Inc570 B St
Hayward,CA94541 		94-2339050 501(c)(3) 60,000       Health Education Referrals Through 2-1-1
(299) Eden Youth & Family Center680 W Tennyson Road
Hayward,CA94544 		94-2442586 501(c)(3) 31,400       You Gotta Have Heart
(300) El Centrito Family Learning Centers450 S K St Rm111
Oxnard,CA93030 		31-1652255 501(c)(3) 20,000       Education Project
(301) El Centro de Accion Social37 E Del Mar Blvd
Pasadena,CA91105 		51-0192257 501(c)(3) 7,050       2011 Annual Gala
(302) El Centro de Libertad1230 Hopkins-500
Redwood City,CA94062 		94-3189174 501(c)(3) 15,000       Youth Intervention Program
(303) El Centro Del Pueblo1157 Lemoyne St
Los Angeles,CA90026 		95-3187780 501(c)(3) 8,000       Knockout Workout
(304) El Concilio of San Mateo County1419 Burlingame Ave-N
Burlingame,CA94010 		94-2772110 501(c)(3) 15,000       Pediatric Obesity Program
(305) El Nido Family Centers10200 Sepulveda Bl
350
Mission Hills,CA91345 		95-3186429 501(c)(3) 10,000       Visiting Nurse Program
(306) El Proyecto del Barrio Fdn8902 Woodman Ave
Arleta,CA91331 		81-0642941 501(c)(3) 8,250       Annual Awards
(307) El Sol Neighborhood Educational Center1717 W 5th St
San Bernardino,CA92401 		33-0552297 501(c)(3) 25,000       Nutrition Education
(308) El Viento Fdn15744 Goldenwest
St
Huntington Beach,CA92647 		33-0905269 501(c)(3) 10,000       Healthful Living
(309) Elk Grove Food Bank Services9820 Dino Dr-140
Elk Grove,CA95624 		38-3664737 501(c)(3) 15,000       Healthy and Active Elk Grove
(310) Elk Grove Unified School District6300 Ehrhardt Ave
Sacramento,CA95823 		94-6002501 Government 44,605       Fifth Annual Health and Fitness Expo
(311) Emergency Food Bank7 W Scotts Ave
Stockton,CA95203 		68-0002165 501(c)(3) 34,611       Mobile Farmer's Market Program
(312) Emergency Shelter Program Inc1180 B St
Hayward,CA94541 		94-2212241 501(c)(3) 26,500       Community Giving on behalf of Greater South Alamed
(313) Emery Education Fdn4727 San Pablo Ave
Emeryville,CA94608 		94-3248242 501(c)(3) 20,000       Smart Choices for Healthy Living
(314) Exceptional Parents Unlimited Inc4440 N First St
Fresno,CA93726 		77-0263702 501(c)(3) 75,000       Strengthening Support for Vulnerable Families
(315) FUN Club Program of Manteca314 Locust Ave
Manteca,CA95337 		26-4698800 501(c)(3) 6,000       FUN Club Program of Manteca
(316) Fairfield Police Activities League Inc250 Travis Blvd
Fairfield,CA94533 		26-1184406 Government 20,000       The Biggest Winner
(317) Fairfield-Suisun Community Action Council416 Union Ave
Fairfield,CA94533 		68-0041385 501(c)(3) 30,000       Interim Care Progam Solano County
(318) Families First Inc251 Llewellyn Ave
Campbell,CA95008 		94-2295953 501(c)(3) 10,000       Yolo Crisis Nursery
(319) Families Forward9221 Irvine Blvd
Irvine,CA92618 		33-0086043 501(c)(3) 25,000       Community Cares Prog
(320) Family Health Care Centers of Greater LA6501 S Garfield Ave
Bell Gardens,CA90201 		95-1641454 501(c)(3) 35,000       New Clinic
(321) Family Health Centers of San Diego823 Gateway Center Way
San Diego,CA92102 		95-2833205 501(c)(3) 40,000       Improving Care
(322) Family Service Agency of San Bernardino1669 N E St
San Bernardino,CA92405 		95-1641436 501(c)(3) 10,000       Educational Services
(323) Family Service Agency of SF1010 Gough St
San Francisco,CA94109 		94-1156530 501(c)(3) 20,000       Healthy Families Healthy Lives/Familias Sanas Vida
(324) Family Service Assoc21250 Box Springs
Rd 212
Moreno Valley,CA92557 		95-1803694 501(c)(3) 20,000       Healthy Families
(325) Family Service Assoc of Redlands612 Lawton St
Redlands,CA92374 		95-1655614 501(c)(3) 15,000       Healthy Kids
(326) Family Violence Law CenterPO Box 22009
Oakland,CA94623 		94-2527939 501(c)(3) 21,900       Stand for Peace Annual Event
(327) Fdn for AIDS Research120 Wall St 13th Fl
New York,NY10005 		13-3163817 501(c)(3) 20,000       San Francisco Fall Event
(328) Fdn for Children's Dental Health Inc27943 Seco Cyn Rd
527
Santa Clarita,CA91350 		95-4416705 501(c)(3) 9,500       Core Operating Support
(329) Feeding America San Diego9455 Waples St-135
San Diego,CA92121 		26-0457477 501(c)(3) 80,000       Healthy Eating
(330) Fighting Back Partnership505 Santa Clara St-3rd Fl
Vallejo,CA94590 		68-0298092 501(c)(3) 20,000       Families And Schools Together Program
(331) Filipino Advocates for Justice310 - 8th St 306
Oakland,CA94607 		94-2218907 501(c)(3) 33,800       eco2: ecofashion meets ecojustice
(332) Folsom Athletic Assoc50 Natoma St
Folsom,CA95630 		94-2835479 501(c)(3) 8,938       Folsom STARS
(333) Food Bank of Contra Costa & Solano4010 Nelson Ave
Concord,CA94520 		94-2418054 501(c)(3) 51,232       Lose a Pound, Lend a Hand
(334) Food In Need of Distribution Inc83775 Citrus Ave
Indio,CA92201 		33-0006007 501(c)(3) 60,000       Healthy Eating
(335) FOOD Inc3403 E Central Ave
Fresno,CA93725 		77-0320851 501(c)(3) 42,500       BackPack Program
(336) FOOD Share Inc4156 Southbank Dr
Oxnard,CA93036 		77-0018162 501(c)(3) 60,000       Healthy Eating
(337) Foothill AIDS Project233 W Harrison Ave
Claremont,CA91711 		33-0341665 501(c)(3) 35,000       Care and Access (CAN)
(338) Foothill Family Service2500 E Foothill Blvd-300
Pasadena,CA91107 		95-1690990 501(c)(3) 10,000       Family Life Program
(339) Foothill Family Shelter Inc1501 W Ninth St-D
Upland,CA91786 		33-0341818 501(c)(3) 15,000       Bright Smiles
(340) Foothill Unity Center415 W Chestnut Ave
Monrovia,CA91016 		95-4310817 501(c)(3) 19,600       Crisis Services
(341) FRED HUTCHINGSON CANCER CENTER1100 Fairview Ave N
Seattle,WA98109 		23-7156071 501(c)(3) 71,289       Pass Through from Northern California region for v
(342) Free Clinic Of Simi Valley2060 Tapo St
Simi Valley,CA93063 		23-7108154 501(c)(3) 17,493       Enhanced Placement
(343) Free Clinic of SW Washington4100 Plomondon St
Vancouver,WA98661 		91-1707542 501(c)(3) 50,000       Capacity building for specialty dental care, denta
(344) Fresno County Office of Education1111 Van Ness Ave
Fresno,CA93721 		94-6002210 Government 28,499       Central Valley Teen Parent Conference
(345) Fresno Healthy Comm Access Partners2043 Divisadero St
Fresno,CA93701 		20-4210175 501(c)(3) 75,000       Outreach Enrollment & Retention Initiative
(346) Fresno Metropolitan Ministry1055 N Van Ness Ave-H
Fresno,CA93728 		94-2181848 501(c)(3) 18,570       Improved school environments through policy
(347) Fresno Rescue Mission310 G St
Fresno,CA93706 		94-1279785 501(c)(3) 28,082       Health and Wellness
(348) Fresno Unified School District2309 Tulare St
Fresno,CA93721 		94-6002206 Government 64,969       Sports and Tdap Vaccine Clinics
(349) Friends For Youth Inc1741 Broadway
Redwood City,CA94402 		94-2961034 501(c)(3) 9,000       Drug and Violence Prevention Project
(350) Friends of Children w Special Needs2300 Peralta Blvd
Fremont,CA94539 		77-0446853 501(c)(3) 10,000       Walk Today Better Life Tomorrow
(351) Friends of Loma Vista Farms150 Rainier Ave
Vallejo,CA94589 		32-0109022 501(c)(3) 7,500       Farm Fresh Learning
(352) Friends of the Los Angeles Free Clinic8405 Beverly Blvd
Los Angeles,CA90048 		95-3433824 501(c)(3) 18,000       35th Annual Gala
(353) Friends of the National Library of Medicine7900 Wisconsin Ave 200
Bethesda,MD20814 		52-1417780 501(c)(3) 150,000       Gift
(354) Friends of the Veterans Memorial Senior Ctr1455 Madison Ave
Redwood City,CA94061 		94-2977907 501(c)(3) 10,000       Adaptive Physical Education Program
(355) Friends of Zenger Farms11741 SE Foster Rd
Portland,OR97266 		93-1269630 501(c)(3) 41,140       Accepting SNAP Funds for CSA Shares
(356) GOALS for Women3356 Adeline St
Berkeley,CA94703 		94-4605707 501(c)(3) 20,000       Transcending Barriers Building Change (TBBC)
(357) Gardner Family Care Corp55 E Julian St
San Jose,CA95112 		23-7153068 501(c)(3) 25,000       Substance Abuse Prevention - Youth
(358) Gardner Family Health Network Inc55 E Julian St
203
San Jose,CA95112 		94-1743078 501(c)(3) 54,500       Silent Heroes Fundraising Gala & Auction
(359) Garfield Health Center210 N Garfield Ave
203
Monterey Park,CA91754 		76-0733752 501(c)(3) 20,000       Health Ins Program
(360) GEISINGER CLINIC100 N Academy Ave
Danville,PA17822 		23-6291113 501(c)(3) 287,164       Pass Through from Northern California region for v
(361) Generations Community Wellness Centers1250 Oakmead Pkwy-109
Sunnyvale,CA94085 		20-0737711 501(c)(3) 41,000       Eat, Play, Love
(362) GEORGETOWN Univ2121 Wisconsin Ave
Washington,DC20007 		53-0196603 501(c)(3) 93,597       Pass Through from Northern California region for v
(363) Gifts to Share co City of Sacramento915 I St 5th Fl
Dr 7A
Sacramento,CA95814 		94-2985546 501(c)(3) 105,500       Outreach Enrollment & Retention Initiative
(364) Gilda's Club of the Desert67-625 E Palm Cyn
Cathedral City,CA92234 		33-0911108 501(c)(3) 10,000       Cancer Program
(365) Girl Scouts of Central California South1377 W Shaw Ave
Fresno,CA93711 		94-6000662 501(c)(3) 6,205       Healthy Eating Fit for Life
(366) Girl Scouts of Northern California1310 S Bascom Ave
San Jose,CA95129 		94-1551410 501(c)(3) 25,000       GOT CHOICES
(367) Girls Inc of Alameda County13666 E 14th St
San Leandro,CA94578 		94-1558073 501(c)(3) 31,000       Strong, Smart & Bold Luncheon
(368) Girls Inc of West Contra Costa Co260 Broadway
Richmond,CA94804 		51-0172193 501(c)(3) 20,000       Capacity Building Grant Fund Developer
(369) Girls Scouts Heart of Central California3621 Forest Glenn Dr
Modesto,CA95355 		94-1582429 501(c)(3) 10,000       Go For It-Day Camp Modesto
(370) Give Every Child A Chance610 Commerce Court
Manteca,CA95336 		68-0399384 501(c)(3) 46,700       Eating Appropriately Teaches Success (EATS)
(371) Glendale Community Free Health Clinic134 N Kenwood St
Glendale,CA91206 		87-0732681 501(c)(3) 9,900       health care to wrking poor
(372) Golden Valley Health Centers737 W Childs
Merced,CA95340 		94-2196086 501(c)(3) 117,562       GVHC, Riverbank Care Access
(373) Gospel Center Rescue Mission Inc445 S San Joaquin St
Stockton,CA95203 		94-1375835 501(c)(3) 50,000       New Life Addiction Treatment Program
(374) Grandparents as Parents Inc22048 Sherman Way-217
Canoga Park,CA91303 		33-0592916 501(c)(3) 10,000       Mental Health Services
(375) GrossCuyamaca Comm Coll Dist Aux Org8800 Grossmont College
Dr
El Cajon,CA92020 		33-0905402 501(c)(3) 63,000       Inroads for Students
(376) GROUP HEALTH COOPERATIVE1730 Minor Ave
Seattle,WA98101 		91-0511770 501(c)(3) 503,670       Pass Through from Northern California region for v
(377) H Street Clinic1329 N H St
San Bernardino,CA92405 		20-8191393 501(c)(3) 15,000       H Street Clinic
(378) Habitat for Humanity International Inc17700 S Figueroa St
Gardena,CA90248 		33-0416470 501(c)(3) 9,500       Corporate Build Days
(379) Hamburger Home7120 Franklin Ave
Los Angeles,CA90046 		95-1693616 501(c)(3) 10,000       High-Risk Girls
(380) Hands On Bay Area135 Bluxome St-2 Fl
San Francisco,CA94107 		77-0195144 501(c)(3) 44,000       MLK Day
(381) Hands On New Orleans1050 S Jefferson Davis
Pkwy-203
NewOrleans,LA70125 		26-2281213 501(c)(3) 95,000       HandsOn Programs
(382) Harbor Area Gang Alternatives309 W Opp St
Wilmington,CA90744 		33-0322451 501(c)(3) 15,000       My Gangfree Life Program
(383) Harbor City-Harbor Gateway BoysGirls Club1220 W 256th St
Harbor City,CA90710 		33-0450797 501(c)(3) 10,000       Capacity Building
(384) Harbor Free Clinic Inc593 W 6th St
San Pedro,CA90731 		23-7103245 501(c)(3) 20,000       Expanded Main Clinic
(385) Harm Reduction Services4001 12th Ave
Sacramento,CA95817 		68-0300656 501(c)(3) 14,000       Health Service Outreach
(386) HARVARD PILGRIM HEALTH CAREPO Box 3672
Boston,MA02241 		04-2452600 501(c)(3) 395,247       Pass Through from Northern California region for v
(387) Hathaway-Sycamores ChildFamily Svs210 S DeLacey Ave-110
Pasadena,CA91105 		95-1691005 501(c)(3) 12,000       Youth Programs
(388) Hawaii COPD Coalition733 Bishop St-1550
Honolulu,HI96813 		35-2328693 501(c)(3) 25,000       Expanded Project SUCCESS: Spirometry-Urged Cessat
(389) Hawthorne School District14120 S Hawthorne Blvd
Hawthorne,CA90250 		95-6001545 Government 8,500       Improving PE Programs
(390) Hayward Unified School District24411 Amador St
Hayward,CA94540 		94-1693499 Government 15,000       Eat Well, Learn Well Club
(391) HC2 The Healthy Community Consortium200 Douglas St
Petaluma,CA94952 		68-0475211 501(c)(3) 15,000       Annual partnership support
(392) Health Care Interpreter Network6400 Hollis St-9
600
Emeryville,CA94608 		26-3075264 501(c)(3) 150,000       Core Support
(393) Health EdCouncil Serving Popultns At Risk3950 Industrial Blvd
600
W Sacramento,CA95691 		68-0249296 501(c)(3) 64,463       HEAL's Charing Forum and Awards Ceremony
(394) Health Initiatives for Youth Inc1550 Market St
San Francisco,CA94102 		94-3162876 501(c)(3) 30,000       Dimensions Clinic Specialized Services for Transge
(395) HEALTH PARTNERS RESEARCHPO Box 1524
Minneapolis,MN55440 		41-1670163 501(c)(3) 498,120       Pass Through from Northern California region for v
(396) Health Research Assoc Inc1640 Marengo St-7 Flr
Los Angeles,CA90033 		95-1683862 501(c)(3) 400,000       Analyst Staff Support
(397) HEALTH RESEARCH INCPO Box 2966
Buffalo,NY14240 		14-1402155 501(c)(3) 368,875       Pass Through from Northern California region for v
(398) Healthcare Fdn of NoCentral CA1215 K St-730
Sacramento,CA95814 		86-1174825 501(c)(3) 54,800       African American Health Disparity Project
(399) Healthy Aging Assoc121 Downey Ave-102
200
Modesto,CA95354 		77-0546574 501(c)(3) 35,000       Young at Heart' Education Outreach
(400) Healthy Smiles for Kids of Orange County10602 Chapman Ave
200
Garden Grove,CA92840 		38-3675065 501(c)(3) 120,000       Pediatric Oral Care
(401) HEAR Center301 E Del Mar Blvd
Pasadena,CA91101 		95-2017214 501(c)(3) 10,000       Free Hearing Program
(402) Heart of Los Angeles Youth Inc2701 Wilshire Blvd
1000
Los Angeles,CA90057 		95-4397418 501(c)(3) 7,000       Family Counseling
(403) Helpline Youth Counseling12440 E Firestone Bl-1000
Norwalk,CA90806 		23-7113824 501(c)(3) 10,000       Youth Services Program
(404) HENRY FORD HEALTH SYSTEM1 Ford Place-5C69
Detroit,MI48202 		38-1357020 501(c)(3) 319,556       Pass Through from Northern California region for v
(405) Herald Christian Health Center923 S San Gabriel Bl
San Gabriel,CA91776 		20-3492620 501(c)(3) 80,000       IMPACT Project
(406) Herald Family Rebuilding Center39155 Liberty St-D450
Fremont,CA94538 		26-1431045 501(c)(3) 12,000       Outshine Your Anger
(407) Hillview Mental Health Center Inc12450 Van Nuys Blvd
Pacoima,CA91331 		95-3928411 501(c)(3) 10,000       Services for young adults
(408) Hispanas Org for Political Equality - Ca634 S Spring St-920
Los Angeles,CA90014 		95-4718409 501(c)(3) 40,000       Youth Leadership
(409) Hispanas Organized Political Equality-CA634 S Spring St-920
Los Angeles,CA90014 		95-4718409 501(c)(3) 10,000       Latinas Action Day (Statewide)
(410) Hispanic Business College Fund Inc1300 L St NW-975
Washington,DC20005 		52-1809680 501(c)(3) 32,000       LA Hispanic Youth
(411) Hispanic College Fund Inc1300 L St NW-975
Washington,DC20005 		52-1809680 501(c)(3) 25,000       Hispanic Youth Symposium - Central Valley/Silicon
(412) Holistic Integrated Services FdnPO Box 2638
Fullerton,CA92837 		95-4680738 501(c)(3) 10,000       Service Award Grant
(413) Hollywood Community Housing Corp5020 Santa Monica Bl
Los Angeles,CA90029 		95-4198215 501(c)(3) 10,000       Supportive Services
(414) Holy Family Day Homes of San Francisco299 Dolores St
San Francisco,CA94103 		94-1156492 501(c)(3) 30,000       Charitable donation - Board matching gift program
(415) Home of Hope Inc190 Tobin Clark Dr
Hillsborough,CA94010 		94-3342348 501(c)(3) 10,000       Service Award Grant
(416) Homeboy Industries130 W Bruno St
Los Angeles,CA90012 		95-4800735 501(c)(3) 10,000       2011 Lo Maximo Awards
(417) Homeless Health Care Los Angeles2330 Beverly Blvd
Los Angeles,CA90057 		95-4074970 501(c)(3) 305,000       Plato De Oro'
(418) House of Ruth IncPO Box 459
Claremont,CA91711 		95-3276033 501(c)(3) 10,000       Child Abuse Program
(419) Housing Authority of the County of Kern601-24th St
Bakersfield,CA93301 		95-6001629 Government 15,000       Kids Beating Obesity
(420) Housing Authority of the Cty of Riverside5555 Arlington Ave
Riverside,CA92504 		95-6001631 Government 20,000       Healthy Lifestyle
(421) Huckleberry Youth Programs Inc3310 Geary Blvd
San Francisco,CA94118 		94-1687559 501(c)(3) 15,000       Community Assessment and Referral Center
(422) Hughson Family Resource Center Inc2413 3rd St
Hughson,CA95326 		87-0729778 501(c)(3) 65,360       Family Wellness and Fitness
(423) Human Options Inc5540 Trabuco Rd-100
Irvine,CA92620 		95-3667817 501(c)(3) 13,000       Annual Awards
(424) Hunger Action Los Angeles961 S Mariposa 205
Los Angeles,CA90006 		20-5142259 501(c)(3) 25,000       Core Support
(425) Hurtt Family Health Clinic IncOne Hope Dr
PMB 41
Tustin,CA92782 		33-0906866 501(c)(3) 14,000       Prescription Program
(426) iCAN Junior Triathlon Club Inc9505 N Sommerville Dr-102
PMB 41
Fresno,CA93720 		26-4149006 501(c)(3) 7,500       Youth Triathtlon and Nutritional Programs
(427) ICF Center For Cross-Border Philanthropy2505 N Ave
National City,CA91950 		26-1640148 501(c)(3) 25,000       Healthy Hands
(428) Imperial Beach Community Clinic949 Palm Ave
Imperial Beach,CA91932 		23-7209592 501(c)(3) 30,000       Health Center
(429) Info Line of San Diego County5251 Viewridge Ct-130
San Diego,CA92123 		33-1029843 501(c)(3) 20,000       2-1-1 Health Program
(430) Inland Counties1737 Atlanta Ave-H5
Riverside,CA92507 		23-7058717 501(c)(3) 25,000       Eating Right
(431) Inland Empire Future Leaders Program5500 University
Parkway
San Bernardino,CA92407 		33-0427435 501(c)(3) 13,150       2011 Youth Conference
(432) Inland Empire United Way9624 Hermosa Ave
Rancho Cucamonga,CA91730 		33-0502676 501(c)(3) 15,000       Kids Pack
(433) Inland Valley Council of Churches1753 N Park Ave
Pomona,CA91768 		95-2674837 501(c)(3) 10,000       Gleaning Hope
(434) INMED Partnerships for Children Inc409 E Palmer St
Compton,CA90221 		52-1482339 501(c)(3) 25,000       L.A. Teen Pregnancy
(435) InnVision The Way Home1900 The Alameda-400
San Jose,CA95126 		77-0033628 501(c)(3) 25,000       Healthcare for the Homeless
(436) Inside the Outdoors Fdn200 Kalmus Dr
Costa Mesa,CA92628 		33-0373014 501(c)(3) 20,000       Step Outdoors
(437) Institute for Healthcare Improvement20 University Rd-7 Flr
Cambridge,MA02138 		38-3017223 501(c)(3) 47,500       Safety Net
(438) Institute of Medicine As A Profession630 W 168th St Box 11
New York,NY10032 		33-1033330 501(c)(3) 20,000       Medical Clinic
(439) Instituto Familiar De La Raza Inc2919 Mission St
412
San Francisco,CA94110 		94-2523608 501(c)(3) 20,000       Latinas Unidas
(440) Insure the Uninsured Project2444 Wilshire Bl-412
Santa Monica,CA90403 		27-4159194 501(c)(3) 75,000       Ca Health Reform
(441) Intercommunity Child Guidance Center10155 Colima Rd
Whittier,CA90603 		95-2031148 501(c)(3) 17,000       Obesity Program
(442) Interfaith Council of Solano County724 Ohio St
170
Fairfield,CA94533 		68-0440432 501(c)(3) 20,000       Heather House Healthy Families Project
(443) Interval House6615 E Pacific Coast
Hwy 170
Long Beach,CA90803 		95-3389113 501(c)(3) 10,000       Wellness Program
(444) Irvine Community Alliance Fund1 Civic Center Plaza
Irvine,CA92623 		33-0258368 501(c)(3) 23,193       Irvine Village Festival
(445) Jefferson Union High School District2780 Junipero Serra Bl
Daly City,CA94015 		94-3083772 Government 32,000       Daly City Youth Health Center Annual Banquest and
(446) Jewish Community Free Clinic490 City Center Dr
Rohnert Park,CA94928 		94-3386103 501(c)(3) 15,000       Comm Health Fair
(447) Jewish Fam & Childrens Svc of LBW OC3801 E Willow St
Long Beach,CA90815 		95-2273033 501(c)(3) 10,000       Counseling for Men
(448) Jewish Family & Children's Svcs600 Fifth Ave
200
San Rafael,CA94901 		94-1156528 501(c)(3) 10,000       Care Management for Medically Ill/Disabled
(449) Jewish Family & Children's Svcs of the East Bay1855 Olympic Bl-200
Walnut Creek,CA94596 		94-3250304 501(c)(3) 11,375       The Art of Living 2011
(450) Juvenile Diabetes Research Fdn Intern'l26 Broadway 14th Flr
New York,NY10004 		23-1907729 501(c)(3) 14,150       Type 1 Diabetes & Passport to a Cure Gala
(451) JWCH Institute Inc1910 W Sunset Bl-650
Los Angeles,CA90026 		95-2289916 501(c)(3) 26,500       Bellflower Clinic
(452) KAISER Fdn HEALTH PLAN OF COLORADO10350 E Dakota Ave
Denver,CO80231 		84-0591617 501(c)(3) 11,036,442       Reimbursement for various projects
(453) KAISER Fdn HEALTH PLAN OF GEORGIA3495 Piedmont Rd NE
Atlanta,GA30305 		58-1592076 501(c)(3) 3,305,393       Reimbursement for various projects
(454) KAISER Fdn HEALTH PLAN OF OHIO1001 LAKESIDE AVE E
1200
Cleveland,OH44114 		34-0922268 501(c)(3) 10,200       Reimbursement for various projects
(455) KAISER FOUNDATION HEALTH PLAN INC393 E Walnut St
Pasadena,CA91188 		94-1340523 501(c)(3) 10,982,534       Reimbursement for various projects
(456) Keaton Raphael Memorial for Neuroblastoma970 Reserve Dr Ste 144
Roseville,CA95678 		68-0406980 501(c)(3) 20,000       Family Navigator Program
(457) KFHP OF THE MID ATLANTIC STATES INC1 KAISER PLAZA 15L
Oakland,CA94612 		52-0954463 501(c)(3) 289,547       Reimbursement for various projects
(458) Kidango44000 Old Warm Springs Bl
Fremont,CA94538 		94-2581686 501(c)(3) 17,940       Kids Health Prog
(459) Kids Breakfast Club TKBC22542 Second St
Hayward,CA94541 		94-3273619 501(c)(3) 14,650       Anniv Celebration
(460) Kids Come First1501A S Bon View Ave
Ontario,CA91761 		33-0969025 501(c)(3) 25,000       Choosing Health
(461) Kids Community Clinic of Burbank400 W Elmwood Ave
Burbank,CA91506 		95-4791296 501(c)(3) 22,251       Dental treatments
(462) KidsFirst124 Main St
