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 private
foundations)
MediumBullet Do not enter social security numbers on this form as it may be made public.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
A For the 2014 calendar year, or tax year beginning 01-01-2014 , and ending 12-31-2014
BCheck if applicable:
CName of organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
ONE KAISER PLAZA 15L
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
OAKLAND, CA94612
D Employer identification number

52-0954463
E Telephone number

G Gross receipts $ 2,860,563,723
F Name and address of principal officer:
KIMBERLY HORN
ONE KAISER PLAZA 15L
OAKLAND,CA94612
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.kp.org
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1972
M State of legal domicile: MD
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTH CARE SERVICES TO IMPROVE 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 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 13
5 Total number of individuals employed in calendar year 2014 (Part V, line 2a) ...... 5 6,903
6 Total number of volunteers (estimate if necessary) ............. 6 635
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 455,644
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 22,290 14,500
9 Program service revenue (Part VIII, line 2g) ......... 2,508,202,069 2,716,653,495
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 3,370,136 3,741,925
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 159,136 210,424
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 2,511,753,631 2,720,620,344
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 3,004,612 15,427,948
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) 605,887,498 608,103,015
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–24e).... 1,916,589,345 2,100,964,584
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 2,525,481,455 2,724,495,547
19 Revenue less expenses. Subtract line 18 from line 12....... -13,727,824 -3,875,203
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,201,017,659 1,396,796,362
21 Total liabilities (Part X, line 26)............. 1,221,895,918 1,538,188,471
22 Net assets or fund balances. Subtract line 21 from line 20..... -20,878,259 -141,392,109
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 MediumBullet
Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2014)
Form 990 (2014)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line 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 are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 2,374,268,303 including grants of $   ) (Revenue $ 2,695,315,065 )
member health care services and medical training for care improvement Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP of MAS) provides medical and surgical care, including urgent care services, extended care and home health care, for its members without regards to age, sex, race, religion or national origin or the ability to pay. KFHP of MAS educates and trains medical students and other health care professionals and promotes scientific and nursing education in order to improve care.
4b (Code:   ) (Expenses $ 39,591,332 including grants of $   ) (Revenue $ 20,406,009 )
Medicaid and Other Government Sponsored Programs Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) is committed to improving medical care for beneficiaries of Medicaid and other government sponsored programs, not only for KFHP-MAS members, but also within the communities we serve. At the end of 2014, more than 18,000 individuals were receiving benefits under KFHP-MAS's Medicaid managed care programs in Maryland and Virginia. In addition, KFHP-MAS provided health care on a fee-for-service basis for Medicaid beneficiaries who were not enrolled as KFHP-MAS members.
4c (Code:   ) (Expenses $ 36,495,080 including grants of $   ) (Revenue $ 932,421 )
Charitable Care (Medical Financial Assistance and Charitable Health Coverage) Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) provides charity care to low-income vulnerable patients through the Medical Financial Assistance (MFA) and Charitable Health Coverage (CHC) Programs. KFHP-MAS offers financial assistance through the MFA program to help families and individuals with a demonstrated financial need pay for all or part of the cost of emergency or medically necessary care provided in Kaiser Permanente facilities and/or by Kaiser Permanente providers. In 2014, this program assisted approximately 33,800 qualifying applicants. The CHC program offers regular Kaiser Foundation Health Plan membership at minimal cost to low income families who are not eligible for other public or privately sponsored coverage. More than 5,800 individuals were receiving comprehensive health care through this program at the end of 2014.
(Code:   ) (Expenses $ 26,270,701 including grants of $ 15,427,948 ) (Revenue $ 0 )
SEE COMMUNITY BENEFIT SUMMARY RPT IN SCH O
4d Other program services (Describe in Schedule O.)
(Expenses $ 26,270,701 including