Roseville,CA95678 		68-0195225 501(c)(3) 34,125       Putting KidsFirst Awards Luncheon
(463) Komen Breast Cancer Fdn - OC3191-A Airport Loop Dr
Costa Mesa,CA92626 		33-0487943 501(c)(3) 25,000       Mammography Screening
(464) Korean Health Ed Info & Research Ctr3727 W 6th St-210
Los Angeles,CA90020 		95-4074660 501(c)(3) 79,100       25th Anniversary Awards
(465) LA Biomed Research InstHarbor-UCLA Med Ctr1124 W Carson St
Torrance,CA90502 		95-2138184 501(c)(3) 78,740       Mental Health Conf
(466) La Casa Community Center203 E Mission Rd
San Gabriel,CA91776 		95-1660846 501(c)(3) 14,700       Lizarraga Founders Awards
(467) La Clinica De La Raza1515 Fruitvale Ave
Oakland,CA94601 		94-1744108 501(c)(3) 144,500       Sponsorship Oakley Health Fair and 7th Annual Pitt
(468) LACER Afterschool Programs1718 N Cherokee Ave-A
Hollywood,CA90028 		95-3890819 501(c)(3) 8,000       Afterschool Programs
(469) Laguna Beach Community Clinic362 Third St
Laguna Beach,CA92651 		95-2637633 501(c)(3) 10,000       Urgent Care Program
(470) Lao Family Community Development6840- 65th St-115
Sacramento,CA94828 		94-3115164 501(c)(3) 40,000       Joy of Living Healthy Families
(471) Larkin Street Youth Svcs701 Sutter St-2
San Francisco,CA94109 		94-2917999 501(c)(3) 29,500       Paving the Way
(472) LA's Best200 N Spring St-M-120
Los Angeles,CA90012 		95-4311058 501(c)(3) 104,450       Annual Family Awards
(473) Latino Community Fdn225 Bush St-500
San Francisco,CA94104 		81-0564400 501(c)(3) 59,250       Celebrating Philanthropy con Sabor Latino!
(474) Latino Health Access450 W 4th St-130
Santa Ana,CA92701 		33-0562943 501(c)(3) 25,000       Healthy Weight Programs
(475) Latino Health Collaborative1800 Western Ave
402
San Bernardino,CA92411 		02-0778114 501(c)(3) 10,000       The Healthy Striders
(476) Latino Leadership Council2945 Bell Rd 274
Auburn,CA95603 		27-0970476 501(c)(3) 33,900       CREER En Tu Salud Program
(477) Lavender Youth Recreation Info Center127 Collingwood St
San Francisco,CA94114 		94-3227296 501(c)(3) 15,000       Youth Anti-Violence Series
(478) League of Volunteers of Newark CA36120 Ruschin Dr
Newark,CA94560 		94-2638329 501(c)(3) 7,000       Summer Recreation in the Parks
(479) Legal Aid Society of San Mateo County521 E 5th Ave
San Mateo,CA94303 		94-1451894 501(c)(3) 25,000       Domestic Violence & Abuse Prevention
(480) Leukemia & Lymphoma Society221 Main St
San Francisco,CA94105 		13-5644916 501(c)(3) 25,000       Team in Training for Nike Women's Marathon
(481) Leven Program2397 Heath Dr
Fairfield,CA94533 		26-3653717 501(c)(3) 30,500       Kids Dualthlon Wine Cheese Auction
(482) LifeLong Medical Care2344 Sixth St
Berkeley,CA94710 		94-2502308 501(c)(3) 50,000       Heart to Heart Phase 2
(483) LIFT for Teens70 Skyview Terrace-D
San Rafael,CA94903 		26-3584878 501(c)(3) 10,000       Levantate! Physical Activity/Nutrition
(484) Lift3 Support Group1125 Missouri St-200
Fairfield,CA94533 		87-0723514 501(c)(3) 20,000       Community Engagement in Violence Prevention
(485) Lighthouse Counseling & Family Resource Ctr427 A St-400
Lincoln,CA95648 		35-2252834 501(c)(3) 27,383       Family Counseling
(486) Lincoln Child Center4368 Lincoln Ave
Oakland,CA94602 		94-1156501 501(c)(3) 20,000       Capacity Building through Evaluation
(487) Livermore Area Recreation & Park District4444 East Ave
Livermore,CA94550 		94-6000849 Government 20,000       Let's Swim' Water Safety Program
(488) Livermore Valley Joint Unified School Distr685 E Jack London Blvd
Livermore,CA94551 		94-2175582 Government 6,000       Healthy Futures
(489) Loaves and Fishes of Contra Costa1985 Bonifacio St-100
Concord,CA94520 		68-0018077 501(c)(3) 15,000       Feed the Hungry Nutritious Meals
(490) Local Initiatives Support Corp369 Pine St-350
San Francisco,CA94104 		13-3030229 501(c)(3) 5,250       Richmond HEAL Collaborative Planning Retreat Sessi
(491) Loma Linda Univ24951 N Circle Dr
Loma Linda,CA92350 		95-1816009 501(c)(3) 95,000       Control Breast Cancer
(492) Los Angeles Alliance for a New Economy464 Lucas Ave-202
Los Angeles,CA90017 		95-4459427 501(c)(3) 13,250       Women for LA
(493) Los Angeles Brotherhood Crusade Inc200 E Slauson Ave
Los Angeles,CA90011 		95-2543819 501(c)(3) 8,600       African American Award
(494) Los Angeles Child Guidance Clinic3031 S Vermont Ave
Los Angeles,CA90007 		95-1690974 501(c)(3) 33,000       First Steps
(495) Los Angeles Conservation Corps605 W Olympic Bl-450
Los Angeles,CA90015 		95-4002138 501(c)(3) 6,000       Services for LA Youth
(496) Los Angeles County Bicycle Coalition634 S Spring St-821
Los Angeles,CA90014 		95-4845170 501(c)(3) 15,000       2011 October Event
(497) Los Angeles Free Clinic8405 Beverly Blvd
Los Angeles,CA90048 		95-2539105 501(c)(3) 155,000       Servicing Underserved
(498) Los Angeles Jewish Aids SvcsPO Box 480241
Los Angeles,CA90048 		95-4232540 501(c)(3) 7,000       HIV/AIDS Program
(499) Los Angeles Leadership Academy2670 Griffin Ave
Los Angeles,CA90031 		95-4862553 501(c)(3) 50,000       Urban Farm Program
(500) Los Angeles Neighborhood Land Trust315 W 9th St-1002
Los Angeles,CA90015 		38-3687836 501(c)(3) 55,000       Wellness Program
(501) Los Angeles Regional Food Bank1734 E 41st St
Los Angeles,CA90058 		95-3135649 501(c)(3) 95,000       Healthy Eating
(502) Los Angeles Youth Network1754 Taft St
Los Angeles,CA90028 		95-3953979 501(c)(3) 10,000       Youth Shelters
(503) LOVELACE CLINIC Fdn2309 Renard Place SE
Albuquerque,NM87106 		85-0392796 501(c)(3) 90,447       Pass Through from Northern California region for v
(504) Lower Columbia College Head StartPO Box 3010
Longview,WA98632 		91-0823636 Government 48,317       The ABCD Plus Project - improve oral health for ch
(505) Lyon-Martin Women's Health Svcs1748 Market St-201
San Francisco,CA94102 		94-2597707 501(c)(3) 33,650       Big Birthday Bash!
(506) Making Waves Education Program200 24th St
Richmond,CA94804 		94-3267851 501(c)(3) 15,000       Mental Health Services for Wave-Makers
(507) Mama's Kitchen3960 Home Ave
San Diego,CA92105 		33-0434246 501(c)(3) 10,000       AIDS Nutrition Program
(508) March of Dimes Fdn1050 Sansome St-400
San Francisco,CA94111 		13-1846366 501(c)(3) 17,840       Signature Chefs Auction
(509) Marin AIDS Project910 Irwin St
San Rafael,CA94901 		68-0072470 501(c)(3) 10,000       HIV Testing
(510) Marin Center for Independent Living710 Fourth St
San Rafael,CA94901 		94-2605669 501(c)(8) 5,310       Angels By The Bay
(511) Marin Community FdnPO Box 8010
San Rafael,CA94912 		94-3007979 501(c)(3) 12,500       Healthy Marin Partnership annual contribution
(512) Marin County Bicycle Coalition733 Center Blvd
Fairfax,CA94930 		68-0419394 501(c)(3) 10,000       After School Bike Club
(513) Marion County Health Dept3180 Center St NE
Salem,OR97301 		93-6002307 Government 50,000       North Marion County Healthy Corner Stores Initiati
(514) Marion-Polk Food Share1660 Salem Industrial Dr NE
Salem,OR97301 		94-3034161 501(c)(3) 60,000       MPFS Repack Equipment Project
(515) Marjaree Mason Center Inc1600 M St
Fresno,CA93721 		94-1156639 501(c)(3) 30,000       Victim Mental Health Program
(516) MARSHFIELD CLINIC RESEARCH1000 N Oak Ave 1R3
Marshfield,WI54449 		39-0452970 501(c)(3) 281,364       Pass Through from Northern California region for v
(517) Marthas Village and Kitchen Inc83791 Date Ave
Indio,CA92201 		33-0777892 501(c)(3) 15,658       Medical Clinic
(518) Martin Luther King Jr Freedom Center333 E 8th St
Oakland,CA94606 		94-3390034 501(c)(3) 95,000       Barbara Lee and Elihu Harris Lecture Series
(519) Mary's Mercy Center Inc641 Roberds Ave
San Bernardino,CA92411 		33-0632426 501(c)(3) 10,000       Dental Health Care
(520) MASSACHUSETTS GENERAL HOSPITAL50 Staniford St
Boston,MA02114 		04-2697983 501(c)(3) 497,670       Pass Through from Northern California region for v
(521) Matibabu Fdn901 Mission St 105
San Francisco,CA94103 		20-1102853 501(c)(3) 20,000       Service Award Grant
(522) May View Community Health Center270 Grant Ave
Palo Alto,CA94306 		94-2239648 501(c)(3) 30,000       Smoking and Tobacco Cessation among MayView Client
(523) MAYO CLINIC200 First St SW
Rochester,MN55905 		41-6011702 501(c)(3) 15,246       Pass Through from Northern California region for v
(524) Meals on Wheels of SF Inc1375 Fairfax Ave
San Francisco,CA94124 		94-1741155 501(c)(3) 24,500       Star Chef and Vintners Event
(525) Meals On Wheels of Solano County95 Marina Center
Suisun City,CA94585 		94-2453452 501(c)(3) 25,000       Elder Nutrition Meal Services
(526) Medical Education Cooperation w Cuba1814 Franklin St-500
Oakland,CA94612 		31-1603765 501(c)(3) 75,000       MD Pipeline to Community Service
(527) Medshare International2937 Alvarado St
San Leandro,CA94577 		58-2433968 501(c)(3) 50,000       Medical Clinic
(528) MEND10641 N San Fernando Rd
Pacoima,CA91331 		23-7306337 501(c)(3) 33,555       MENDing Poverty
(529) Mercy Fdn-BakersfieldPO Box 119
Bakersfield,CA93302 		77-0201321 501(c)(3) 20,000       Stipend Program
(530) Mex Amer Legal Defense and Ed Fund634 S Spring St-11 Fl
Los Angeles,CA90014 		74-1563270 501(c)(3) 9,240       LA Awards Gala
(531) MFI Recovery Center5870 Arlington Ave
Riverside,CA92504 		95-2833715 501(c)(3) 10,000       Medical Screening
(532) Mid-Peninsula Boys & Girls Club200 N Quebec St
San Mateo,CA94401 		94-1431583 501(c)(3) 20,000       Nutrition & Physical Fitness Program
(533) Mission City Community Network Inc15206 Parthenia St
North Hills,CA91343 		95-4226189 501(c)(3) 25,000       Health Education
(534) Mixteco Indigena Comm Org ProjectPO Box 20543
Oxnard,CA93034 		30-0045901 501(c)(3) 9,656       Healthcare Program
(535) MOMS Orange County1128 W Santa Ana Blvd
Santa Ana,CA92703 		33-0518078 501(c)(3) 29,500       Annual Awards Presentation
(536) Montebello Unified School District123 S Montebello Blvd
Montebello,CA90640 		95-6002104 Government 10,000       Mobile Dental Clinic
(537) Monument Community Partnership1760 Clayton Rd
Concord,CA94520 		68-0476982 501(c)(3) 33,000       Momentum for Movement (towards better health)
(538) Monument Crisis Center2350 Monument Blvd-B
Concord,CA94520 		41-2111171 501(c)(3) 27,349       Annual Heartfelt Event
(539) Morongo Basin Mental Health Svs Assoc55475 Santa Fe Trail
Yucca Valley,CA92284 		95-2762200 501(c)(3) 20,000       Health Center Planning
(540) Mountain Health & Comm Svcs Inc31115 Highway 94
Campo,CA91906 		33-0164420 501(c)(3) 30,000       Quality Assurance
(541) Mountain View Whisman School District750-A San Pierre Wy
Mountain View,CA94043 		93-0991812 Government 8,000       SV Healthcorps Nutrition-Based Garden Club
(542) Mt Diablo Unified School District (MDUSD)1936 Carlotta Dr
Concord,CA94519 		68-0091157 Government 10,000       Bay Point Garden Project
(543) Mt Hood Community College10100 NE Prescott
Portland,OR97220 		93-0546890 Government 47,880       Farm-to-Head Start: Increasing children's access t
(544) Multnomah County Health426 SW Stark St Fl 8
Portland,OR97204 		93-6002309 Government 109,967       Multnomah County Healthy Retail Initiative: Good
(545) Museum of the African Diaspora685 Mission St
San Francisco,CA94105 		94-3338239 501(c)(3) 6,175       Annual Gala
(546) Music in Schools Today582 Market St 213
San Francisco,CA94104 		94-2920480 501(c)(3) 8,000       Achieving Through Music
(547) My Sister's House915 Broadway
Sacramento,CA95818 		68-0464114 501(c)(3) 22,500       One Night Only- 10th Anniversary Celebration
(548) NAACP National Headquarters4805 Mount Hope Dr
Baltimore,MD21215 		13-1084135 501(c)(3) 33,500       Health Symposium
(549) Napa County Health and Human Svcs Agency2261 Elm St
napa,CA94559 		94-6000525 Government 10,000       The Network of Care for Healthy Communities Progra
(550) Napa Emergency Women's Svcs1141 Pear Tree Ln-220
Napa,CA94558 		94-2745889 501(c)(3) 15,000       Domestic Violence Response Team
(551) Napa Valley Child Advocacy Network1909 Jefferson St
Napa,CA94559 		56-2498308 501(c)(3) 15,000       Outreach Initiative
(552) Napa Valley Hospice & Adult Day Svcs414 S Jefferson St
Napa,CA94559 		68-0393144 501(c)(3) 15,000       Latino Community and Bilingual Services
(553) National Academy Of Sciences500 Fifth St NW
Washington,DC20001 		53-0196932 501(c)(3) 20,000       Violence Prevention
(554) National Coalition of 100 Black Women6175 Shattuck Ave
Oakland,CA94609 		94-3298877 501(c)(3) 8,204       Madam C.J. Walker Business & Community Recognition
(555) National Kidney Fdn of NCAL Inc131 Steuart St-520
San Francisco,CA94105 		13-1673104 501(c)(3) 9,280       Authors Luncheon (VIP: G Halverson)
(556) National Medical Fellowships Inc347 Fifth Ave-510
New York,NY10016 		01-0963657 501(c)(3) 24,550       Planning Development & 65th LA Gala
(557) Natomas Crossroads Church Inc1101 National Dr-A
Sacramento,CA95834 		26-3625632 501(c)(3) 20,000       Natomas Crossroads Clinic
(558) NCB Capital Impact1333 Broadway-602
Oakland,CA94612 		52-1290127 501(c)(3) 200,000       Cal FreshWorks
(559) Neighborhood Healthcare425 N Date St
Escondido,CA92025 		95-2796316 501(c)(3) 45,000       Access to Care
(560) Neighborhood House Inc7780 SW Capitol Hwy
Portland,OR97214 		93-0386875 501(c)(3) 20,000       Strategic Food Initiative Emergency Food Box progr
(561) Neighborhood Legal Svs of LA Cnty1102 E Chevy Chase Dr
Glendale,CA91205 		95-2408642 501(c)(3) 102,298       6th Annual Just Neighbors Celebration
(562) New Directions for Youth7315 N Lankershim Bl
N Hollywood,CA91605 		95-2973008 501(c)(3) 15,000       Health Watch
(563) New Directions Inc480 Manor Plaza
Pacifica,CA94044 		94-2251653 501(c)(3) 15,000       Bayshore Community Prevention Partnership
(564) New Economics for Women303 S Loma Dr
Los Angeles,CA90017 		95-3969029 501(c)(3) 9,955       Passion and Impact
(565) New Horizons Caregivers Group3120 S Hacienda Bl
809
Hacienda Hghts,CA91745 		75-3132090 501(c)(3) 7,000       FIESTA Program
(566) Next Door Solutions to Domestic Violence234 E Gish Rd-200
San Jose,CA95112 		94-2420708 501(c)(3) 30,000       Kids Club Program and Youth Leadership Forum
(567) Nile Sisters Development Initiative6035 University Ave-22
San Diego,CA92115 		91-2131196 501(c)(3) 15,000       Health-Link Project
(568) North by Northeast Community Health Clinic3030 NE MLK Jr Blvd
Portland,OR97212 		72-1618287 501(c)(3) 20,000       Increase capacity and expand care to patients on t
(569) North Clackamas School District4444 SE Lake Rd 950
Milwaukie,OR97222 		93-0599524 Government 20,000       North Clackamas Dental Health Solutions Program
(570) North County Health Project Inc150 Valpreda Rd
San Marcos,CA92069 		95-2847102 501(c)(3) 50,000       Trans for HIV Individuals
(571) North of the River Rec and Park District405 Galaxy Ave
Bakersfield,CA93308 		95-3156985 Government 30,000       Splash Program
(572) Northeast Community Clinic2550 W Main St-301
Alhambra,CA91801 		95-2687213 501(c)(3) 14,000       Nutrition Intelligente
(573) Northeast Valley Health Corp1172 N Maclay Ave
San Fernando,CA91340 		23-7120632 501(c)(3) 65,600       Colonoscopy Pilot
(574) Northern California Center for Well-Being365 B Tesconi Circle
Santa Rosa,CA95401 		93-1144835 501(c)(3) 22,680       Skate A Thon
(575) Northern California Grantmakers625 Market St-15 Fl
San Francisco,CA94105 		94-2761355 501(c)(3) 7,000       Annual Award
(576) Northwest Health Fdn221 NW Second Ave-300
Portland,OR97209 		93-1293344 501(c)(3) 25,000       Safety Net Patient Centered Primary Care Home Tran
(577) NORTHWESTERN Univ633 Clark St
Evanston,IL60208 		36-2167818 501(c)(3) 37,738       Pass Through from Northern California region for v
(578) Novato Youth Center680 Wilson Ave
Novato,CA94947 		94-1735064 501(c)(3) 15,000       Healthy Novato Promotores
(579) Oak Grove Institute Fdn Inc24275 Jefferson Ave
Murrieta,CA92562 		33-0470446 501(c)(3) 25,000       Counseling Project
(580) Oak View Renewal Partnership17241 Oak Lane
Huntington Beach,CA92647 		61-1495237 501(c)(3) 15,000       Healthy Living
(581) Oakland Based Urban Gardens1724 Mandela Pkwy 1
Oakland,CA94607 		94-3345794 501(c)(3) 20,000       OBUGS Afterschool and Summer Camp
(582) Oakland School for the Arts530-18th St
Oakland,CA94612 		68-0463892 501(c)(3) 24,700       Gala supporting Programs
(583) Oakland USD-Complementary Learning Dept495 Jones Ave
Oakland,CA94603 		94-6000385 Government 50,000       Coordinated School Health Program Manager
(584) Occidental College1600 Campus Rd
Los Angeles,CA90041 		95-1667177 501(c)(3) 125,000       Preschool Project
(585) Odd Fellow- Rebekah Children's Home of CA290 IOOF Ave
Gilroy,CA95020 		94-1167402 501(c)(3) 25,000       Violence Prevention and Early Intervention Groups
(586) Off The Front7676 N Palm 101
Fresno,CA93711 		27-2022802 501(c)(3) 35,000       Off The Front
(587) Okizu Fdn16 Digital Dr-130
Novato,CA94949 		68-0291178 501(c)(3) 37,000       An Evening Under the Stars
(588) Olive Crest Treatment Center2130 E 4th St-200
Santa Ana,CA92705 		95-2877102 501(c)(3) 20,000       At-risk Youth
(589) Olive View UCLA Ed and Research Inst Inc14445 Olive View Dr
Sylmar,CA91342 		95-2249539 501(c)(3) 153,333       Promote ALL
(590) On Lok Day Services1333 Bush St
San Francisco,CA94109 		94-3101292 501(c)(3) 14,250       Autumn Magic Celebration
(591) On The Move780 Lincoln Ave
Napa,CA94558 		75-3149095 501(c)(3) 30,000       Community Giving Donation on behalf of Napa Solano
(592) ONEgeneration17400 Victory Blvd
Van Nuys,CA91406 		95-4066979 501(c)(3) 20,000       Aging Gracefully
(593) Ontario-Montclair School District950 West D St
Ontario,CA91762 		95-6002267 Government 20,000       Child Health Point
(594) Open Heart Kitchen of Livermore1141 Catalina Dr-137
Livermore,CA94550 		94-3396038 501(c)(3) 27,000       Gift of Wellness
(595) Opera Noir345 Camino Sobrante
Orinda,CA94563 		77-0503778 501(c)(3) 9,500       Summer Intensive Artists Development Performance
(596) Operation Safe House Inc9685 Hayes St
Riverside,CA92503 		33-0326090 501(c)(3) 20,000       Anti-Human Trafficking
(597) Orangewood Children's Fdn1575 E 17th St
Santa Ana,CA92705 		95-3616628 501(c)(3) 20,000       Healthy Future
(598) Oregon Child Development CoalitionPO Box 2780
Wilsonville,OR97070 		93-0591240 501(c)(3) 20,000       Training for Healthy Changes General Operating Sup
(599) Oregon College Of Oriental Medicine10525 SE Cherry Blossom
Dr
Portland,OR97216 		93-0845182 501(c)(3) 20,000       Expanding Health Care Access to Low-Income Patient
(600) Oregon Dept of Public Health800 NE Oregon St-805
Portland,OR97232 		93-6001752 Government 60,000       Healthier Food Environment for Incarcerated Women
(601) Oregon Food Bank7900 NE 33rd Dr
Portland,OR97211 		93-0785786 501(c)(3) 70,000       OFB West Nutrition education, advocacy & hunger aw
(602) Oregon Health and Science Univ3181 SW Sam Jackson Park
Rd
Portland,OR97239 		93-1176109 Government 370,165       The Kaiser Permanente Health Care Career Scholarsh
(603) Oregon Health and Science Univ Fdn1121 SW Salmon St-100
Portland,OR97205 		23-7083114 501(c)(3) 49,965       Access to dental care improved through motivated O
(604) Oregon Partnership5100 SW Macadam Ave-400
Portland,OR97239 		93-0725294 501(c)(3) 18,000       Parents Teaching Prevention (PTP) EMPLOYEE SPONSOR
(605) Oregon Physicians for Social Responsibility812 SW Morrison St
Portland,OR97205 		93-0774594 501(c)(3) 41,994       Healthy Food in Health Care Project - 2 year proje
(606) P F Bresee Fdn184 S Bimini Place
Los Angeles,CA90004 		95-3797363 501(c)(3) 10,000       After-School Program
(607) Pacific Asian Counseling Services8616 La Tijera Bl-200
Los Angeles,CA90045 		95-4564739 501(c)(3) 10,000       Mental Health Services
(608) Pacific Clinics800 S Santa Anita Ave
Arcadia,CA91006 		95-1644034 501(c)(3) 8,500       Homeless Connect Day
(609) Pacific Institute for Studies654 13th St
Oakland,CA94612 		94-3050434 501(c)(3) 19,920       Participatory Research with Formerly Incarcerated
(610) Pacifica's Environmental Family690 Alta Vista Dr
Pacifica,CA94044 		94-3229680 501(c)(3) 5,670       One Hundred Mile Meal Event'
(611) Pacoima Beautiful11243 Glenoaks Blvd 1
Pacoima,CA91331 		95-4770745 501(c)(3) 15,000       Community Garden
(612) Palm Springs Cultural Center2100 Tahquitz Cyn Wy
Palm Springs,CA92262 		55-0914693 501(c)(3) 20,000       Farmers' Markets
(613) Para Los Ninos500 Lucas Ave
Los Angeles,CA90017 		95-3443276 501(c)(3) 84,400       Annual Cinco de Mayo
(614) Partners for a Hunger-Free Oregon712 SE Hawthorne Blvd
Portland,OR97214 		20-4970868 501(c)(3) 75,000       Healthy Kids, Healthy Minds
(615) Partnership for Children and Youth1611 Telegraph Ave-404
Oakland,CA94612 		04-3653529 501(c)(3) 75,000       Summer Learning and Wellness Initiative
(616) Pasadena - Foothill Valley YWCA1200 N Fair Oaks Ave
Pasadena,CA91103 		95-1644059 501(c)(3) 35,000       Just For Girls (JFG)
(617) Pasadena Senior Center85 E Holly St
Pasadena,CA91103 		95-2085393 501(c)(3) 35,430       Zest 2011
(618) Pasadena Youth Center805 N Madison Ave
Pasadena,CA91104 		15-4819333 501(c)(3) 10,000       Latina Conference
(619) Passion Society3447 Investment Blvd-202
Hayward,CA94545 		80-0105838 501(c)(3) 15,000       Youth For Peace
(620) Path of Life Ministries6216 Brockcon 111
Riverside,CA92506 		33-0724945 501(c)(3) 175,000       Health Care Access
(621) Pathways Volunteer Hospice3701 Michaelson St
Lakewood,CA90712 		33-0241726 501(c)(3) 18,000       At-Risk Youth Program
(622) Peace Over Violence1015 Wilshire Bl-200
Los Angeles,CA90017 		51-0179305 501(c)(3) 9,250       Humanitarian Awards
(623) Ped Adolescent Diabetes Research & Ed Fdn455 S Main St
Orange,CA92868 		33-0099451 501(c)(3) 12,500       Healthcare Professionals
(624) Pediatric Dental Initiative of NoCoast1380 19th Hole Dr
Windsor,CA95492 		34-2012430 501(c)(3) 15,400       Make Kids Smile Fundraiser Dinner
(625) Peninsula Family Service24 2nd Ave
San Mateo,CA94401 		94-1186169 501(c)(3) 25,300       Annual 'Winners Event'
(626) Peninsula Jewish Community Center800 Foster City Blvd
Foster City,CA94404 		94-3227262 501(c)(3) 20,000       Get Up & Go
(627) People Acting In Community Together1100 Shasta Ave-210
San Jose,CA95126 		77-0090129 501(c)(3) 30,000       PACT'S Leadership Luncheon: Celebrating the Valle
(628) People Reaching Out Inc5299 Auburn Blvd
Sacramento,CA95841 		94-2795430 501(c)(3) 26,000       Family Fun Day
(629) Petaluma Bounty210 Fourth St-B
Petaluma,CA94952 		26-3208708 501(c)(3) 9,974       Partnership for Healthy Food
(630) Petaluma Health Center1179 N McDowell Blvd
Petaluma,CA94954 		68-0437840 501(c)(3) 50,000       Petaluma Medical Capacity Expansion Project
(631) Phys for Social Responsibility Inc- LA617 S Olive St 200
Los Angeles,CA90014 		95-3956136 501(c)(3) 140,000       Fellows Program
(632) Placer People of Faith Together3080 Sunshine Meadow Ln
Auburn,CA95604 		27-0240478 501(c)(3) 20,000       Community Assessment to Prevent Violence
(633) Placer Womens Center Inc700 Sunrise Ave-N
Roseville,CA95661 		94-2578871 501(c)(3) 25,000       Therapy Services and Bilingual Outreach
(634) Planned Parenthood Los Angeles400 W 30th St
Los Angeles,CA90007 		95-2408623 501(c)(3) 25,151       Health Center
(635) Planned Parenthood of the Pacific Southwest1075 Camino del Rio S
San Diego,CA92108 		95-6111785 501(c)(3) 50,000       HIV/AIDS Prevention
(636) Planned Parenthood Shasta Diablo2185 Pacheco St
Concord,CA94520 		94-1575233 501(c)(3) 42,500       Dream Come True Graduation Celebration AFLP/Cal Le
(637) Playworks Education Energized477 Valley Way
Milpitas,CA95032 		94-3251867 501(c)(3) 76,000       Corporate Kickball Tournament
(638) Point Break Resources1102 N School St
Stockton,CA95205 		94-1708137 501(c)(3) 47,147       Reducing School Violence Partnership
(639) Pomona Community Health Center750 S Park Ave-101
Pomona,CA91766 		22-3914738 501(c)(3) 75,000       Admin Services
(640) Portland Public Schools501 N Dixon St
Portland,OR97227 		93-6000830 Government 49,100       ViDA Collaborative Partnership Year 1 of a 3 yr pr
(641) Portola Family Connection Center2565 San Bruno Ave
San Francisco,CA94134 		94-3213689 501(c)(3) 15,000       Healthy Connections Initiative
(642) Positive Resource Center785 Market St 10th Fl
San Francisco,CA94103 		94-3078431 501(c)(3) 7,200       Windows of Opportunity event
(643) Powerhouse Ministries Inc311 Market St
Folsom,CA95630 		68-0020855 501(c)(3) 25,000       Health Links
(644) PRESIDENT AND FELLOWS OF HARVARD COLLEGE6400 Perkins Rd
Baton Rouge,LA70808 		72-1304948 501(c)(3) 6,093       Pass Through from Northern California region for v
(645) Pretend City The Children's Museum of OC29 Hubble
Irvine,CA92618 		33-0761254 501(c)(3) 37,500       Health Center Exhibit
(646) Prevention Institute221 Oak St
Oakland,CA94607 		94-3282858 501(c)(3) 150,000       Core Support: Advancing Local, State, and National
(647) Project Access NOWPO Box 10953
Portland,OR97296 		20-8928388 501(c)(3) 97,000       Access to medical care for uninsured populations,
(648) Project Angel Food922 Vine St
Los Angeles,CA90038 		95-4115863 501(c)(3) 24,000       Meals to People
(649) Project Quest dba Quest Integrative Health2901 E Burnside
Portland,OR97214 		93-1121778 501(c)(3) 20,000       Provide integrated health care to 115 low-income p
(650) Project Sister Family Services363 S Park Ave-303
Pomona,CA91769 		23-7116161 501(c)(3) 20,000       Counseling Programs
(651) PROTOTYPES Centers for Innovation in Health1000 N Alameda St-390
Los Angeles,CA90012 		95-4092046 501(c)(3) 8,000       Empowerment and Hope
(652) Providence-Speech and Hearing Center1301 Providence Ave
Orange,CA92868 		95-6154473 501(c)(3) 25,000       Subsidy Program
(653) Proyecto Pastoral-Jesuit Hispano Ministry135 N Mission Rd
Los Angeles,CA90033 		95-3213958 501(c)(3) 10,000       Women's Conference
(654) Public Health Fdn Enterprises (PHFE)13200 Crossroads
Parkway N-135
City of Industry,CA91746 		95-2557063 501(c)(3) 10,000       Gang Awareness
(655) Public Health Institute555 12th St 10th Fl
Oakland,CA94607 		94-1646278 501(c)(3) 205,000       The California Health Workforce Alliance
(656) Public Health Policy & Law2201 Broadway-502
Oakland,CA94612 		26-3710746 501(c)(3) 70,000       Ca Healthy Food
(657) Puente de la Costa Sur620 North St
Pescadero,CA94060 		37-1484262 501(c)(3) 10,000       Rural Health Outreach, Prevention, Utilization
(658) Queen of the Valley Medical Center3448 Villa Lane-102
Napa,CA94558 		94-1243669 501(c)(3) 20,000       Healthy for Life'
(659) Quinn Community Outreach Corp25400 Alessandro Bl
Moreno Valley,CA92553 		33-0637525 501(c)(3) 9,900       So Cal Witness Project
(660) Rails-toTrails Conservancy2121 Ward Ct NW 5 Fl
Washington,DC20037 		52-1437006 501(c)(3) 10,600       Compton Bike Fest
(661) Rape Trauma Services1860 El Camino Real
406
Burlingame,CA94010 		94-3215045 501(c)(3) 10,000       Rape & Relationship Abuse Prevention
(662) Reach Out West End Inc1126 W Foothill Blvd-150
Upland,CA91786 		95-2642747 501(c)(3) 20,000       Student Assistant Prog
(663) Reading and Beyond4670 E Butler Ave
Fresno,CA93702 		77-0508471 501(c)(3) 50,000       Workforce Development Wrap-around Project
(664) Rebuilding Together Oakland1111 Pine St-A
Oakland,CA94607 		94-3213325 501(c)(3) 7,500       Golden Gate Oakland Community Volunteer
(665) Redwood City Police Activities League3399 Bay Rd
Redwood City,CA94063 		94-3229506 501(c)(3) 10,000       Redwood City PAL Health Academy
(666) Redwood Community Health Coalition1310 Redwood Way-135
Petaluma,CA94954 		94-3220029 501(c)(3) 330,000       Enrollment Training for Healthy Kids
(667) Redwood Empire Food Bank3320 Industrial Dr
Santa Rosa,CA95403 		68-0121855 501(c)(3) 136,500       Holiday Bag Campaign
(668) Regents of the Univ of California10833 Le Conte Ave-13
154CHS
Los Angeles,CA90095 		94-6006143 501(c)(3) 42,000       Health Policy
(669) Regents of the Univ of California3333 California St
315
San Francisco,CA94143 		94-3067788 501(c)(3) 35,000       UCSF Health Professions Pipeline Program
(670) Regents of UCLA11000 Kinross Ave-102
Los Angeles,CA90095 		95-6006143 Government 550,000       Health Survey
(671) Regional Parks Fdn2950 Peralta Oaks Court
Oakland,CA94620 		23-7011877 501(c)(3) 195,000       Let's Swim
(672) Remote Area Medical Fdn1834 Beech St
Knoxville,TN37920 		62-1650446 501(c)(3) 20,000       Health Expedition in Sacramento and Oakland
(673) Restaurant Opportunities Cntr of LA634 S Spring St-614
Los Angeles,CA90014 		01-0939141 501(c)(3) 40,000       Workers Health Care
(674) RFK Institute of Comm and Family Med544 N Avalon-309
Wilmington,CA90744 		33-0531975 501(c)(3) 15,000       Health Program
(675) Richmond Police Activities League2200 Macdonald Ave
Richmond,CA94801 		94-2826455 501(c)(3) 25,000       Richmond Entrepreneur Program
(676) Rio Vista CARE Inc125 Sacramento St
Rio Vista,CA94571 		68-0063763 501(c)(3) 18,000       Flip the Script
(677) Ritter Center16 Ritter St
San Rafael,CA94912 		94-2675517 501(c)(3) 10,200       Ritter Health Center
(678) Riverside Comm Coll Dist Fdn4800 Magnolia Ave
Riverside,CA92506 		95-2993847 501(c)(3) 25,000       Dental Hygiene Program
(679) Riverside County Phys Mem Fdn3993 Jurupa Ave
Riverside,CA92506 		95-6080778 501(c)(3) 25,000       Project K.I.N.D.
(680) Riverside Cty Regional Med Cntr Fdn26520 Cactus Ave
Moreno Valley,CA92555 		33-0374018 501(c)(3) 25,000       Medication Clinics
(681) Roberts Family Development Center770 Darina Ave
Sacramento,CA95815 		68-0470557 501(c)(3) 21,000       Anniv Lunch Event
(682) Ronald McDonald House Charities of SC763 S Pasadena Ave
Pasadena,CA91105 		95-3167869 501(c)(3) 15,000       2011 Shine Gala
(683) Rotacare Bay Area Inc225 S Cabrillo Hwy
200 A
Half Moon Bay,CA94019 		77-0328723 501(c)(3) 83,500       RotaCare Coastside Clinic Support
(684) Rubicon Programs Inc2500 Bissell Ave
Richmond,CA94804 		94-2301550 501(c)(3) 20,000       Reentry and Violence Prevention Initiative
(685) Ryse Inc205 41st St
Richmond,CA94805 		26-0692904 501(c)(3) 20,000       RYSE Health & Wellness Program
(686) SAC Health System1454 E Second St
San Bernardino,CA92408 		33-0664371 501(c)(3) 20,000       Operation FIT
(687) Sacramento Area Congregations Together2510 J St 200
Sacramento,CA98516 		94-3146791 501(c)(3) 27,500       ACT Out!
(688) Sacramento City Unified School District5735 47th Ave
Sacramento,CA95825 		94-6002491 Government 50,000       SCUSD Connect Center
(689) Sacramento County Dept of HHS7001-A E Parkway-600A
Sacramento,CA95823 		94-6000529 Government 49,737       Low-Income School Flu Clinics
(690) Sacramento Employment & Training Agency925 Del Paso Blvd-100
Sacramento,CA95815 		81-0640257 Government 35,000       Sacramento Safe Community Partnership
(691) Sacramento Loaves and Fishes1321 North C St
Sacramento,CA95811 		68-0189897 501(c)(3) 7,000       Genesis Mental Health
(692) Sacramento Native American Health Center2020 J St
Sacramento,CA95811 		20-4287737 501(c)(3) 75,000       Full Circle: Chronic Care program
(693) Sacramento Neighborhood Housing Svcs2400 Alhambra Blvd
Sacramento,CA95817 		68-0118032 501(c)(3) 24,877       Oak Park Farmers Market
(694) Safe Alternatives for Everyone Inc28910 Pujol St
Temecula,CA92590 		91-1962947 501(c)(3) 25,000       Violence Services
(695) SafeQuest Solano1745 Enterprise Dr 2-D
Fairfield,CA94533 		94-2853669 501(c)(3) 9,999       Child Witness Project
(696) Samaritan House4031 Pacific Blvd
San Mateo,CA94403 		23-7416272 501(c)(3) 30,000       Safe Harbor for Health
(697) SAN DIEGANS FOR HEALTH CARE COVERAGE1850 Fifth Ave
San Diego,CA92101 		47-0846723 501(c)(3) 16,000       Health Coverage
(698) San Diego American Indian Health Center2602 First Ave 105
San Diego,CA92103 		95-3397369 501(c)(3) 19,933       Elder Patient program
(699) San Diego County Medical Society Fdn5575 Ruffin Rd 250
San Diego,CA92123 		95-2568714 501(c)(3) 40,000       Project San Diego
(700) San Diego Family Care6973 Linda Vista Rd
San Diego,CA92111 		95-2700856 501(c)(3) 20,000       Patients Support
(701) San Diego Fdn For Change3758 30th St
San Diego,CA92104 		33-0628755 501(c)(3) 9,200       2012 Retreat
(702) San Diego Food Bank Corp9850 Distribution Ave
San Diego,CA92121 		20-4374795 501(c)(3) 80,000       Healthy Eating
(703) San Diego Hunger Coalition4305 University Ave
630
San Diego,CA92105 		30-0507718 501(c)(3) 25,000       Healthy Food
(704) San Diego Organizing Project4305 University Ave-530
San Diego,CA92105 		95-3284521 501(c)(3) 17,000       Youth Project
(705) San Diego Unified School District4100 Normal St
San Diego,CA92103 		95-6002781 Government 50,000       Health & Wellness
(706) San Diego Youth Services3255 Wing St
San Diego,CA92110 		95-2648050 501(c)(3) 10,000       Peer Education Program
(707) San Francisco AIDS Fdn1035 Market St-400
San Francisco,CA94103 		94-2927405 501(c)(3) 10,000       AIDS Walk San Francisco
(708) San Francisco AIDS Fund12 Grace St 300
San Francisco,CA94013 		94-2922039 501(c)(3) 20,000       Eviction Prevention/Housing Stabilization for Peop
(709) San Francisco Community Clinic Consortium1550 Bryant St-450
San Francisco,CA94103 		94-2897258 501(c)(3) 317,000       Annual Gala
(710) San Francisco Fleet Week Assoc609 Sutter St-2M
San Francisco,CA94102 		27-2832209 501(c)(3)   10,000 book low income bldg proj Senior Leadership Seminar - Disaster Relief building and have the site reclassified for medical use zoning baseline at 12 KP hospitals by the end of 2013
(711) San Francisco General Hospital Fdn2789 25th St-2028
San Francisco,CA94110 		94-3189424 501(c)(3) 23,500       Heroes & Hearts, February 10, 2011
(712) San Francisco Public Health Fdn1450 Sutter St 101
San Francisco,CA94109 		94-3117093 501(c)(3) 25,000       Project Homless Connect 42
(713) San Francisco Study Center Inc1095 Market St-601
San Francisco,CA94103 		94-2168838 501(c)(3) 45,000       Brothers Bouncing Back
(714) San Francisco Unified School District555 Franklin St
San Francisco,CA94102 		94-6000416 Government 15,000       YOWhoo.org: Alcohol/Drug Prevention Youth Website
(715) San Gabriel Unified School District408 Jumipero Serra Dr
San Gabriel,CA91776 		95-6000777 Government 10,000       All Aboard!
(716) San Gabriel Vly Conserv & Svc Corps3629 Cypress
El Monte,CA91731 		27-0030016 501(c)(3) 10,000       EarthWorks
(717) San Joaquin County of Public Health Svcs1601 E Hazelton Ave
Stockton,CA95201 		94-6000531 Government 50,000       Putting the Brakes on Diabetes
(718) San Joaquin County Office of Education2901 Arch-Airport Rd
Stockon,CA95213 		68-0006282 Government 50,000       Exercise Across California
(719) San Jose Children's Discovery Museum180 Woz Way
San Jose,CA95110 		94-2870828 501(c)(3) 52,500       Legacy for Children Award 2011
(720) San Leandro Boys and Girls Club401 Marina Blvd
San Leandro,CA94577 		94-6003779 501(c)(3) 66,020       Gala Auction and Wine Tasting, May 14, 2011
(721) San Leandro Education Fdn14735 Juniper St
San Leandro,CA94577 		94-6002608 Government 25,000       Play works for kids@Wilson
(722) San Leandro Public Library Fdn300 Estudillo Ave
San Leandro,CA94577 		94-3180326 501(c)(3) 15,000       Teen Parent Health and Literacy
(723) Santa Clara County Office of Education1290 Ridder Park Dr
San Jose,CA95131 		77-0272168 Government 27,500       Fit for Learning Program
(724) Santa Clara Family Health Fdn210 E Hacienda Ave
Campbell,CA95008 		77-0545774 501(c)(3) 47,500       Data Publication - Status on Children's Health in
(725) Santa Clara Univ500 El Camino Real
Santa Clara,CA95053 		94-1156617 501(c)(3) 80,000       MSIS Program
(726) Santa Clarita Valley Boys and Girls Club24909 Newhall Ave
Newhall,CA91321 		95-2572622 501(c)(3) 10,000       Fitness Program
(727) Santa Rosa Memorial Hospital1165 Montgomery Dr
Santa Rosa,CA95405 		94-1231005 501(c)(3) 10,000       Partnering funding for Sonoma Health Alliance
(728) Save San Francisco Bay Assocation350 Frank H Ogawa Plaza
900
Oakland,CA94612 		94-6078420 501(c)(3) 20,000       wetland initiatives
(729) School Health Clinics of Santa Clara County5671 Santa Teresa Bl-105
San Jose,CA95123 		77-0031679 501(c)(3) 20,000       Patient Navigator
(730) SCOTT AND WHITE MEMORIAL5701 Airport Rd
Temple,TX76502 		74-1166904 501(c)(3) 108,929       Pass Through from Northern California region for v
(731) Second Harvest Food Bank San JoaquinStanislaus704 E Industrial Park Dr
Manteca,CA95337 		68-0376587 501(c)(3) 20,000       Food 4 Thought
(732) Second Harvest Food Bank Santa ClaraSan Mateo750 Curtner Ave
San Jose,CA95125 		94-2614101 501(c)(3) 42,500       Community Giving Award on behalf of Santa Clara Se
(733) Seeds Community Resolution Center1968 San Pablo Ave
Berkeley,CA94702 		94-3054165 501(c)(3) 11,500       Cultivating Common Ground
(734) Senior Advocacy Services3262 Airway Dr C
Santa Rosa,CA95403 		94-2684774 501(c)(3) 5,600       Pick of the Vine
(735) Senior Community Centers of San Diego525 14th St-200
San Diego,CA92101 		95-2850121 501(c)(3) 25,000       Wellness Program
(736) Senior Support of the Tri-Valley5353 Sunol Blvd
Pleasanton,CA94596 		20-3225569 501(c)(3) 10,000       Healthy Lifestyles Program
(737) Seniors First11566 D Ave
Auburn,CA95603 		68-0430154 501(c)(3) 25,000       Health Express
(738) SEQUOIA Fdn2166 Avenida de la Playa
La Jolla,CA92037 		33-0100208 501(c)(3) 7,658       Pass Through from Northern California region for v
(739) Serotonin Surge Charities824 Falcon Ave
Davis,CA95616 		68-0411254 501(c)(3) 50,000       Spring Break 2011
(740) Seventh-Day Adventist ChurchPO Box 23165
Pleasant Hilll,CA94523 		94-1026064 501(c)(3) 20,000       GracePoint Community Clinic
(741) Shane's Inspiration15213 Burbank Blvd
Van Nuys,CA91411 		95-4760497 501(c)(3) 10,000       Together, We Are Able
(742) Shanti Orange County23461 S Pointe Dr
100
Laguna Hills,CA92653 		33-0236592 501(c)(3) 15,000       HIV/AIDS Services
(743) Sharefest Community Development Inc3525 Lomita Blvd-200
Torrance,CA90505 		20-5651596 501(c)(3) 10,500       Remembrance Project
(744) Shelter Inc of Contra Costa County1815 Arnold Dr
Martinez,CA94553 		68-0117241 501(c)(3) 15,000       Food Smarts: Nutrition Workshops
(745) Sierra Vista Children's Center100 Poplar Ave
Modesto,CA95354 		94-2158023 501(c)(3) 50,000       Mental Health Services for Families
(746) Silicon Valley Council of Nonprofits1400 Parkmoor Ave-130
San Jose,CA95126 		77-0524747 501(c)(3) 7,000       The Health Care Reform Summit
(747) Slavic Assistance Center Inc2117 Cottage Way
Sacramento,CA95825 		01-0620969 501(c)(3) 7,500       Access to Essential Services
(748) So El Monte Emergency Resources Assoc2645 Lee Ave 6
South El Monte,CA91733 		95-6097318 501(c)(3) 10,000       Healthy Families
(749) Socially Responsible Network1221 Oak St-536
Oakland,CA94612 		61-1458993 501(c)(3) 7,500       Disaster Preparation Workshops
(750) Socrates Opportunity Scholarship Fdn24241 Park Granada
Calabasas,CA91302 		95-4722980 501(c)(3) 7,500       SOSMentor
(751) Soil Born Farm Urban Agriculture Project3000 Hurley Way
Sacramento,CA95864 		20-0774693 501(c)(3) 25,000       A Day on the Farm
(752) Solano Coalition for Better Health360 Campus Lane-200
Fairfield Ca,CA94534 		94-3189914 501(c)(3) 75,000       Outreach Enrollment and Retention Initiative
(753) Solano Community Fdn470 Chadbourne Rd-D
Fairfield,CA94534 		68-0354961 501(c)(3) 40,000       Education Plus! Mini-Grant Program
(754) Solano County Library Fdn601 Kentucky St
Fairfield,CA94533 		68-0342423 501(c)(3) 7,500       Solano Kids Read
(755) Solano Midnight Sun795 Alamo Dr-106
Vacaville,CA95688 		20-8124921 501(c)(3) 15,000       Breast Health Project
(756) Soledad Enrichment Action Inc222 Virgil Ave
Los Angeles,CA90004 		95-4399127 501(c)(3) 80,000       Caught in the Crossfire
(757) Sonoma County Adult & Youth Development7345 Burton Ave
Rohnert Park,CA94928 		94-2812489 501(c)(3) 13,525       Volunteer Awards
(758) South Bay Cntr for Counseling & Human Dev360 N Sepulveda Blvd
2075
El Segundo,CA90245 		23-7360521 501(c)(3) 9,895       Counseling Programs
(759) South Bay Community Services1124 Bay Blvd D
Chula Vista,CA91910 		95-2693142 501(c)(3) 17,500       Domestic Programs
(760) South Bay Family Healthcare Center23430 Hawthorne Blvd-210
Torrance,CA90505 		23-7049937 501(c)(3) 40,000       HIV/AIDS Services
(761) South Central Family Health Center4425 S Central Ave
Los Angeles,CA90011 		95-3877793 501(c)(3) 17,500       Awards & Fundraiser
(762) South County Community Health Center1798 A Bay Rd
East Palo Alto,CA94303 		94-3372130 501(c)(3) 95,000       Family Wellness Program
(763) South San Francisco Friends of The Library840 W Orange Ave
S San Francisco,CA94080 		74-3116201 501(c)(3) 20,000       Project Read/Learning Wheels
(764) South San Francisco High Schools400 B St
South San Francisco,CA94080 		94-3083861 Government 18,000       Emerging Leaders Project
(765) Southern California Leadership Network350 S Bixel St-201
Los Angeles,CA90017 		93-1055450 501(c)(3) 9,550       Visionaries Awards
(766) Southside Coalition of Comm Health Cntr555 W 5th St 19th Fl
Los Angeles,CA90013 		20-8892311 501(c)(3) 300,000       LA Collaborative
(767) Southwest Community Health Center3569 Round Barn Circle
Santa Rosa,CA95403 		68-0365296 501(c)(3) 80,000       Increasing health insurance benefits access
(768) Special Olympics Northern California3480 Buskirk Ave
340
Pleasant Hill,CA94523 		68-0363121 501(c)(3) 25,000       Summer Games
(769) Special Service for Groups Inc605 W Olympic Bl-600
Los Angeles,CA90015 		95-1716914 501(c)(3) 16,000       Children's Dental Proj
(770) St Joseph Center204 Hampton Dr
Venice,CA90291 		95-3874381 501(c)(3) 7,000       Senior Program
(771) St Anne's Maternity Home155 N Occidental Blvd
Los Angeles,CA90026 		95-1691306 501(c)(3) 10,000       Family Development
(772) St Anthony Fdn150 Golden Gate Ave
San Francisco,CA94102 		94-1513140 501(c)(3) 15,000       Obesity Management Program (OMP)
(773) St Francis Med Cntr of Lynwood Fdn3630 E Imperial Hwy
Lynwood,CA90262 		95-3190773 501(c)(3) 12,000       Homeless Services
(774) St Helena Family Center1440 Spring St
St Helena,CA94574 		69-0362076 501(c)(3) 9,998       Teen Mentoring CLARO and CLARA
(775) St Helena Unified School District465 Main St
St Helena,CA94574 		68-0314470 Government 15,000       St. Helena Student Assistance Program
(776) St Jeanne De Lestonnac Free Clinic1215 E Chapman Ave
Orange,CA92866 		95-3499011 501(c)(3) 25,000       Bridge to Care
(777) St John of God Health Care Svcs13333 Palmdale Rd
Victorville,CA92392 		95-3806996 501(c)(3) 19,000       Samaritan's Assist
(778) St John's Shelter for Women and Children4410 Power Inn Rd
Sacramento,CA95826 		68-0132934 501(c)(3) 25,000       St. John's AOD Program Expansion
(779) St Johns Well Child and Family Center Inc5701 S Hoover St
Los Angeles,CA90037 		95-4067758 501(c)(3) 21,750       1st Annual Movable Award
(780) St Mary's Interfaith Community Svcs545 W Sonora St
Stockton,CA95203 		94-2687280 501(c)(3) 35,000       Access to Healthcare for Uninsured
(781) St Rose Hospital Fdn27200 Calaroga Ave
Hayward,CA94545 		94-2428886 501(c)(3) 10,000       Mommy & Me Preventing Obesity
(782) St Vincent de Paul of Contra Costa County2210 Gladstone Dr
Pittsburg,CA94565 		94-1448577 501(c)(3) 42,000       St.Vincent de Paul Employee Wellness Program
(783) St Vincent De Paul Society-Roseville Area503 Giuseppe Court-8
Roseville,CA95678 		68-0205405 501(c)(3) 27,250       Community Health Clinics
(784) St Vincent de Paul Village Inc3350 E St
San Diego,CA92102 		33-0492302 501(c)(3) 55,000       Mental Health Services
(785) STANFORD Univ1215 Welch Rd Building
Stanford,CA94305 		94-1156365 501(c)(3) 304,575       Pass Through from Northern California region for v
(786) Stanislaus County Health Svcs Agency830 Scenic Dr
Modesto,CA95350 		94-6000540 Government 5,523       Public Communication of 2010 Community Health Impr
(787) StarVista610 Elm St-212
San Carlos,CA94070 		94-3094966 501(c)(3) 16,500       Starting Line Breakfast
(788) Stop the Violence Movement Inc1016 S Owens St
Bakersfield,CA93307 		74-3172044 501(c)(3) 7,000       Farmer's Market
(789) Stroke Recovery Center2800 E Alejo Rd
Palm Springs,CA92262 		95-3402464 501(c)(3) 10,000       Rehabilitation services
(790) Student Health Services Support Fund333 S Beaudray Ave
Los Angeles,CA90017 		95-4262448 501(c)(3) 25,000       Vaccination Program
(791) Students Run America5252 Crebs Ave
Tarzana,CA91356 		95-4430502 501(c)(3) 24,000       Training For Life
(792) Summer Scholars3401 Quebec St-5010
Denver,CO80207 		84-1314292 501(c)(3) 6,000       Service Award Grant
(793) Susan G Komen Breast Cancer Fdn11845 W Olympic Blvd
665W
Los Angeles,CA90064 		95-4582064 501(c)(3) 20,000       Latino Breast Health
(794) Sustainable Community Gardens1055 Dunford Way
Sunnyvale,CA94087 		55-0886675 501(c)(3) 20,000       Healthy People, Healthy Gardens & Farms
(795) Sutter Medical Center3325 Chanate Rd
Santa Rosa,CA95404 		68-0374805 501(c)(3) 13,940       Latino Health Forum
(796) Tapfound Inc dba Taproot Fdn466 Geary St- 200
San Francisco,CA94102 		91-2162645 501(c)(3) 15,000       Evaluation Phase for OUSD Program Development
(797) Tarzana Treatment Center Inc18646 Oxnard St
Tarzana,CA91356 		94-2219349 501(c)(3) 45,000       Health Care
(798) Team-Up for Youth310 Eighth St-300
Oakland,CA94607 		94-3310845 501(c)(3) 75,000       Core Operating Support to Expand Youth Sports Prog
(799) Teen Pregnancy Coalition of San Mateo Co120 James Ave
Redwood City,CA94062 		94-3227947 501(c)(3) 22,500       'Creating Hope for the Future: Working Together t
(800) Terrance TK Kelly Youth FdnP O Box 1006
Richmond,CA94802 		20-1772303 501(c)(3) 20,000       EAGLES
(801) The Alameda County Community Food Bank7900 Edgewater Dr
Oakland,CA94621 		94-2960297 501(c)(3) 21,225       Savor the Season!
(802) The Alliance for Children's Rights3333 Wilshire Bl-550
Los Angeles,CA90010 		95-4358213 501(c)(3) 75,000       NextSTEP Program
(803) The Arc of Alameda County2700A Merced St
San Leandro,CA94577 		94-1707724 501(c)(3) 15,000       Future Fitness/Understanding Nutrition
(804) The Boys & Girls Aid Society of Los Angeles760 W Mountain View St
Altadena,CA91001 		95-1647810 501(c)(3) 25,000       Services for Deaf Mothers
(805) The CA Conf for Equality and Justice444 W Ocean Blvd-940
Long Beach,CA90802 		54-2178438 501(c)(3) 23,320       In Class Program
(806) The CA Health Care Safety-Net Inst70 Washington St-215
Oakland,CA94607 		94-2970752 501(c)(3) 487,765       CAPH/SNI Annual Conf
(807) The Children's Cntr of Antelope Valley45111 N Fern Ave
Lancaster,CA93534 		95-4212759 501(c)(3) 12,300       Heartsound Gala 2011
(808) The Child's Clinic Serving ChildrenFam2790 Atlantic Ave
Long Beach,CA90806 		95-1643332 501(c)(3) 320,000       Health Care Services
(809) The Cntr to Promote Healthcare Access Inc1333 Broadway 1020
Oakland,CA94612 		59-3831966 501(c)(3) 540,216       One-e-App in LA
(810) The Community Fdn4280 Latham C
Riverside,CA92501 		33-0748536 501(c)(3) 200,000       Development Workshop
(811) The Davis Street Community Center3081 Teagarden St
San Leandro,CA94577 		94-3121699 501(c)(3) 19,800       Opera Night at Paradiso
(812) The Effort Inc1820 J St
Sacramento,CA95811 		94-1713704 501(c)(3) 274,118       Interim Care Program
(813) The Eli Home Inc1175 N East St
Anaheim,CA92805 		33-0189254 501(c)(3) 12,300       Caribbean Event
(814) The Family Giving Tree312 S Abbott Ave
Milpitas,CA95035 		77-0284682 501(c)(3) 10,000       Back to School
(815) The Fdn at FCOE1111 Van Ness Third Fl
Fresno,CA93721 		80-0381096 501(c)(3) 43,000       Nutrition and Wellness in Schools
(816) The Fdn for Comm and Family Health815 W Sixth St 110
Corona,CA92882 		33-0071575 501(c)(3) 17,310       Childhood Obesity Prog
(817) The Gathering Inn201 Berkley Ave
Roseville,CA95678 		84-1657746 501(c)(3) 22,500       Holiday Festival
(818) The Girl Scout Council of Orange County9500 Toledo Way
Irvine,CA92628 		95-2023244 501(c)(3) 10,000       Healthy Summer
(819) The Health Trust2105 S Bascom Ave-220
Campbell,CA95008 		94-6050231 501(c)(3) 42,000       Early Childhood Obesity Prevention Project
(820) The Illumination Fdn2691 Richter Ave-107
Irvine,CA92606 		71-1047686 501(c)(3) 24,175       Homeless Families
(821) The Latina Center3919 Roosevelt Ave
Richmond,CA94805 		68-0470904 501(c)(3) 19,975       De Casa en Casa
(822) The Link to Children5236 Claremont Ave-2nd Fl
Oakland,CA94618 		94-2224033 501(c)(3) 22,300       Benefit Concert & Silent Auction
(823) The National Council on Crime & Delinquency1970 Broadway 500
Oakland,CA94612 		13-1624111 501(c)(3) 15,000       Warriors for Peace Digital Storytelling
(824) The Raise Fdn1920 E Warner Ave A
Santa Ana,CA92705 		33-0240178 501(c)(3) 50,000       Director of Development
(825) The Regents of the Univ of CA1855 Folsom St
San Francisco,CA94103 		94-6036493 501(c)(3) 20,000       Reducing Mental Health Treatment Waitlist People w
(826) THE REGENTS OF THE Univ OF MICHIGAN3003 S State St
Ann Arbor,MI48109 		38-6006309 501(c)(3) 67,595       Pass Through from Northern California region for v
(827) The Salvation Army322 Sumner St
Honolulu,HI96817 		94-1156347 501(c)(3) 19,150       Service Award Grant
(828) The San Francisco Fdn225 Bush St 500
San Francisco,CA94104 		01-0679337 501(c)(3) 10,000       The Safety Net Funders Network
(829) The Tower Fdn of San Jose State UnivOne Washington Square
San Jose,CA95192 		83-0403915 501(c)(3) 79,369       Integrating SJSU Violence Prevention Education
(830) The Tri-Valley Community Fdn5674 Stoneridge Dr-206
Pleasanton,CA94588 		91-2078642 501(c)(3) 41,643       Sponsorship of Junction Ave. K-8 Running Marathon
(831) The Tucker Maxon Oral School2860 SE Holgate Blvd
Portland,OR97202 		93-0391592 501(c)(3) 15,000       Support for our Early Intervention through fifth g
(832) The UCLA Fdn10920 Wilshire Bl-900
Los Angeles,CA90024 		95-2250801 501(c)(3) 22,119       50th Anniversary Gala
(833) The Vacaville Neighborhood Boys &Girls Club1625 Alamo Dr
Vacaville,CA95687 		13-4223488 501(c)(3) 15,000       Triple Play and KeyStone
(834) The Wall-Las Memorias Project111 N Ave 56
Los Angeles,CA90042 		95-4468225 501(c)(3) 21,000       Pride Benefit Event
(835) The Westside HIV Community Center2012 Lincoln Blvd
Santa Monica,CA90405 		95-4460765 501(c)(3) 7,000       HIV Care Services
(836) The Women's Center of San Joaquin620 N San Joaquin St
Stockton,CA95202 		94-2341360 501(c)(3) 50,000       Sexual Assault Victim Services
(837) The Women's Fdn of California340 Pine St 302
San Francisco,CA94104 		94-2752421 501(c)(3) 14,250       First Annual Pathways
(838) The Wright Institute2728 Durant Ave
Berkeley,CA94704 		94-1674865 501(c)(3) 15,000       Gompers Continuation High School Collaboration
(839) Therapy Center Inc5540 Lake Park Way
La Mesa,CA91942 		33-0248878 501(c)(3) 15,000       Assisted Fitness Prog
(840) Tiburcio Vasquez Health Center22331 Mission Blvd
Hayward,CA94541 		23-7118361 501(c)(3) 106,720       Binational Health Week Activities
(841) Tides Center1390 Market St 900
San Francisco,CA94102 		94-3213100 501(c)(3) 361,150       Teen/Young Adult Health Provider Gathering
(842) Tiger Woods Learning Center FdnOne Tiger Woods Way
Anaheim,CA92801 		20-0677815 501(c)(3) 10,000       Fitness Program
(843) Time for Change FdnPO Box 5753
San Bernardino,CA92412 		52-2405277 501(c)(3) 50,000       Community program
(844) Toberman Neighborhood Center Inc131 N Grand
San Pedro,CA90731 		95-1643387 501(c)(3) 14,500       Gang Intervention Unit
(845) TownsPeople4080 Centre St 201
San Diego,CA92103 		33-0623634 501(c)(3) 9,000       HIV/AIDS Services
(846) TransFormCA436 14th St 600
Oakland,CA94612 		72-1521579 501(c)(3) 60,000       Healthy, Equitable Transportation: Northern Califo
(847) Transportation for a Livable City995 Market St 1450
San Francisco,CA94103 		94-3350190 501(c)(3) 15,000       Sunday Streets
(848) TreePeople12601 Mulholland Dr
Beverly Hills,CA90210 		23-7314838 501(c)(3) 25,000       Healthy Eating
(849) Tri-City Health Center39465 Paseo Padre Pkwy
2100
Fremont,CA94538 		23-7255435 501(c)(3) 82,623       Health Walk
(850) Tri-Valley Community Fdn5674 Stoneridge Dr-206
Pleasanton,CA94588 		91-2078642 501(c)(3) 20,000       Live Well
(851) UC - BERKELEY21985 Hearst Ave
Berkeley,CA94720 		94-6002123 501(c)(3) 53,042       Pass Through from Northern California region for v
(852) UC - SAN FRANCISCOAcctg Off EMF-0897
San Francisco,CA94143 		94-6036493 501(c)(3) 5,787,488       Pass Through from Northern California region for v
(853) UC - SANTA CRUZ1156 High St
Santa Cruz,CA95064 		94-1539563 501(c)(3) 28,336       Pass Through from Northern California region for v
(854) Ujima Family Recovery Svcs1901 Church Lane
San Pablo,CA94806 		68-0127450 501(c)(3) 20,000       Ujima Perinatal Programs
(855) United Health Ctrs of the San Joaquin Valley650 Zediker Ave
Parlier,CA93648 		94-1732538 501(c)(3) 48,200       Comprehensive Group Diabetes Education
(856) United Negro College Fund220 Montgomery St
1120
San Francisco,CA94104 		13-1624241 501(c)(3) 32,500       Walk for Education, Health and Education Fair
(857) United Samaritans Fdn220 S Broadway
Turlock,CA95380 		77-0393321 501(c)(3) 10,000       Daily Bread Mobile Lunch Program
(858) United Way of Fresno County4949 E Kings Canyon Rd
Fresno,CA93727 		94-1156514 501(c)(3) 105,500       Community Giving Campaign on behalf of Central Val
(859) United Way of the Bay Area221 Main St 300
San Francisco,CA94105 		94-1312348 501(c)(3) 50,000       UWBA 211/HELPLINK
(860) United Way of the Stanislaus Area422 McHenry Ave
Modesto,CA95354 		94-1212129 501(c)(3) 95,160       Stanislaus County 2-1-1
(861) United Way of the Wine Country418 B St 400
Santa Rosa,CA95401 		94-1669646 501(c)(3) 51,000       Day of Caring 2011
(862) United Way of Ventura County1317 Del Norte 100
Camarillo,CA93010 		95-1945833 501(c)(3) 8,850       HIV Service
(863) United Way Silicon Valley1400 Parkmoor Ave 250
San Jose,CA95126 		94-1450153 501(c)(3) 50,000       211 Santa Clara County
(864) UNITE-LA INC350 S Bixel St
Los Angeles,CA90017 		82-0576380 501(c)(3) 10,000       LA Youth at Work
(865) Univ Enterprises Corp at CSUSB5500 University
Parkway
San Bernardino,CA92407 		95-6067343 501(c)(3) 110,000       COYOTE ACTIVE CLUB
(866) Univ Muslim Medical Assoc Inc1704 W Manchester Ave
Los Angeles,CA90047 		95-4666712 501(c)(3) 9,500       2011 Gala Fundraiser
(867) Univ OF ALABAMA BIRMINGHAMAB 990 1530 3rd Ave S
Birmingham,AL35294 		63-0649108 501(c)(3) 16,182       Pass Through from Northern California region for v
(868) Univ OF CHICAGO6030 S Ellis Ave ED-114
Chicago,IL60637 		36-2177139 501(c)(3) 66,046       Pass Through from Northern California region for v
(869) Univ OF HAWAII2530 Dole St Sakamarki
D-200
Honolulu,HI96822 		99-6000354 501(c)(3) 72,997       Pass Through from Northern California region for v
(870) UNIV OF MASS MED SCHOOL333 South St
Shrewsbury,MA01545 		04-3167352 501(c)(3) 295,290       Pass Through from Northern California region for v
(871) Univ OF NORTH CAROLINACB 1350-104 Airport
Dr
Chapel Hills,NC27599 		56-6001393 501(c)(3) 81,355       Pass Through from Northern California region for v
(872) Univ OF PENNSYLVANIA3451 Walnut St
Philadelphia,PA19104 		23-1352685 501(c)(3) 24,159       Pass Through from Northern California region for v
(873) Univ OF PITTSBURGH123 University Place
Pittsburgh,PA15213 		25-0965591 501(c)(3) 29,642       Pass Through from Northern California region for v
(874) Univ of Southern California3607 Trosdale Pkwy
330
Los Angeles,CA90089 		95-1642394 501(c)(3) 8,000       USC Camp for Kids
(875) Univ of the Pacific Pacific Ctr for Special Care3601 Pacific Ave
Stockton,CA95211 		94-1156266 501(c)(3) 10,000       Healthy Children 2011
(876) Univ OF UTAH75 S 2000 E
Salt Lake City,UT84112 		23-7112869 501(c)(3) 343,782       Pass Through from Northern California region for v
(877) UNIVERISTY OF CALIFORNIA - DAVISPO Box 989062
West Sacramento,CA95798 		94-6036494 501(c)(3) 387,631       Pass Through from Northern California region for v
(878) URDC Human Svs Corp - BMoore Comm Clinic1460 N Lake Ave 107
Pasadena,CA91114 		95-4410426 501(c)(3) 10,000       Chronic Disease Ed
(879) UTAH STATE Univ1415 Old Main Hill
Logan,UT84322 		87-0276385 501(c)(3) 189,615       Pass Through from Northern California region for v
(880) Vacaville Public Education Fdn3442 Browns Valley Rd
400
Vacaville,CA95688 		61-1568727 501(c)(3) 25,000       CHOOSE WELL BE WELL
(881) Vacaville Social Services Corp712 Catherine St
Vacaville,CA95688 		68-0364021 501(c)(3) 15,000       Health Education for Homeless Population
(882) Valley Care Community Consortium Inc7515 Van Nuys Blvd-5 Fl
Van Nuys,CA91405 		20-5569606 501(c)(3) 160,000       Fit Familes
(883) Valley Community Clinic6801 Coldwater Cyn Av
1B
N Hollywood,CA91605 		23-7050082 501(c)(3) 29,000       40th Anniversary Gala
(884) Valley Family Center302 S Brand Blvd
San Fernando,CA91340 		95-4105054 501(c)(3) 17,000       Culturally Program
(885) Valley Health Team Inc21890 Colorado Ave
San Joaquin,CA93660 		94-2217261 501(c)(3) 40,000       Cardiovascular Disease Panel Management Program
(886) Veggielution647 S King Rd
San Jose,CA95116 		27-2021333 501(c)(3) 20,000       Healthy food access and engagement for low-income
(887) Venice Family Clinic604 Rose Ave
Venice,CA90291 		95-2769432 501(c)(3) 339,000       Health Care Project
(888) Ventura College Fdn4667 Telegraph Rd
Ventura,CA93003 		77-0037747 501(c)(3) 10,000       Ventura College Promise
(889) Venture Humanity Inc32119 Beachlake
Lane
Westlake Village,CA91361 		20-8881179 501(c)(3) 10,000       Service Award Grant
(890) Viet-Amer Cervical Cancer Prevention Proj2295 Vallejo St-508
San Francisco,CA94123 		94-3245978 501(c)(3) 10,000       Service Award Grant
(891) VIRGINIA COMMONWEALTH Univ800 E Leigh St
Richmond,VA23298 		54-6001736 501(c)(3) 32,133       Pass Through from Northern California region for v
(892) Virginia Garcia Memorial FdnPO Box 486
Cornelius,OR97113 		91-2077840 501(c)(3) 50,000       Extension of preventive oral health and advocacy s
(893) Vision y Compromiso2536 Edwards Ave
El Cerrito,CA94530 		32-0071651 501(c)(3) 8,235       Ninth Annual Conf
(894) Vista Community Clinic1000 Vale Terrace
Vista,CA92084 		95-2815615 501(c)(3) 100,000       Mental Health prog
(895) VMC Fdn2400 Moorpark 207
San Jose,CA95128 		77-0187890 501(c)(3) 132,448       Childhood feeding waiting room videos
(896) Volunteer Center of Greater Orange County1901 E Fourth St 100
Santa Ana,CA92705 		95-2021700 501(c)(3) 30,000       PARENTS IN ACTION
(897) Wallace Medical Concern254 NW Burnside
Gresham,OR97030 		93-0853709 501(c)(3) 25,000       General Operating Funds for Urgent Care Services a
(898) Washington State Univ FdnPO Box 641927
Pullman,WA99164 		91-1075542 501(c)(3) 15,000       Charitable donation - Board matching gift program
(899) WEAVE Inc1900 K St
Sacramento,CA95811 		94-2493158 501(c)(3) 51,020       Feast for WEAVE
(900) Well of Healing Mobile Medical Clinic7623 East Ave
Fontana,CA92336 		33-0831503 501(c)(3) 20,000       Intervention Program
(901) West Coast Sports Medicine Fdn1200 Rosecrans Av
206
Manhattan Beach,CA90266 		95-4497009 501(c)(3) 50,000       Medicine Clinic
(902) West County Health Centers Inc14045 Mill St
Guerneville,CA95446 		23-7310613 501(c)(3) 15,170       Resorts in Bloom 2011
(903) West Marin Senior Services11435 State Hwy1
Pt Reyes Station,CA94956 		51-0192320 501(c)(3) 12,240       Holstein 100 Charity Bike Rides and Walk
(904) West Side Food Bank1710 22nd St
Santa Monica,CA90404 		95-3685875 501(c)(3) 60,000       Healthy Eating
(905) Westminster Free Clinic5560 Napoleon Ave
Oak Park,CA91377 		77-0563241 501(c)(3) 9,500       Family Clinic Proj
(906) Westside Family Health Center1711 Ocean Park Blvd
Santa Monica,CA90405 		95-2931931 501(c)(3) 11,100       Believe. Achieve. Gala
(907) Westside Neighborhood Clinic2125 Santa Fe Ave
Long Beach,CA90810 		95-2973364 501(c)(3) 15,000       Nurse Expansion
(908) Whiteside Manor2473 Orange St
Riverside,CA92501 		23-7126416 501(c)(3) 20,000       Housing for Individuals
(909) Whittier Area First Day Coalition12426 Whittier Blvd
Whittier,CA90602 		93-1141844 501(c)(3) 8,250       Wellness Clinic
(910) Whittier Rio Hondo AIDS Project9200 Colima Rd 104
Whittier,CA90605 		95-4438637 501(c)(3) 22,000       Mental Health Services
(911) Wholesome Wave Foundtn Charit Ventures189 State St
Bridgeport,CT06896 		26-0352899 501(c)(3) 122,934       Healthier Comm
(912) Wilmington Community Free Clinic1009 N Avalon Blvd
Wilmington,CA90744 		95-3137803 501(c)(3) 20,000       Self Management
(913) Women At Work3871 E Colorado Blvd
Pasadena,CA91107 		95-3411403 501(c)(3) 13,000       2011 Annual Awards
(914) Women Organized to Respond414 13th St 2nd flr
Oakland,CA94612 		94-3177103 501(c)(3) 10,000       HIV/AIDS Awards
(915) Women Organizing Resources Knowledge & Svs795 N Ave 50
Los Angeles,CA90042 		95-4680440 501(c)(3) 10,000       Nutrition Programs
(916) Women's Empowerment1400 North C St
Sacramento,CA95811 		03-0520643 501(c)(3) 10,000       Substance Abuse Education and Prevention Program
(917) Women's Initiative for Self Employment1398 Valencia St
San Francisco,CA94110 		94-3081525 501(c)(3) 70,000       Economic Opportunity for Low-Income Entrepreneurs
(918) Worksite Wellness LA5955 S Western Ave
Los Angeles,CA90047 		55-0802354 501(c)(3) 29,000       South LA Project
(919) WorldLink Fdn38 Keyes Ave 17
San Francisco,CA94129 		95-4271075 501(c)(3) 20,000       Nourish Oakland
(920) Yamhill County412 NE Ford St
McMinnville,OR97128 		93-6002318 Government 30,000       Yamhill County Dental Project General Operating Su
(921) YMCA of Anaheim240 S Euclid St
Anaheim,CA92802 		95-1709299 501(c)(3) 10,000       Y.E.S. Program
(922) YMCA of Greater Whittier12510 E Hadley St
Whittier,CA90601 		95-1684795 501(c)(3) 75,000       HEAL Grant
(923) YMCA of Metropolitan Los Angeles2900 Whitter Blvd
Los Angeles,CA90023 		95-1644052 501(c)(3) 109,500       PLAY Program
(924) YMCA of Silicon Project Conerstone1922 The Alameda 3rd Fl
San Jose,CA95126 		94-1156318 501(c)(3) 62,000       Asset Champions Awards Breakfast
(925) YMCA of Silicon Valley1445 Hudson St
Redwood City,CA94061 		94-1212140 501(c)(3) 35,000       Fit Kids
(926) YMCA of the East Bay263 S 20th St
Richmond,CA94804 		94-1156317 501(c)(3) 45,000       YMCA Annual Partners Campaign
(927) Yolo County Childrens Alliance600 A St Y
Davis,CA94616 		68-0526185 501(c)(3) 102,100       Yolo County Celebrity Fashion Show
(928) Yolo Family Resource Center828 Court St
Woodland,CA95695 		47-0871252 501(c)(3) 25,000       YoloAccess
(929) Yolo Family Service Agency455 First St
Woodland,CA95695 		94-1452884 501(c)(3) 10,000       Low Income Counseling West Sacramento
(930) Young Men's Christian Assoc of San Francisco631 Howard St 500
San Francisco,CA94105 		94-0997140 501(c)(3) 50,000       Gateway to Fitness
(931) Young Women's Christian Assoc8172 Magnolia Ave
Riverside,CA92504 		95-1667178 501(c)(3) 23,186       Teen Pregnancy Program
(932) Youth ALIVE3300 Elm St
Oakland,CA94609 		94-3143254 501(c)(3) 76,580       20th Anniversary Gala
(933) Youth and Family Services Inc1017 Tennessee St
Vallejo,CA94590 		94-2793548 501(c)(3) 20,000       Learning To Live Healthy
(934) Youth Enrichment Strategies2811 Macdonald Ave
Richmond,CA94804 		03-0458294 501(c)(3) 15,000       PeaceTalk
(935) Youth Radio1701 Broadway
Oakland,CA94612 		94-3180825 501(c)(3) 92,500       STD Prevention Awareness Month training event
(936) Youth Speak Collective11243 Glenoaks Blvd 11
Pacoima,CA91331 		27-0126980 501(c)(3) 12,000       Project Youth Green
(937) YWCA Clark County3609 Main St
Vancouver,WA98663 		91-0569882 501(c)(3) 9,914       Childcare for Families Experiencing Domestic Viole
(938) YWCA of San Pedro437 W 9th St
San Pedro,CA90731 		95-1691337 501(c)(3) 10,000       Breast Cancer Detection
(939) YWCA of Sonoma County1421 Guerneville Rd
200
Santa Rosa,CA95403 		94-2347428 501(c)(3) 10,000       Bilingual Domestic Violence Family Counseling
(940) YWCA San Gabriel Valley943 N Grand Ave
Covina,CA91724 		95-1641967 501(c)(3) 7,500       Healthy Teens Program
(941) ZERO BREAST CANCER4340 Redwood Hwy
San Rafael,CA94903 		68-0386016 501(c)(3) 50,879       Pass Through from Northern California region for v
(942) Alameda County Health Care Svcs Agency1000 San Leandro Blvd
Suite 300
San Leandro,CA94577 		94-6000501 501(c)(3)   41,303 Invoice Kick-count videos In-kind work w/ multi-media
(943) CA School Health Centers Assoc1203 Preservation Park Wy
Suite 302
Oakland,CA94612 		94-3201896 501(c)(3)   17,493 invoice communications suppo MMC Communications support
(944) County of Santa Clara1400 Parkmoor 120B
San Jose,CA95126 		94-6000533 government   79,970 invoice public svc announcem In-kind work w/ multi-media
(945) Martin Luther King Jr Freedom Center333 E 8th St
Oakland,CA94612 		94-3390034 501(c)(3)   18,972 invoice video in-kind works w/ multi-media
(946) Soil Born Farm Urban Agriculture Project3000 Hurley Way
Sacramento,CA95864 		20-0774693 501(c)(3)   23,657 invoice short video from MMC In kind work w/ multi-media
(947) American Pediatric AcademyPO Box 22212
San Diego,CA92192 		33-0782521 501(c)(3)   19,320 cost new children books literacy program
(948) Reach Out & Reach Los Angeles5371 Wilshire Blvd
Suite 210
Los Angeles,CA90036 		04-3481253 501(c)(3)   25,760 cost new children books literacy program
(949) American Pediatric Academy17320 Red Hill 120
Irvine,CA92614 		33-0782521 501(c)(3)   18,400 cost new children books literacy program
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
949
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
0
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
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
(1) Scholarships 221 407,000      













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
SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANTS Grantees are required to submit a final report that describes progress toward goals, impact to date, as well as financial accounting for how funds were used.
Schedule I (Form 990) 2011


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
2011
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number

94-1105628
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 or provision 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. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
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 Regulations 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) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is 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) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(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 as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) Gregory Adams (i)
(ii)		 0
632,621 		0
744,399 		0
687,313 		0
279,554 		0
12,994 		0
2,356,881 		0
662,623
(2) Peter Andruszkiewicz (i)
(ii)		 0
162,469 		0
241,999 		0
230,261 		0
130,331 		0
7,677 		0
772,737 		0
220,256
(3) Mary Ann Barnes (i)
(ii)		 0
348,775 		0
202,360 		0
120,881 		0
113,232 		0
12,064 		0
797,312 		0
100,230
(4) Anthony Barrueta (i)
(ii)		 0
394,713 		0
356,000 		0
128,616 		0
141,188 		0
12,994 		0
1,033,511 		0
107,821
(5) Raymond Baxter (i)
(ii)		 0
526,478 		0
697,967 		0
42,520 		0
61,308 		0
12,994 		0
1,341,267 		0
0
(6) Christopher L Boyd (i)
(ii)		 0
357,510 		0
147,435 		0
19,149 		0
83,506 		0
12,994 		0
620,594 		0
0
(7) Michael Brady (i)
(ii)		 0
346,875 		0
297,771 		0
34,405 		0
93,294 		0
23,885 		0
796,230 		0
0
(8) Virginia Campbell (i)
(ii)		 0
356,247 		0
130,638 		0
23,276 		0
98,955 		0
13,517 		0
622,633 		0
0
(9) Christine Cassel (i)
(ii)		 0
184,500 		0
0 		0
0 		0
0 		0
0 		0
184,500 		0
0
(10) William Caswell (i)
(ii)		 0
391,732 		0
283,422 		0
160,719 		0
110,997 		0
12,064 		0
958,934 		0
124,624
(11) Thomas Chapman (i)
(ii)		 0
191,695 		0
0 		0
0 		0
89,109 		0
0 		0
280,804 		0
0
(12) Greg K Christian (i)
(ii)		 0
313,454 		0
150,515 		0
17,150 		0
84,418 		0
12,567 		0
578,104 		0
0
(13) Benjamin Chu (i)
(ii)		 0
633,952 		0
784,900 		0
513,634 		0
277,443 		0
12,567 		0
2,222,496 		0
488,944
(14) Judith Coffey (i)
(ii)		 0
290,608 		0
118,577 		0
133,884 		0
78,643 		0
12,994 		0
634,706 		0
113,411
(15) Jeffrey A Collins (i)
(ii)		 0
312,509 		0
155,690 		0
19,626 		0
81,720 		0
12,994 		0
582,539 		0
0
(16) Charles Columbus (i)
(ii)		 0
470,126 		0
284,304 		0
101,707 		0
191,573 		0
12,994 		0
1,060,704 		0
0
(17) Diane Comer (i)
(ii)		 0
313,874 		0
264,557 		0
35,048 		0
90,148 		0
12,994 		0
716,621 		0
0
(18) Mark Costa (i)
(ii)		 0
314,025 		0
158,243 		0
18,266 		0
82,769 		0
12,064 		0
585,367 		0
0
(19) James Goff Crawford (i)
(ii)		 0
279,663 		0
201,665 		0
112,041 		0
77,710 		0
12,064 		0
683,143 		0
0
(20) Richard Daniels (i)
(ii)		 0
461,937 		0
515,084 		0
178,617 		0
121,170 		0
13,517 		0
1,290,325 		0
0
(21) Steven Doshay (i)
(ii)		 0
185,296 		0
68,472 		0
5,689 		0
42,340 		0
12,064 		0
313,861 		0
0
(22) Philip Fasano (i)
(ii)		 0
731,546 		0
1,070,000 		0
342,820 		0
313,947 		0
12,640 		0
2,470,953 		0
0
(23) Elizabeth Finley (i)
(ii)		 0
299,356 		0
170,330 		0
140,097 		0
94,134 		0
12,064 		0
715,981 		0
101,158
(24) Jerry Fleming (i)
(ii)		 0
413,228 		0
501,100 		0
164,115 		0
134,930 		0
13,517 		0
1,226,890 		0
103,400
(25) Diane Gage-Lofgren (i)
(ii)		 0
432,992 		0
390,000 		0
207,011 		0
147,179 		0
13,517 		0
1,190,699 		0
184,137
(26) Daniel Garcia (i)
(ii)		 0
562,551 		0
640,000 		0
26,214 		0
61,308 		0
12,296 		0
1,302,369 		0
0
(27) Lazaro Garcia (i)
(ii)		 0
286,288 		0
236,467 		0
129,206 		0
83,371 		0
12,994 		0
748,326 		0
95,687
(28) Edward Glavis (i)
(ii)		 0
313,966 		0
175,944 		0
83,462 		0
104,156 		0
12,994 		0
690,522 		0
46,450
(29) Sandra Golze (i)
(ii)		 0
249,384 		0
143,927 		0
17,098 		0
84,922 		0
12,994 		0
508,325 		0
0
(30) Mitchell Goodstein (i)
(ii)		 0
430,852 		0
455,116 		0
557,161 		0
151,857 		0
12,994 		0
1,607,980 		0
531,838
(31) William Graber (i)
(ii)		 0
208,269 		0
0 		0
0 		0
0 		0
0 		0
208,269 		0
0
(32) J Eugene Grigsby III (i)
(ii)		 0
210,900 		0
0 		0
0 		0
0 		0
0 		0
210,900 		0
0
(33) George Halvorson (i)
(ii)		 0
1,215,613 		0
5,039,506 		0
1,606,796 		0
61,308 		0
13,287 		0
7,936,510 		0
0
(34) Corwin Harper (i)
(ii)		 0
273,720 		0
129,711 		0
115,033 		0
73,647 		0
13,517 		0
605,628 		0
91,310
(35) Judith Johansen (i)
(ii)		 0
200,075 		0
0 		0
0 		0
0 		0
0 		0
200,075 		0
0
(36) Marilyn Kawamura (i)
(ii)		 0
391,430 		0
475,000 		0
175,759 		0
200,305 		0
13,090 		0
1,255,584 		0
132,168
(37) Patricia Kennedy-Scott (i)
(ii)		 0
359,537 		0
233,004 		0
331,498 		0
135,879 		0
17,789 		0
1,077,707 		0
292,404
(38) Kerry Kohnen (i)
(ii)		 0
356,960 		0
188,914 		0
149,505 		0
126,718 		0
14,839 		0
836,936 		0
81,203
(39) Kathryn Lancaster (i)
(ii)		 0
630,520 		0
907,953 		0
570,629 		0
276,632 		0
12,994 		0
2,398,728 		0
529,003
(40) Wendy L Lee (i)
(ii)		 0
279,829 		0
190,874 		0
97,177 		0
84,251 		0
23,885 		0
676,016 		0
0
(41) Janet Liang (i)
(ii)		 0
381,012 		0
364,157 		0
19,693 		0
169,440 		0
10,734 		0
945,036 		0
0
(42) Donna Lynne (i)
(ii)		 0
476,108 		0
475,000 		0
363,809 		0
208,108 		0
14,839 		0
1,537,864 		0
323,554
(43) Philip Marineau (i)
(ii)		 0
200,769 		0
0 		0
0 		0
0 		0
0 		0
200,769 		0
0
(44) Gerald McCall (i)
(ii)		 0
407,550 		0
283,422 		0
82,119 		0
123,842 		0
12,567 		0
909,500 		0
58,778
(45) Andrew McCulloch (i)
(ii)		 0
388,769 		0
354,518 		0
75,624 		0
204,811 		0
14,672 		0
1,038,394 		0
0
(46) Colleen McKeown (i)
(ii)		 0
317,251 		0
152,504 		0
118,363 		0
92,958 		0
12,994 		0
694,070 		0
99,561
(47) Judith Mears (i)
(ii)		 0
240,165 		0
134,809 		0
32,164 		0
78,643 		0
13,517 		0
499,298 		0
0
(48) Thomas Meier (i)
(ii)		 0
314,471 		0
339,188 		0
148,588 		0
97,808 		0
12,994 		0
913,049 		0
113,944
(49) Julie Miller-Phipps (i)
(ii)		 0
333,887 		0
181,454 		0
128,003 		0
96,807 		0
12,064 		0
752,215 		0
110,909
(50) Jenny Ming (i)
(ii)		 0
179,269 		0
0 		0
0 		0
0 		0
0 		0
179,269 		0
0
(51) Chadwick Henry Nestman (i)
(ii)		 0
262,902 		0
205,670 		0
129,256 		0
96,732 		0
13,517 		0
708,077 		0
0
(52) Indrajit Obeysekere (i)
(ii)		 0
221,679 		0
88,315 		0
11,298 		0
43,104 		0
13,517 		0
377,913 		0
0
(53) Donald Orndoff (i)
(ii)		 0
376,297 		0
235,328 		0
22,649 		0
124,482 		0
13,517 		0
772,273 		0
0
(54) Nathaniel Oubre (i)
(ii)		 0
355,459 		0
118,324 		0
159,402 		0
90,369 		0
12,064 		0
735,618 		0
110,339
(55) Edward Pei (i)
(ii)		 0
173,000 		0
0 		0
0 		0
16,500 		0
0 		0
189,500 		0
0
(56) J Neal Purcell (i)
(ii)		 0
234,858 		0
0 		0
0 		0
0 		0
0 		0
234,858 		0
0
(57) Paul Records (i)
(ii)		 0
0 		0
0 		0
502,499 		0
23,697 		0
10,090 		0
536,286 		0
0
(58) Frank Richardson (i)
(ii)		 0
196,528 		0
76,249 		0
5,731 		0
32,638 		0
10,734 		0
321,880 		0
0
(59) Christine Robisch (i)
(ii)		 0
290,836 		0
118,494 		0
96,593 		0
82,963 		0
13,517 		0
602,403 		0
79,638
(60) ROCHELLE ROTH (i)
(ii)		 0
167,206 		0
26,934 		0
2,844 		0
29,508 		0
12,585 		0
239,077 		0
0
(61) Jacqueline Sellers (i)
(ii)		 0
181,205 		0
64,010 		0
5,459 		0
43,670 		0
13,517 		0
307,861 		0
0
(62) Arthur Southam (i)
(ii)		 0
741,374 		0
1,175,000 		0
732,850 		0
336,623 		0
12,064 		0
2,997,911 		0
688,121
(63) Deborah Stokes (i)
(ii)		 0
315,132 		0
337,575 		0
67,595 		0
105,024 		0
12,994 		0
838,320 		0
48,521
(64) Cynthia Telles (i)
(ii)		 0
204,613 		0
0 		0
0 		0
0 		0
0 		0
204,613 		0
0
(65) Bernard Tyson (i)
(ii)		 0
892,605 		0
1,290,000 		0
617,691 		0
469,158 		0
12,994 		0
3,282,448 		0
587,707
(66) Max Villalobos (i)
(ii)		 0
325,389 		0
119,724 		0
130,317 		0
84,392 		0
13,517 		0
673,339 		0
84,257
(67) Herman Weil (i)
(ii)		 0
330,618 		0
339,494 		0
195,216 		0
78,643 		0
17,265 		0
961,236 		0
154,343
(68) Jed Weissberg (i)
(ii)		 0
489,199 		0
418,100 		0
23,523 		0
232,350 		0
12,994 		0
1,176,166 		0
0
(69) Vita Willett (i)
(ii)		 0
313,765 		0
151,737 		0
16,906 		0
94,212 		0
12,064 		0
588,684 		0
0
(70) Carlos Zaragoza (i)
(ii)		 0
265,911 		0
166,182 		0
25,379 		0
118,797 		0
12,064 		0
588,333 		0
0
(71) Steven Zatkin (i)
(ii)		 0
4,500 		0
542,685 		0
26,936 		0
66,393 		0
10,532 		0
651,046 		0
0
(72) Victoria Zatkin (i)
(ii)		 0
192,675 		0
85,692 		0
36,401 		0
82,570 		0
1,961 		0
399,299 		0
0
(73) Mark Zemelman (i)
(ii)		 0
398,502 		0
259,500 		0
120,574 		0
179,338 		0
12,585 		0
970,499 		0
80,051
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 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 Hospitals 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 4-A SEVERANCE PAYMENTS Paul Records $ 502,313 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 4-B SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENTS Gregory Adams 662,623 Peter Andruszkiewicz 220,256 Mary Ann Barnes 100,230 Anthony Barrueta 107,821 William Caswell 124,624 Benjamin Chu 488,944 Judith Coffey 113,411 James Goff Crawford 86,962 Elizabeth Finley 101,158 Jerry Fleming 107,333 Diane Gage-Lofgren 184,137 Lazaro Garcia 95,687 Edward Glavis 48,068 Mitchell Goodstein 532,912 George Halvorson 1,500,000 Corwin Harper 91,310 Marilyn Kawamura 134,185 Patricia Kennedy-Scott 292,404 Kerry Kohnen 81,203 Kathryn Lancaster 529,350 Wendy L. Lee 80,740 Donna Lynne 323,554 Gerald McCall 60,592 Colleen McKeown 99,561 Judith Mears 2,750 Thomas Meier 114,428 Julie Miller-Phipps 110,909 Nathaniel Oubre 141,906 Christine Robisch 79,638 Arthur Southam 688,121 Deborah Stokes 48,521 Bernard Tyson 587,707 Max Villalobos 84,257 Herman Weil 154,343 Steven Zatkin 4,891 Mark Zemelman 81,133 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, 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, Part II   Sandra Thompkins - Board of Directors to 4/1/11. Peter Andruszkiewicz - Regional President of Georgia until 4/26/11. Kerry Kohnen - Regional President of Georgia beginning 5/30/11. Steven Zatkin - General Counsel to 6/30/10; Consultant 3/4/11 to Present.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number
94-1105628
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		52-1598225 130911RW2 08-06-2003 213,060,000 PAR REFUNDING CHFFA 83,85,93 SER C   X   X   X
B CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130911WF3 03-30-2004 1,600,000,000 FINANCE HEALTH CARE FACILITY   X   X   X
C CALIFORNIA STATEWIDE CMNTY DEV AUTH
  		68-0164610 1309112G4 06-08-2006 916,299,000 FINANCE HEALTH CARE FACILITY   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTH
  		52-1643828 13033FK74 06-08-2006 600,000,000 FINANCE HEALTH CARE FACILITY   X   X   X
CALIFORNIA STAEWIDE COMNTYS DEV AUTH
  		68-0164610 1309116M7 02-01-2007 476,113,486 PREM/DISC REFUNDING 01A,02D,04F&G   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795SZ1 05-01-2008 500,000,000 PAR REFUNDING 04A-D ARS BONDS& 04H   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795D38 06-03-2009 1,638,437,048 FINANCE HEALTH CARE FACILITY   X   X   X
CALIFORNIA STATEWIDE CMNTY DEV AUTH
  		68-0164610 130911LD0 06-03-2009 99,996,058 REOFFERING CSCDA (PREMIUM)   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795TP2 06-03-2009 149,996,162 REOFFERING CSCDA (PREMIUM)   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTH
  		52-1643828 13033LML8 05-03-2011 204,545,000 PAR REFUNDING 01A,B,C KHAC BONDS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 213,060,000 1,639,844,037 954,024,896 602,245,616
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 88,159,219 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 0 6,375,000 0 0
8 Credit enhancement from proceeds . . . . . . . . . . 0 10,073,543 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 0 1,535,236,275 954,024,896 602,245,616
11 Other spent proceeds . . . . . . . . . . . 213,060,000 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2009 2009 2009 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X     X   X   X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .   X   X   X   X
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .   X   X   X   X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0% 0% 0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000% 0.00000%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0.00000% 0.00000% 0.00000%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue? X   X     X X  
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X X     X   X
6 Did the bond issue qualify for an exception to rebate? . X     X X   X  
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X     X X   X  
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number
94-1105628
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		52-1598225 130911RW2 08-06-2003 213,060,000 PAR REFUNDING CHFFA 83,85,93 SER C   X   X   X
B CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130911WF3 03-30-2004 1,600,000,000 FINANCE HEALTH CARE FACILITY   X   X   X
C CALIFORNIA STATEWIDE CMNTY DEV AUTH
  		68-0164610 1309112G4 06-08-2006 916,299,000 FINANCE HEALTH CARE FACILITY   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTH
  		52-1643828 13033FK74 06-08-2006 600,000,000 FINANCE HEALTH CARE FACILITY   X   X   X
CALIFORNIA STAEWIDE COMNTYS DEV AUTH
  		68-0164610 1309116M7 02-01-2007 476,113,486 PREM/DISC REFUNDING 01A,02D,04F&G   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795SZ1 05-01-2008 500,000,000 PAR REFUNDING 04A-D ARS BONDS& 04H   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795D38 06-03-2009 1,638,437,048 FINANCE HEALTH CARE FACILITY   X   X   X
CALIFORNIA STATEWIDE CMNTY DEV AUTH
  		68-0164610 130911LD0 06-03-2009 99,996,058 REOFFERING CSCDA (PREMIUM)   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795TP2 06-03-2009 149,996,162 REOFFERING CSCDA (PREMIUM)   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTH
  		52-1643828 13033LML8 05-03-2011 204,545,000 PAR REFUNDING 01A,B,C KHAC BONDS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 213,060,000 1,639,844,037 954,024,896 602,245,616
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 88,159,219 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 0 6,375,000 0 0
8 Credit enhancement from proceeds . . . . . . . . . . 0 10,073,543 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 0 1,535,236,275 954,024,896 602,245,616
11 Other spent proceeds . . . . . . . . . . . 213,060,000 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2009 2009 2009 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X     X   X   X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .   X   X   X   X
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .   X   X   X   X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0% 0% 0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000% 0.00000%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0.00000% 0.00000% 0.00000%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue? X   X     X X  
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X X     X   X
6 Did the bond issue qualify for an exception to rebate? . X     X X   X  
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X     X X   X  
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number
94-1105628
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		52-1598225 130911RW2 08-06-2003 213,060,000 PAR REFUNDING CHFFA 83,85,93 SER C   X   X   X
B CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130911WF3 03-30-2004 1,600,000,000 FINANCE HEALTH CARE FACILITY   X   X   X
C CALIFORNIA STATEWIDE CMNTY DEV AUTH
  		68-0164610 1309112G4 06-08-2006 916,299,000 FINANCE HEALTH CARE FACILITY   X   X   X
D CALIFORNIA HEALTH FACILITIES FINANCING AUTH
  		52-1643828 13033FK74 06-08-2006 600,000,000 FINANCE HEALTH CARE FACILITY   X   X   X
CALIFORNIA STAEWIDE COMNTYS DEV AUTH
  		68-0164610 1309116M7 02-01-2007 476,113,486 PREM/DISC REFUNDING 01A,02D,04F&G   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795SZ1 05-01-2008 500,000,000 PAR REFUNDING 04A-D ARS BONDS& 04H   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795D38 06-03-2009 1,638,437,048 FINANCE HEALTH CARE FACILITY   X   X   X
CALIFORNIA STATEWIDE CMNTY DEV AUTH
  		68-0164610 130911LD0 06-03-2009 99,996,058 REOFFERING CSCDA (PREMIUM)   X   X   X
CALIFORNIA STATEWIDE CMNTYS DEV AUTH
  		68-0164610 130795TP2 06-03-2009 149,996,162 REOFFERING CSCDA (PREMIUM)   X   X   X
CALIFORNIA HEALTH FACILITIES FINANCING AUTH
  		52-1643828 13033LML8 05-03-2011 204,545,000 PAR REFUNDING 01A,B,C KHAC BONDS   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 0 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 213,060,000 1,639,844,037 954,024,896 602,245,616
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 88,159,219 0 0
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 0 6,375,000 0 0
8 Credit enhancement from proceeds . . . . . . . . . . 0 10,073,543 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 0 1,535,236,275 954,024,896 602,245,616
11 Other spent proceeds . . . . . . . . . . . 213,060,000 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 0
13 Year of substantial completion . . . . . . . . . . . 2009 2009 2009 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . . X     X   X   X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X   X  
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .   X   X   X   X
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . X   X   X   X  
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .   X   X   X   X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0.00000% 0% 0% 0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet 0.00000% 0.00000% 0.00000% 0.00000%
6 Total of lines 4 and 5 . . .. . . . . . . . . 0.00000% 0.00000% 0.00000% 0.00000%
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .   X   X   X   X
2 Is the bond issue a variable rate issue? X   X     X X  
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X   X
b Name of provider . . . . . . . . 0
  		0
  		0
  		 
 
c Term of hedge . . . . . . . .        
d Was the hedge superintegrated? . . . .                
e Was a hedge terminated? . . . . .                
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X X     X   X
6 Did the bond issue qualify for an exception to rebate? . X     X X   X  
7 Has the organization established written procedures to monitor the requirements of section 148? . . . X     X X   X  
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
Schedule K (Form 990) 2011

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
2011
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number

94-1105628
Identifier Return Reference Explanation
PART I, LINE 19   CURRENT YEAR REVENUE LESS EXPENSES $ 1,536,117,826 OTTI (NOTE 1) (621,166,171) BOOK GAIN ON SALE OF INVESTMENTS 803,271,493 TAX GAIN ON SALE OF INVESTMENTS (434,210,591) HEALTH CARE MANAGEMENT SOLUTIONS, LLC 4,301,990 OTHER PASSTHROUGH INCOME 4,380,255 KP ONCALL, LLC (1,946,853) KPV, LLC - SERIES A (949,869) NXT CAPITAL 270,563 INTERCOMPANY ELIMINATIONS (9,360,160) UNAUDITED STANDALONE GAAP REVENUE LESS EXPENSES $ 1,280,708,483 NOTE 1: OTHER THAN TEMPORARY IMPAIRMENT OF INVESTMENT RECOGNIZED FOR FINANCIAL STATEMENT PURPOSES, WHICH WILL BE TAX REPORTED WHEN REALIZED
PART V, LINE 4B   Kaiser Foundation Hospitals' foreign investments are held in a U.S. third party custodian bank. Kaiser Foundation Hospitals personnel cannot directly access the foreign investments.
PART VI, LINE 4   THE FOLLOWING WERE THE AMENDMENTS TO THE BYLAWS IN 2011: On March 3, 2011, Article D., 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 D-1, Officers); (b) add a new Section D-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 D-7, President); (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) change the reference to "the President" in Sections D-3, D-4 and D-11 to "any President"; and On June 23, 2011, minor technical amendments were made to the Bylaws of the Corporation to make the Bylaws of the Corporation more consistent with the Bylaws of Kaiser Foundation Health Plan, Inc. and its Health Plan subsidiaries and with organizational policies and current law. None of the changes were significant; and On September 9, 2011, Article D, Officers (Section D-12, Hospital Administrators) was amended to include responsibilities that the Board of Directors previously authorized Hospital Administrators to perform concerning the governance and oversight of end stage renal disease facilities, hospice programs and home health agencies as permitted under state and federal law; and On December 1, 2011, amendments were made to the Bylaws of the Corporation to provide for (a) annual actuary reports, to comply with National Association of Insurance Commissioner's regulations; (b) approval of the annual audit plan of the internal auditors, as well as subsequent changes; (c) review and approval of the internal audit department's charter; and (d) review of policies developed by the Chief Compliance Officer and General Counsel, as appropriate.
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 Pricewaterhousecoopers LLP 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.
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. Retaliation is prohibited. 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 or manage 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 Chief Compliance Officer and the SVP 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 process 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 informs 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: - Oral discussion and/or warning by the employee's immediate supervisor or higher level manager to correct the problem - Written notice, with or without final warning - Paid or unpaid suspension, with or without final warning - Termination of employment
PART VI, LINE 15   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.
PART VI, LINE 19   Governing documents - are available as provided to the California Secretary of State 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 the state regulatory agency. Combined data is published for Kaiser Foundation Health Plan Inc. and subsidiaries and Kaiser Foundation Hospitals and Subsidiaries with audit opinion by KPMG. To request copies contact: VP - NATIONAL tax compliance Kaiser Foundation Health Plan and Hospitals One Kaiser Plaza, 15L Oakland, CA 94612
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.
PART XI, LINE 5 Other Changes in Net Assets or Fund Balances Change in Donated Capital $ <30,792,333> Change in Interregional Transfer 61,675,850 Change in Partnership Capital 42,029,149 Restricted Grants - CO <20,299,327> Restricted Grants Reclass 180,492,431 Change in Unrealized Holding Gain <458,323,831> Change in Other Comprehensive Income <963,100,328> Passthrough Income from HCMS 4,301,990 Other passthrough income 4,380,255 KP OnCall book income 2,318,772 KP OnCall tax income <1,946,853> KPV-A book income <467,527> KPV-A tax income <949,869> Gain/Loss on sale of inv. - Book 803,271,493 Gain/Loss on sale of inv. - Tax <434,210,591> OTTI Losses <621,166,171> _________________ TOTAL $ <1,432,786,890>
PART III, LINE 4A-D   2011 COMMUNITY BENEFIT REPORT KAISER FOUNDATION HOSPITALS Kaiser Foundation Hospitals (KFH) and Kaiser Foundation Health Plan, Inc. (KFHP), with its five principal operating tax-exempt subsidiary health plans-Kaiser Foundation Health Plan of Colorado; Kaiser Foundation Health Plan of Georgia, Inc.; Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.; Kaiser Foundation Health Plan of the Northwest; and Kaiser Foundation Health Plan of Ohio, are nonprofit corporations that are part of the integrated health care delivery system known as the Kaiser Permanente Medical Care Program or "Kaiser Permanente." Kaiser Permanente is an integrated health care delivery system that combines the provision and financing of health care services. People who elect to enroll in a Kaiser Permanente health plan receive a full range of prepaid health care services, including hospital care, professional care in hospitals and physicians' offices, x-ray and laboratory services, physical therapy, emergency, ambulance transportation, preventive services, health education and certain prescribed drugs. More comprehensive drug coverage is also provided through a separate coverage rider. KFHP and KFH are separate corporations governed by identical boards of directors. KFH accepts responsibility to provide or arrange necessary hospital services and facilities for Health Plan members. KFH owns and operates 38 licensed hospitals, including several licensed hospitals with multiple campuses in California, Hawaii and Oregon, which provide emergency and in-patient services to all persons in the community regardless of membership or ability to pay. Staff privileges are available on a nondiscriminatory basis to physicians in the communities served. KFH also contracts with other community hospitals to provide hospital services to members for specialized care and other services. In California, KFH medical centers are located in the cities of Anaheim, Antioch, Baldwin Park, Clackamas, Downey, Fontana, Fremont, Fresno, Harbor City, Hayward, Irvine, Los Angeles, Manteca, Modesto, Moreno Valley, Oakland, Ontario, Panorama City, Redwood City, Richmond, Riverside, Roseville, Sacramento, San Diego, San Francisco, San Jose, San Rafael, Santa Clara, Santa Rosa, South Sacramento, South San Francisco, Vacaville, Vallejo, Walnut Creek, West Los Angeles, and Woodland Hills. In Hawaii, the Moanalua Medical Center is located in the City of Honolulu on the island of Oahu. In Oregon, the Sunnyside Medical Center is located in the City of Clackamas. Services provided by KFH and membership in Health Plan are available without regard to sex, race, religion, ethnic background, sexual orientation, occupational status or income level. Health Plan members are broadly representative of the various ages, social, and income groups within the areas served. Once enrolled, a member is free to maintain membership regardless of age, health status, or employment. KAISER PERMANENTE'S COMMITMENT TO THE COMMUNITY Through the Kaiser Permanente mission, the organization contributes to the health of communities in two related ways. First, Kaiser Permanente strives for excellence in serving its 8.9 million members through market-leading performance in quality, service and affordability. By doing so, Kaiser Permanente provides a discipline in the marketplace by demonstrating meaningful value and affordability, and generating resources to reinvest in the community's health. Second, Kaiser Permanente directly invests in improvements to community health by working to increase access for the underserved, disseminating care improvements, altering the social determinants of health, educating healthcare workers and consumers, and informing public policy. This latter approach, which Kaiser Permanente calls 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 priority areas. COMMUNITY BENEFIT PROVIDED BY KAISER FOUNDATION HOSPITALS KFH's principal purpose is to provide hospital, medical, and surgical care, including emergency services, extended care, and home health care to members of the public without regard to age, sex, race, religion, or national origin, or to the individual's ability to pay. KFH's general community benefits are: Emergency Departments - KFH operates full-time emergency departments in each of its 38 licensed hospitals, including five licensed hospitals with multiple campuses in California, Hawaii and Oregon. Emergency medical services are available to all individuals regardless of their ability to pay. Care Provided to All Patients - Hospital care is provided to individuals with health care coverage from any private or government-sponsored health plan, insured and uninsured referrals from safety net and other public health partnerships, and uninsured patients admitted through the emergency department. Open Medical Staff Privileges - Staff privileges in the hospitals are available to community practitioners who are not affiliated with a Permanente Medical Group. Board of Directors - KFH and KFHP have identical 14-member Boards of Directors. The board is comprised of individuals from the academic world and private industry who are representative of the community. George C. Halvorson serves as the Chairman and Chief Executive Officer for the KFHP and KFH Boards of Directors. Reinvestment of Surplus Revenues - KFHP pays KFH for hospital services and all surplus revenues are reinvested for capital replacement or expansion of facilities and equipment, debt amortization, improvement in patient care and services, and other community benefit services including charity care, medical education, and research. THE COMMUNITY BENEFIT PROGRAMS IN CALIFORNIA, HAWAII, OREGON AND WASHINGTON In 2011, KFH spent approximately $888 million to support Community Benefit Programs in the hospital based regions. Breakdowns of the 2011 Community Benefit dollars is described 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 KFH.
CARE AND COVERAGE FOR LOW-INCOME PEOPLE   There are roughly 49 million people in America without access to health care or 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 2011, KFH invested approximately $576 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. Following are highlights of the programs and services provided to vulnerable populations in California, Hawaii, Oregon and Washington: Charitable Care (Medical Financial Assistance and Charitable Health Coverage) KFH provided charity care to low-income vulnerable populations through the Medical Financial Assistance and Charitable Health Coverage programs. KFH invested $244 million to underwrite the cost of care provided in Kaiser Permanente facilities in California, Hawaii, Oregon and Washington. - Medical Financial Assistance (MFA) KFH contributed approximately $178 million to assist patients with limited or no resources to pay for care provided in Kaiser Permanente facilities. Each hospital-based region offers financial assistance to help families and individuals who are unable to meet all or part of the cost of medical care on an immediate and nonrecurring basis. Kaiser Permanente expanded its charity care program to include discounted charges for uninsured patients below 400% of the federal poverty guidelines and aligned contracted collection agency practices with Kaiser Permanente social values. The amount reported under this category is only part of the funds spent by KFH and KFHP for the poor and uninsured. The organization's commitment to charitable care is also reflected in a variety of other programs and initiatives such as the Charitable Health Coverage Program and grants and donations to community clinics and other safety net providers. The MFA programs in California and Hawaii strive to assist families and individuals who are unable to meet all or part of the cost of medical care on an immediate and nonrecurring basis. The program is designed to assist as many patients as reasonably possible and is generally available to people in greatest financial need, including those experiencing unusual or unfortunate circumstances. The MFA program's eligibility criteria allows most patients below 350% of the federal poverty guidelines (FPG) to receive full write off, that uninsured patients who do not qualify for MFA but make less the 400% FPG will receive up to a 70% discount on charges and that any patient experiencing financial hardship due to unreasonable medical expenses relative to their income may qualify for the program under "special circumstances". In 2011, the programs provided 116,501 MFA awards, which included approximately 751,998 prescriptions and more than 94,000 subsidized I/P days of care. In Oregon and Washington, the MFA program supports patients with limited resources by forgiving full or partial expenses for medical and /or dental expenses if they meet the qualifying guidelines. In 2011, the program provided 5,328 MFA awards, which included approximately 50,242 prescriptions and more than 19,000 subsidized I/P days of care. - Charitable Health Coverage Program Charitable Health Coverage (CHC) is a unique approach to caring for low-income uninsured people in the community. Participants receive a regular Kaiser Permanente membership card and access to the full range of our services and providers-a much better alternative to a brief and costly emergency room visits or hospitalization. This allows us to invest in the longer term health of patients and the community. Since the early 1980s, CHC programs have made a real difference in the lives of low-income people who were not eligible for other public or privately sponsored coverage. In 2011, more than 88,000 low-income adults and children who were not eligible for other public or privately sponsored coverage received health care coverage through one of Kaiser Permanente's Charitable Health Coverage Programs in California, Hawaii, Oregon and Washington. KFH contributed $67 million to provide subsidized care for these underserved populations in 2011. The Steps Plan and Kaiser Permanente Child Health Plan are the specific products that form the Charitable Health Coverage Programs in California. Kaiser Permanente Steps Plan - The Steps Plan provided 3,013 individuals the opportunity to continue their health care coverage at reduced cost when experiencing financial difficulty due to job loss, involuntary reduction in work hours, legal separation, divorce or death of a spouse. Typically, participants are not eligible for any public or private group health insurance plan, and have family income between 100% and 300% of the federal poverty guidelines. The plan is available to parents of children enrolled in AIM, Healthy Families or Kaiser Permanente Child Health Plan as well as to individuals participating in vocational training programs offered through government, private industry councils and social agencies. The Steps Plan premium is subsidized at four levels or steps: 20%, 40%, 60%, and 80%. Participants are placed in an initial premium step based on their current family income. They remain at the initial step for one year and are then moved to the next higher step. Kaiser Permanente Child Health Plan (KPCHP) - The Child Health Plan provides medical and dental coverage to eligible children (birth through 18) in families with income up to 300% of the federal poverty guidelines who do not have access to employer-subsidized coverage and do not qualify for public programs because of family income or immigration status. Child Health Plan provides comprehensive benefits including preventive care, inpatient and outpatient services, prescription drugs, and vision and dental care. Premiums are $8 or $15 per child per month, depending on family income, for a maximum of three children (additional children are covered free of charge). In 2011, approximately 80,566 children received care and coverage through this program. KFH in the Northwest subsidized coverage to 4,583 low-income adults and children who are not eligible for standard Medicaid or privately funded coverage. The Charitable Health Coverage Program consists of Transitions, Child Health Program, and Washington Basic Health. Transitions - This program is a fully subsidized health insurance program for eligible low-income families. Eight college campuses currently participate within the Portland Metropolitan area. Students must be enrolled in a participating school, meet the financial criterion, and cannot be enrolled in another private or public health care plan. Graduates are eligible for an additional six months coverage or until the employer-paid coverage is activated. Child Health Plan - Northwest Health Plan offers full subsidy health insurance for eligible low-income students. Currently, 180 schools within the Multnomah Education Service District, Salem-Keizer School District and Hillsboro School District participate in this program. Students must be enrolled in a participating school, meet the financial criterion, and cannot be enrolled in another private or public health care plan. The participating school districts act as the administrator for the program and are responsible for outreach and enrollment. Washington Basic Health Plan - This program offers quality low-cost health coverage to eligible people who live in Washington State and managed by Washington Health Care Authority (HCA). The Northwest Health Plan provides services to eligible participants who reside in Clark or Cowlitz counties.
Participation in Medicaid and Other Government-Sponsored Programs   KFH has a long history of participating in publicly financed health programs. In 2011, $253 million was expended (in excess of reimbursement) in government- sponsored programs for low-income people in California, Hawaii, Oregon and Washington. Highlights of the government-sponsored health care coverage programs in California supported by KFH include: - Medi-Cal - KFH provided access to inpatient care for 187,780 Medi-Cal (Medicaid) managed care members in California. . - Medi-Cal Fee-for-Service - KFH in California provided subsidized care to approximately 75,000 Medi-Cal Fee-for-Service patients. Of this amount, approximately $57 million is attributed to services provided by KFH. - Healthy Families - KFHP enrolled, and KFH provided access to inpatient care for 190,286 California children in this federal- and state-funded insurance program that provides low- and moderate-income families with health insurance for their children under 19 years of age. The program provides comprehensive health benefits, including dental and vision care. To qualify, families must have a total income between 100% and 250% of the federal poverty guidelines and the children must be ineligible for Medi-Cal coverage. Highlights of the government-sponsored health care coverage programs in Hawaii supported by KFH include: - Quest & Medicaid Fee-for-Service - QUEST is a Medicaid managed care program run by the Hawaii's Department of Human Services. KFH participates in the QUEST programs on the islands of Oahu and Maui. KFH provided access to care for 23,557 individuals enrolled in Quest and expended approximately $7.7 million on subsidized medical care services. The Hawaii Region also contributed an additional $3 million on subsidized care for Medicaid Fee-for-Service patients. - CHIP - This government program provides children with family incomes up to twice the federal poverty guidelines for Hawaii, health care coverage under Title XXI of the Social Security Act. CHIP is one of several aid categories under the QUEST program. More than 4,250 children enrolled in this program were cared for by KFH in Hawaii. Highlights of the government-sponsored health care coverage programs in Oregon and Washington supported by KFH include: - Washington Basic Health Plus (BH-Plus) - This is Washington's Medicaid program for children under age 19 who live in households that meet the eligibility guidelines for Medicaid. The Maternity Benefits Program is a Medicaid program for pregnant women. The Department of Social and Health Services (DSHS) determines eligibility for BH Plus. Northwest Health Plan and KFH provide services to eligible participants who reside in Clark and Cowlitz counties. - Medicaid Fee-for-Service - KFH in Northwest provided $5.9 million in subsidized care to Medicaid Fee-for-Service patients. Grants and Donations for Care and Coverage In 2011, KFH donated approximately $4.1 million to more than 100 nonprofit and community-based organizations in California to help low-income families and uninsured children navigate the enrollment and recertification processes for public and private programs and improve their ability to access needed medical care. Following are a few examples: - Redwood Community Health Coalition (RCHC): With the $75,000 grant, RCHC will increase its managed care Medi-Cal enrollment and retention rates by improving clinic operation systems - including integrating electronic health records with One eApp. In addition they will focus on redesigning their work flows and providing workforce training to increase skills and efficiencies. - Tides Center: The Tides Center received a $200,000 grant to address universal enrollment needs of state and federal health insurance exchanges mandated by the passage of the Affordable Care Law. It will ensure that the user experience is efficient and appropriate along federally required dimensions with tools that allow for state-specific situations and needs. In addition, it will introduce efficiencies into the design process through the centralization of design standards that allow for reuse of key elements, broad distribution, and usage at scale. 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. Our community Health Initiatives (CHI) started with a focus on nutrition and physical activity. Our work has since expanded to address community economic development, environmental sustainability, and neighborhood safety - additional factors that are key to promoting health communities. In 2011, KFH expended approximately $14.8 million to support CHI work. The following are examples of programs and services funded in 2011: Health Eating Active Living (HEAL) Programs The HEAL program combats obesity by promoting place-based healthy eating and active living programs and interventions in the community. The program supports community health initiatives and coalitions that bring community-level medical, environmental, and social changes such as empowering community residents to eat healthy foods, changing physical and social environments to promote physical activity, and supporting policy changes to reduce racial and ethnic health disparities, particularly those related to poor nutrition and inactivity. Community Health Education and Prevention Programs KFH in California, Hawaii, Oregon, and Washington provided a variety of activities and programs to assist health care consumers in managing their health and well-being. The hospitals serve as the primary site for the dissemination of health education information to both Health Plan and community members who access these resources through the health education centers. Expenditures in this category exclude program costs for health education programs targeting or restricted to Health Plan members. Other programs and services are offered in various community locations. Grants and Donations for Community Health Initiatives KFH contributed approximately $13.2 million to nonprofit community organizations in California, Hawaii, Oregon and Washington to support a variety of community health initiatives. The following are examples of programs and services funded in 2011: - The Effort, Inc.: The $200,000 grant to The Effort will fund the life-changing Sacramento Violence Intervention Program, a program that is integral to Kaiser Permanente's South Sacramento Trauma Center. The program provides intensive case management to youth ages 15-24 and connects them with the health and social services they need after being hospitalized for violence-related injuries. The program also provides conflict resolution for these youth, their friends and family with the goal of preventing retaliation and re-injury. - California Association of Food Banks (CAFB): With a $100,000 grant, the food bank will purchase 100 million pounds of fresh produce that will be distributed to low-income populations. In addition, they will focus on increasing the efficiency and capacity of the Farm to Family Program, as well as the safety net of Federal nutrition programs. - The Community Alliance with Family Farmers (CAFF): With the $70,000 grant, CAFF will help bring healthy, sustainably grown produce to hospital patients and employees of organizations across the Bay Area. By connecting local farmers with nearby institutions and better equipping farmers to consistently meet demand CAFF will help improve the overall food system in Northern California. - Occidental College's Urban & Environmental Policy Institute received $125,000 to replicate its Farm to Preschool program. The program trains preschool staff to establish vendor relationships with local farmers and to establish buying practices. Students and parents are introduced to nutrition education and cooking lessons in school curriculum. Advocacy on how to improve school food policy is included in parent workshops in an effort to influence early childhood eating habits that maintain a healthy weight and prevent obesity. - Oregon Public Health Division, Oregon Department of Corrections: The Oregon Public Health Division, Oregon Department of Corrections received a $180,000 grant from the KFH Northwest donor advised fund to provide healthier food and teach gardening and food preparation skills to female inmates. By eating healthier, achieving better health outcomes, and developing new skills, these women will have improved employment opportunities and be able to contribute more productively to family and their community upon release.
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. In 2011, KFH contributed $15.9 million to support these programs. Through contractual arrangements with safety net partners, specific populations of nonmembers received specialty and dental care in Northwest KFH and Health Plan facilities. The following describes two of these special community partnerships: - Through a special contract with Multnomah County, the Dental Care Program provides urgent dental care services to uninsured residents of Multnomah, Clackamas, and Washington counties. - Through an agreement between the Dental Care Program and the Salem-Keizer school district, the Dental Program provides urgent dental care services to uninsured school children each month school is in session at each of the two Salem-area dental offices. Grants and Donations for Safety Net Partnerships During 2011, KFH spent $15.5 million to support more than 270 organizations that deliver medical and/or dental care services to uninsured people in community setting, primarily safety net clinics in California, Oregon and Washington. Below are examples of the community organizations supported by these grants: - Central Valley Health Network (CVHN) received a $90,000 grant for core operating support. The network members operate in 21 counties across California and provide more than 2.5 million encounters to more than 600,000 patients annually. CVHN will utilize this grant to continue pursuing its priorities to enhance members' capacity and improve access to primary care services in the Central Valley Region. CVHN will also increase clinician capacity through participation in Institute for Healthcare Improvement programs and in all health reform implementation activities with California Primary Care Association and National Association of Community Health Centers. - California Primary Care Association received a $300,000 core operating support grant. It positions community health centers to succeed in the new health care delivery system with the Affordable Care Act and Medicaid 1115 Waiver by helping organizations navigate new reimbursement and billing mechanisms and enrollment processes. - The California Health Care Safety Net Institute received a $300,000 core operating support grant to expand its scope of services and expertise in assisting California's public hospitals in meeting the requirements of the Medicaid 1115 waiver. - The California Health Care Safety Net Institute received a $165,000 grant to help pursue its major goals around quality and coordinated, efficient care delivery systems, working with KP and its member hospital systems to improve specialty care access, conduct a gap analysis and identify where to focus future efforts and resources, and operationalize the partnership goals. - Health Care Interpreter Network received a $300,000 core operating support grant to support the ongoing management and infrastructure development of the organization, expand membership, plan/test/evaluate a pilot project, and convene a conference to advance the skills and knowledge of interpreters. - California School Health Centers Association received a $80,000 core operating support grant to expand awareness and support for school-based health centers (SBHCs) as a way to increase access to health care and improve academic success and help school districts and community clinics start up SBHCs. - Pomona Community Health Center received a $75,000 grant to help provide administrative support for the agency as it expands to a new clinic site. The funding supports an administrative services coordinator. This grant will allow for operational transition for the new clinic site as well as better access to care through development of policies and workflows for the new clinic site. - Vista Community Clinic received a $75,000 grant for its Vale Terrace Capital Expansion project. The agency utilized funds to help purchase equipment and furnishings for a new expanded clinic site. The grant will help provide additional capacity for women's health care and expand pediatric, family and dental services. - Bartz-Altadonna Community Health Center received a $250,000 grant over one year for renovation of its East Lancaster facility. With this support, the agency will be able to triple its clinic space, and thus greatly increase the number of patients. - The Coalition of Orange County Community Clinics received a $330,000 grant over two years ($165,000 in 2011) for core operations and quality improvement support to help member clinics keep serving over 200,000 low-income, uninsured, and underserved individuals in Orange County annually. Core operating support will help the coalition increase the effectiveness and efficiencies of member clinics, better the quality improvement infrastructure, implement clinical and administrative performance measuring systems, and conduct a patient evaluation survey using outside consultants. Supporting the coalition as it creates and develops new strategies, improves the financial infrastructure, and maintains core operations is vital to the success and sustainability of the safety net system in Orange County. - Lower Columbia College Head Start Cowlitz County: They received a $129,317 grant to support the development of a bilingual Community Health Outreach Worker to serve 4,800 under/uninsured individuals, sponsor provider training's, and purchase curriculums for preschool training's. 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. KFH spent $258 million to support programs and services for the development and dissemination of knowledge and provided grants and donations to nonprofit organizations. Since 1946, Kaiser Permanente researchers have made thousands of medical discoveries. In 2011, investigators at our research centers in California, Oregon and Washington conducted more than 2,900 research and evaluation studies and published almost 700 journal articles Kaiser Permanente investigators participated in research and evaluation studies, collaborating with several prominent academic research institutions, including Harvard University, Oregon Health & Sciences University, Stanford University, University of California (Los Angeles, Berkeley, and San Francisco), University of Southern California, University of Washington, National Institutes of Health, Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention. In California, Kaiser Permanente has three research departments: the Division of Research (DOR) in Northern California, established in 1961; Department of Research & Evaluation (R&E) in Southern California, established in the early 1980s: and Kaiser Foundation Research Institute (KFRI). Two nursing research units for KFH in California also engage in studies on nursing practices, patient care, and patient outcomes to improve clinical practices. The Center for Health Research (CHR) is the primary research department for KFH in Oregon and Washington and the Center for Health Research Hawaii (CHRH) is a formal subdivision of CHR in the Northwest. CHR, CHRH, DOR, KFRI, and R&E-together with the Northern and Southern California Nursing Research Departments-spent approximately $160 million to support research and evaluation studies. Their studies appeared in The New England Journal of Medicine, The Journal of the American Medical Association, American Journal of Public Health, Annals of Internal Medicine and many other leading general and specialized journals. Following is a sampling of the evidence-based studies conducted in 2011: - Adequate Sleep and Reduced Stress Helps with Weight Loss. Getting the right amount of sleep and reducing stress levels can help with weight loss, according to a Kaiser Permanente Center for Health Research study published in 2011 in the International Journal of Obesity. The study found that people trying to lose ten pounds within six months were more likely to lose that weight if they slept between 6-8 hours a night and had lower stress levels. Study author Charles Elder MD, suggests that some people may need to cut back on their schedules to get to bed earlier, while others may find exercise can reduce stress and help them sleep. For some, he says mind/body techniques such as meditation will help.
.   - Elderly Women Who Break a Hip are at Higher Risk of Dying. Breaking a hip doubles the risk of short-term death for most elderly women, but if women 65-69 break a hip they are five times more likely to die within a year, compared to women the same age who don't break a hip. Those are the findings of a Kaiser Permanente Center for Health Research study published in the prestigious Archives of Internal Medicine in 2011. The study also finds that the hip fracture itself increases the risk of death. Researchers had thought that women who break a hip are just sicker to begin with and therefore more likely to die. - Our Research Helps Experts Set National Prevention Guidelines. What tests are best for detecting cervical cancer? Should doctors counsel adolescents about how to prevent skin cancer? Do behaviorally based programs help adults lose weight? These questions are addressed in three important papers published in the Annals of Internal Medicine in 2011. The papers summarize evidence reviews conducted by a group of Kaiser Permanente researchers from the Oregon Evidenced-based Practice Center. These researchers conduct their reviews for the US Preventive Services Task Force, an independent panel of experts that develops recommendations for primary care clinicians and health systems. - Teen Peer Educators and Diabetes Knowledge of Low-income Fifth Grade Students. Researchers evaluated a unique peer education program for fifth grade children focused on type 2 diabetes prevention. The program involved nearly two dozen high school students of minority background as peer educators. The peer educators planned and organized a two-hour health fair for the fifth graders. After the fair, researchers found a significant increase in how much the fifth graders knew about diabetes and its warning signs. Journal of Community Health. 2011 Feb;36(1):23-6. - Long-term Safety of Radiotherapy and Breast Cancer Laterality in Older Survivors. While radiotherapy after breast cancer surgery extends health, there are concerns about the long term impact on cardiovascular health. In this study, researchers found that women treated with radiotherapy for left-side breast cancer had a significant increased risk of cardiovascular disease compared with women with breast cancer on the right side. The findings point to a need to consider laterality of tumors in understanding the relationship between radiotherapy and cardiovascular disease. Cancer Epidemiol Biomarkers Prev. 2011 Aug 30. - Herpes zoster vaccine in older adults and the risk of subsequent herpes zoster disease. In a retrospective study of 300,000 men and women 60 years and older, researchers found that the herpes zoster vaccine was associated with a 55 percent reduced risk of getting shingles. Researchers found a significant reduced risk of shingles across all sub-groups - those who are healthy as well as those with chronic conditions including diabetes or heart, lung or kidney diseases. JAMA. 2011 Jan 12;305(2):160-6. - Evaluation of the incidence of herpes zoster after concomitant administration of zoster vaccine and polysaccharide pneumococcal vaccine. Researchers found that administering both the pneumococcal and the herpes zoster vaccines to patients during the same visit is beneficial and does not appear to compromise the protective effect of the zoster vaccine. The study's findings challenge information in the zoster vaccine manufacturer's package insert. This new information is important to patients who find it more convenient and less costly to receive both vaccines from their health care providers during the same visit. Vaccine. 2011 May 9;29(20):3628-32. Epub 2011 Mar 22. - Daily or intermittent budesonide in preschool children with recurrent wheezing. Researchers found that preschool children with recurrent wheezing fared no better on a daily low dose regimen of budesonide than children who received intermittent doses of the same drug. This challenges existing recommendations for children under five years old who are at risk for persistent asthma. New England Journal of Medicine 2011 Nov 24;365(21):1990-2001. - Maternal Exposure to Magnetic Fields During Pregnancy in Relation to the Risk of Asthma in Offspring. In this prospective study, researchers compared the daily magnetic-field exposure of 801 pregnant women in Kaiser Permanente Northern California and used electronic medical records to follow their children for 13 years to see which children developed asthma. The study found that women with high magnetic field exposure in pregnancy had a more than threefold risk of asthma in their offspring compared to mothers whose exposure level was low. This is the first study to demonstrate a link between maternal magnetic-field exposure in pregnancy and the risk of asthma in offspring. Previous research has found that magnetic fields - generated typically by power lines and appliances such as microwave ovens, hair dryers and vacuum cleaners - could lead to miscarriage, poor semen quality, immune disorders, and certain type of cancers. Recently, the International Agency for Research on Cancer, a World Health Organization agency, classified radio frequency electromagnetic field as a possible carcinogen. Arch Pediatr Adolesc Med. 2011 Oct;165(10):945-50. Epub 2011 Aug 1. Antidepressant Use During Pregnancy and Childhood Autism Spectrum Disorders. Exposure to selective serotonin reuptake inhibitor anti-depressants (SSRIs) in early pregnancy may modestly increase risk of autism spectrum disorders (ASD), according to a Kaiser Permanente study published online in the current issue of Archives of General Psychiatry. However the researchers cautioned that the number of children exposed prenatally to SSRIs was low and that further studies are needed to validate these results Funded by the Centers for Disease Control and Prevention, the population-based, case-control study of 1,805 children is the first to systematically address the association between prenatal SSRI exposure and ASD risk. Researchers reported a two-fold increased risk of ASD associated with maternal treatment with SSRI anti-depressants during the year before delivery. The strongest effect was associated with first trimester treatment, said the study's lead author, Lisa Croen, PhD, director of the Autism Research Program at the Kaiser Permanente Division of Research in Oakland, Calif. She explained that in utero exposure to anti-depressant medications was reported in 6.7 percent of cases and 3.3 percent of controls. "Our results suggest a possible, albeit small, risk to the unborn child associated with in utero exposure to SSRIs, but this possible risk must be balanced with risk to the mother of untreated mental health disorders," said Croen, who explained that further studies are needed to replicate and extend these findings. Prior studies have indicated that abnormalities in serotonin levels and serotonin pathways may play a role in autism. Collectively these studies suggest the possibility that prenatal SSRI exposure may operate directly on the developing brain, perhaps selectively in fetuses with abnormalities in serotonin-related genes, explained Croen. She adds that physiologic changes related to maternal stress or depression during pregnancy, in combination with SSRI exposure, may contribute to changes in fetal brain development leading to later-diagnosed ASD. This study is part of ongoing body of autism research being conducted at the Kaiser Permanente Division of Research. Arch Gen Psychiatry. 2011 Jul 4. Health Sciences and Medical Libraries KFH spent approximately $443,000 to support its medical libraries, and other health resource and information dissemination services. These programs give medical staff and the greater professional community access to health-related research conducted within and outside of Kaiser Permanente. Medical libraries participated in an inter-loan system with other community hospitals, supported students in training and education programs to conduct literature searches, and conducted searches for community clinics and other community-based organizations on advances in medical treatment, clinical protocols and new development on specific health issues. During 2011, health sciences and medical libraries in California, Hawaii, Oregon and Washington completed thousands of requests for general knowledge and literature searches for research purposes. Tumor Board and Cancer Registry KFH spent $1.7 million to support the Tumor Board and Cancer Registry in the Northwest and Hawaii Regions. Besides being a statistical database utilized by clinicians and researchers within the regions, the registry submits statistics to the National Cancer Data Base annually. The Cancer Program, which oversees the registry, is surveyed for accreditation every three years by the American College of Surgeons Commission on Cancer.
Educational Theatre Programs (ETP)   For 20 years, Educational Theatre Programs has used live theatre, music, comedy, and drama to inspire children, teens, and adults to make healthier choices and better decisions about their well-being. These educational programs were developed with the advice of teachers, parents, students, health educators, medical professionals, and professional theatre artists. All performances are delivered by professional actors who are also trained as peer health educators, and performed free of charge for the community. ETP also provides schools and organizations with supplementary educational materials, such as workbooks, parent and teacher guides, and student wallet cards to reinforce the messages presented on stage. KFH in California spent $9.6 million to provide more than 640 thousand children and adults the opportunity to view one of ETP's 3,200 performances during 2011. Continuing Medical Education KFH spent approximately $527 thousand to provide continuing medical education to community physicians and providers, and physicians affiliated with the Permanente Medical Groups and other health care providers. Graduate Medical Education Kaiser Permanente's first KFH Graduate Medical Education (GME) program began nearly 60 years ago in Oakland, California. Today, all hospital-based regions provide training and education for medical residents and interns. The nationally acclaimed program attracts some of the top medical school graduates in the United States and serves as a national model by educating the next generation of physicians in an integrated health care delivery system. Residents are offered the opportunity to serve a large, culturally diverse patient base in a setting with sophisticated technology and information systems, established clinical guidelines and an emphasis on preventive and primary care. KFH contributed $59.9 million to educate 1,180 independent and approximately 1,627 affiliated interns and residents in California, Hawaii, Oregon, and Washington. The majority of medical residents are studying within the primary care medicine areas of Family Practice, Internal Medicine, Ob/Gyn, Pediatrics, Preventive Medicine, and Psychiatry. Residents and fellows in Oregon and Washington received training in Dermatology, Endocrinology, Family Practice, Internal Medicine, Geriatrics, Genetics, Obstetrics & Gynecology, Otolaryngology, Pathology, Pediatrics, Palliative Medicine, Plastic Surgery, and Rheumatology. Nurse Practitioner and Other Non-Physician Training Programs During 2011, KFH supported nearly 4,800 students pursuing a career in the allied health care field and spent over $8 million on training and education programs for nurse practitioners, nurses, radiology and sonography technicians, physical therapists, post-graduate psychology and social work students, pharmacists, and other non-physician health professionals. - In the Northwest, KFH and Health Plan provide uncompensated on-site clinical training for students from various community institutions that are pursuing careers in the health care field. The Graduate Medical Education Department provides administrative support for the nurse practitioner, physician assistant, allopathic medicine, midwifery, optometry, podiatry, nurse anesthetist and behavioral health programs. - The Kaiser Permanente School of Allied Health Sciences (KPSAHS), located in Richmond, California, was originally established in 1989 as a radiology program in response to the severe shortage of radiology technologists. Due to the continued national shortage of medical imaging and therapy workforce, KPSAHS expanded the school to include 18-month programs in sonography, nuclear medicine and radiation therapy. In addition, the school provides courses in anatomy and physiology and advanced/basic phlebotomy. - Through Kaiser Permanente's pharmacist residency programs in California, licensed pharmacists gain additional experience and training in the provision of pharmaceutical care and administrative pharmacy services in an integrated managed care organization during a one- or two-year postgraduate education and training program. These programs enable residents to improve their clinical knowledge and skills while enhancing continuity of patient care in a wide range of ambulatory, intermediate and hospital settings. - The Board of Registered Nurses Work Study program gives nursing students valuable direct clinical experience before graduation, allowing them to enter the workplace with additional confidence and competence. This program helps educate the future nursing workforce and enables students to assume a nursing role more rapidly and safely. Each partnering nursing program offers a BRN-approved course and develops an agreement with a Kaiser Permanente facility to offer work study internships. Interns work under the direct supervision of a Kaiser Permanente staff nurse and receive support and direction from a faculty member from the nursing program. - The Kaiser Permanente Deloras Jones Nursing Scholarship program provides financial assistance for students enrolled in any California nursing program to encourage and support them to become registered nurses or to pursue advanced nursing degrees. Scholarships are awarded in the categories of underrepresented minorities, academic excellence, nursing as a second career and pursuit of graduate nursing degree. Grants and Donations for Knowledge Dissemination KFH donated approximately $3.9 million in charitable contributions to nonprofit organizations in California, Hawaii, Oregon, and Washington for the dissemination of evidence-based studies, which informed the community about on health care public policy and educational opportunities for individuals seeking a career as a health care provider or professional. Below are examples of the community organizations supported by these grants: - Albert Schweitzer Fellowship Inc. received a $65,000 grant for the Los Angeles Schweitzer's Fellows Program to support the training and education of health professionals. Fellows work with local community organizations to identify specific local health needs that affect low-income and marginalized populations. With support from their faculty advisors, Fellows utilize their professional training to design and implement projects that address unmet health-related needs. Each year 15 Fellows are selected to provide 200 hours of direct service through a local agency. These projects will reach approximately 10,000 people. In addition to making an enduring contribution to the local agency, the proposed outcomes for this program are to affect areas such as health education, health behaviors, and access to service. - The Public Health Institute received a $25,000 grant to support its California Health Workforce Alliance (CHWA), a public-private partnership to implement coordinated strategies to meet California's emerging health workforce. - Community Clinic Association of Los Angeles County received a $500,000 grant ($250,000 in 2011) to expand support for the community clinic workforce through recruitment and retention activities, as well as development of ongoing business revenue sources for the association. - The California Institute for Nursing and Health Care received a $250,000 grant over two years ($125,000 in 2011) to provide technical assistance to schools of nursing in order to facilitate fast tracking and efficient implementation of the Collaborative Model of Nursing Education. This project supports the pathway to an associate degree in nursing leading to a bachelor of science in nursing education. - The California State University, San Bernardino received a $100,000 grant to support its nursing learning center with the purchase of clinical hospital-style patient beds, computer equipment, video networks, switches, and recording equipment for its new lab space. OTHER COMMUNITY BENEFITS In 2011, KFH in California, Hawaii, Oregon and Washington spent approximately $25 million on other community benefit activities and programs beyond the national streams of work.
Self Sufficiency Programs   KFH provided community-based programs and services to low-income residents and students through the Learning Centers and Youth Employment Programs. In 2011, KFH spent $6.1 million to support the following programs. - Learning Centers - Through the Watts Counseling and Learning Center (WCLC) and Educational Outreach Program (EOP), disadvantaged children and their families in Southern California are provided a variety of counseling, education, and social services. WCLC provides mental health and counseling services, assistance to children with learning disabilities, and pre-employment training to high school youth. It also operates a state-licensed preschool program, a summer day camp, and "Kids Can Cope" support groups for children dealing with siblings or parents fighting cancer. EOP provides education and support services to primarily Latino youth, ages 10 to 14, in the San Gabriel Valley, east of downtown Los Angeles. The focus of EOP is to provide dropout prevention programs in a community setting. Currently, EOP provides nine different programs both in English and Spanish to children and parents during after-school hours and on Saturdays. Community Giving Campaigns In 2011, KFH contributed $727,000 to support Community Giving Campaigns, a program-wide effort that has a direct impact on local communities. While a number of federations, including America's Charities, Black United Fund, Earth Share and United Way, and the many charities they represent, are listed in Campaign materials, the Campaign also supports a write-in option, which allows participants to donate to the non-profit 501(c) of their choice. Participants can make a donation using payroll deduction or make a one-time contribution via cash, check, or credit card. Kaiser Permanente underwrites all of the associated processing costs for the Campaign, so 100% of all pledges go directly to the organizations our employees and physicians choose to support. Other Grants and Donations KFH donated approximately $3.7 million to support community benefit activities and programs in California, Hawaii, Oregon, and Washington beyond the national streams of work. ATTACHMENT A DIRECT COMMUNITY BENEFIT INVESTMENT PROGRAM 2011 KFH COMMUNITY BENEFIT FINANCIALS The following chart summarizes 2011 Community Benefit investments by KFH for California, Hawaii, Oregon, and Washington. The investments in the community reflected in the chart are unaudited. CARE AND COVERAGE Charitable Care and Coverage Programs $ 244,324,609 Government Sponsored Programs 326,314,513 Grants & Donations for Care and Coverage 4,078,813 Care and Coverage for CB Operations 877,569 Subtotal: $ 575,595,504 COMMUNITY HEALTH INITIATIVES Community Health Initiatives Programs and Services $ 1,329,746 Grants & Donations for Community Health Initiatives 13,216,073 Community Health Initiatives for CB Operations 287,965 Subtotal: $ 14,833,784 SAFETY NET PARTNERSHIPS Grants & Donations for Safety Net Partnerships $ 15,490,409 Safety Net CB Operations 397,211 Subtotal: $ 15,887,620 KNOWLEDGE DISSEMINATION Medical Research $ 162,980,181 Educational Theatre Program 10,213,656 Health Care Training and Education Programs 79,834,064 Grants & Donations for Knowledge Dissemination 4,320,252 Knowledge Dissemination CB Operations 194,661 Subtotal: $ 257,542,814 OTHER COMMUNITY BENEFITS Self-Sufficiency Programs $ 6,086,214 Grants & Donations for other community benefits 4,626,134 Other CB Operations 13,895,368 Subtotal: $ 24,607,716 TOTAL $ 888,467,438
SCHEDULE K, PART VI   2003 CSDA The 2003 bonds refunded were bonds issued from October 1983, November 1985, and May 1993. 2006 CSDA / CHFFA 2006 CSCDA / CHFFA Variable and 2006 CSCDA / CHFFA Fixed have multiple Issuers and therefore multiple EIN numbers. The EIN number reported matched the reported cusip. PART II, LINE 3 Difference between total proceeds (Part II line 3) and issue price (Part I) is due to interest earned on the construction fund.
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Christine Cassel TITLE:Director HOURS:5
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HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Deborah Stokes TITLE:SVP, CC & CAO HOURS:36
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Bernard Tyson TITLE:President & COO HOURS:38
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Herman Weil TITLE:SVP, Federal & State Programs HOURS:40
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jed Weissberg TITLE:SVP, Quality & Care Delivery HOURS:25
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Carlos Zaragoza TITLE:VP, Practice Leader-Labor &Emp HOURS:25
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Victoria Zatkin TITLE:VP, Off of Brd & Corp Gov Svcs HOURS:36
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mark Zemelman TITLE:SVP, Gen. Counsel & Secretary HOURS:34
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mary Ann Barnes TITLE:SVP, Exec Dir - San Diego HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Christopher L Boyd TITLE:SVP, Area Mgr - Santa Clara HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Michael Brady TITLE:SVP, Infrastructure Mgmt Group HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Virginia Campbell TITLE:SVP & Area Mgr - Diablo HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:William Caswell TITLE:SVP, Operations HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Greg K Christian TITLE:Exec Dir - Fontana HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Judith Coffey TITLE:SVP & Area Mgr - Marin/Sonoma HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jeffrey A Collins TITLE:SVP & Area Manager - Fresno HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Mark Costa TITLE:Exec Dir - Los Angeles HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Richard Daniels TITLE:SVP, Shared Services HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Elizabeth Finley TITLE:SVP & Exec Dir - Downey HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Edward Glavis TITLE:SVP & Area Mgr - Roseville HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Corwin Harper TITLE:SVP & Area Mgr -Central Valley HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Gerald McCall TITLE:SVP Operations HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Colleen McKeown TITLE:SVP & Area Mgr - Greater So. A HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Julie Miller-Phipps TITLE:SVP & Exec Dir - Orange HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Nathaniel Oubre TITLE:SVP & Area Mgr - East Bay HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Christine Robisch TITLE:SVP & Area Manager - SF HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Max Villalobos TITLE:SVP & Area Manager - Napa/Sola HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Vita Willett TITLE:Exec Dir - Riverside HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Diane Comer TITLE:SVP, Bus. Info Officer - HP HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:James Goff Crawford TITLE:VP, Group Bus. Info Officer HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Lazaro Garcia TITLE:VP, Data Center Svcs HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Wendy L. Lee TITLE:VP, Strategic Initiatives & Op HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Chadwick Henry Nestman TITLE:VP, Chief Architect HOURS:20
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Paul Records TITLE:SVP, Human Resources HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Steven Zatkin TITLE:Consultant 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) 2011

Additional Data


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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
2011
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HOSPITALS
 
Employer identification number

94-1105628
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







(1) KP ONCALL LLC
ONE KAISER PLAZA 15L
OAKLAND,CA94612
91-2166347 		CALL CENTER CA   10,210,994 NA
 
(2) KAISER PERMANENTE VENTURES LLC SERIES A
ONE KAISER PLAZA 15L
OAKLAND,CA94612
27-2252521 		INVESTMENTS CA   12,656,339 NA
 
(3) NXT CAPITAL SENIOR LOAN FUND LLC
ONE KAISER PLAZA 15L
OAKLAND,CA94612
37-1651297 		LOANS CA 174,152 45,107,856 NA
 






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 FDN HEALTH PLAN OF COLORADO

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

OAKLAND,CA94612
58-1592076 		HEALTH CARE GA 501(c)(3) 9 KFHP INC
 
Yes
 
(3) KFHP OF THE MID-ATLANTIC STATES INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
52-0954463 		HEALTH CARE MD 501(c)(3) 9 KFHP INC
 
Yes
 
(4) KAISER FDN HEALTH PLAN OF THE NORTHWEST

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

OAKLAND,CA94612
34-0922268 		HEALTH CARE OH 501(c)(3) 9 KFHP INC
 
Yes
 
(6) KAISER FOUNDATION HEALTH PLAN INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-1340523 		HEALTH CARE CA 501(c)(3) 9 NA
 
 
No
(7) CAMP BOWIE SERVICE CENTER

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299123 		ADMIN CA 501(c)(3) 11 - I KFHP INC
 
Yes
 
(8) KAISER HOSPITAL ASSET MANAGEMENT INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299125 		ASSET MGT CA 501(c)(3) 11 - I KFH
 
Yes
 
(9) KAISER HEALTH PLAN ASSET MANAGEMENT INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299124 		ASSET MGT CA 501(c)(3) 11 - I KFHP INC
 
Yes
 
(10) LOKAHI ASSURANCE LTD

ONE KAISER PLAZA 15L

OAKLAND,CA94612
91-2171891 		RISK MGMT HI 501(c)(3) 11 - I KFHP INC
 
Yes
 
(11) KAISER HEALTH ALTERNATIVES

ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0954562 		HEALTH CARE OR 501(c)(3) 9 KFHP INC
 
Yes
 
(12) OHP

ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0480268 		LEASING WA 501(c)(3) 11 - I KFHP INC
 
Yes
 
(13) 1800 HARRISON FOUNDATION

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

OAKLAND,CA94612
31-1779500 		FINANCING CA 501(c)(3) 11 - III-O KFH
 
Yes
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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 		CARE MANAGEMENT CA NA
  		                 












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




Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
Yes
 
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
Yes
 
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
Yes
 
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
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 HEALTH PLAN INC

 A 23,744,469 PER AGREEMENT
(2) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 A 11,290,667 PER AGREEMENT
(3) KAISER FOUNDATION HEALTH PLAN OF OHIO

 A 5,162,877 PER AGREEMENT
(4) KAISER FOUNDATION HEALTH PLAN OF MID ATLANTIC

 A 41,096 PER AGREEMENT
(5) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 B 54,155 PER AGREEMENT
(6) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 B 180,492,431 PER AGREEMENT
(7) KAISER FOUNDATION HEALTH PLAN OF THE MAS

 D 50,000,000 PER AGREEMENT
(8) KAISER FOUNDATION HEALTH PLAN OF OHIO

 D 34,000,000 PER AGREEMENT
(9) KAISER FOUNDATION HEALTH PLAN of COLORADO

 E 780,805,744 PER AGREEMENT
(10) KAISER FOUNDATION HEALTH PLAN INC

 G 6,507 PER AGREEMENT
(11) KAISER HOSPITAL ASSET MANAGEMENT

 G 7,514,096 PER AGREEMENT
(12) KAISER HOSPITAL HEALTH PLAN OF THE MAS

 G 12,564 PER AGREEMENT
(13) KAISER HOSPITAL OF THE NW

 G 2,814,672 PER AGREEMENT
(14) KAISER FOUNDATION HEALTH PLAN INC

 H 38,759,383 PER AGREEMENT
(15) KAISER HOSPITAL ASSET MANAGEMENT

 J 175,490,779 PER AGREEMENT
(16) KAISER FOUNDATION HEALTH PLAN INC

 K 8,087,381,017 PER AGREEMENT
(17) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 K 1,257,365,851 PER AGREEMENT
(18) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 K 248,163,274 PER AGREEMENT
(19) KAISER FOUNDATION HEALTH PLAN OF THE MAS

 K 942,095,980 PER AGREEMENT
(20) KAISER FOUNDATION HEALTH PLAN OF THE NW

 K 788,095,500 PER AGREEMENT
(21) KAISER FOUNDATION HEALTH PLAN OF OHIO

 K 43,524,690 PER AGREEMENT
(22) ORDWAY INDEMNITY

 K 278,930 PER AGREEMENT
(23) LOKAHI ASSURANCE LTD

 K 11,760,200 PER AGREEMENT
(24) KAISER FOUNDATION HEALTH PLAN INC

 L 6,950,612,472 PER AGREEMENT
(25) KAISER FOUNDATION HEALTH PLAN OF THE MAS

 L 10,016,876 PER AGREEMENT
(26) ORDWAY INDEMNITY

 L 828,290 PER AGREEMENT
(27) KAISER FOUNDATION HEALTH PLAN OF OHIO

 L 61,651,131 PER AGREEMENT
(28) LOKAHI ASSURANCE LTD

 L 9,613,768 PER AGREEMENT
(29) OAK TREE ASSURANCE LTD

 L 269,000 PER AGREEMENT
(30) KAISER HOSPITAL ASSET MANAGEMENT

 M 79,023,246 PER AGREEMENT
(31) KAISER FOUNDATION HEALTH PLAN OF THE NW

 N 5,056 PER AGREEMENT
(32) KAISER FOUNDATION HEALTH PLAN INC

 N 127,091,897 PER AGREEMENT
(33) KAISER HOSPITAL ASSET MANAGEMENT

 N 2,293,388 PER AGREEMENT
(34) KAISER FOUNDATION HEALTH PLAN INC

 O 13,179,492,343 PER AGREEMENT
(35) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 O 503,431,364 PER AGREEMENT
(36) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 O 33,088,236 PER AGREEMENT
(37) KAISER FOUNDATION HEALTH PLAN OF THE MAS

 O 697,561,487 PER AGREEMENT
(38) KAISER FOUNDATION HEALTH PLAN OF THE NW

 O 658,526,203 PER AGREEMENT
(39) KAISER FOUNDATION HEALTH PLAN OF OHIO

 O 148,401,013 PER AGREEMENT
(40) KAISER HOSPITAL ASSET MANAGEMENT

 O 5,473,780 PER AGREEMENT
(41) KAISER HEALTH PLAN ASSET MANAGEMENT

 O 21,202 PER AGREEMENT
(42) KP CAL LLC

 O 259,398 PER AGREEMENT
(43) KAISER PERMANENTE INSURANCE COMPANY

 O 8,322,498 PER AGREEMENT
(44) KAISER FOUNDATION HEALTH PLAN INC

 P 13,426,867,130 PER AGREEMENT
(45) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 P 4,380,457 PER AGREEMENT
(46) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 P 53,448,814 PER AGREEMENT
(47) KAISER FOUNDATION HEALTH PLAN OF THE MAS

 P 28,149,509 PER AGREEMENT
(48) KAISER FOUNDATION HEALTH PLAN OF THE NW

 P 520,136,194 PER AGREEMENT
(49) KAISER FOUNDATION HEALTH PLAN OF OHIO

 P 59,807,090 PER AGREEMENT
(50) KAISER PROPERTY SERVICES

 P 1,318 PER AGREEMENT
(51) KAISER HOSPITAL ASSISTANCE CORP

 P 71,353 PER AGREEMENT
(52) KAISER HEALTH PLAN ASSET MANAGEMENT

 P 11,464,658 PER AGREEMENT
(53) KAISER PERMANENTE INSURANCE COMPANY

 P 3,476,084 PER AGREEMENT
(54) LOKAHI ASSURANCE LTD

 P 113,739,817 PER AGREEMENT
(55) OAK TREE ASSURANCE LTD

 P 4,735,939 PER AGREEMENT
(56) ORDWAY INDEMNITY

 P 112,680 PER AGREEMENT
(57) 1800 HARRISON

 P 160 PER AGREEMENT
(58) KAISER FOUNDATION HEALTH PLAN INC

 Q 38,787,822,200 PER AGREEMENT
(59) KAISER FOUNDATION HEALTH PLAN OF THE MAS

 Q 2,005,676,920 PER AGREEMENT
(60) KAISER FOUNDATION HEALTH PLAN OF THE NW

 Q 594,762,702 PER AGREEMENT
(61) KAISER HOSPITAL ASSET MANAGEMENT

 Q 19,692,509 PER AGREEMENT
(62) LOKOHI ASSURANCE LTD

 Q 56,966,723 PER AGREEMENT
(63) KAISER HOSPITAL ASSISTANCE CORPORATION

 Q 14,060,365 PER AGREEMENT
(64) KAISER FOUNDATION HEALTH PLAN INC

 R 26,773,561,398 PER AGREEMENT
(65) KAISER FOUNDATION HEALTH PLAN OF OHIO

 R 40,000,000 PER AGREEMENT
(66) KAISER HOSPITAL ASSISTANCE CORPORATION

 R 8,505,242 PER AGREEMENT
(67) KAISER HOSPITAL ASSET MANAGEMENT

 R 15,347,423 PER AGREEMENT
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(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 Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
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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Software Version: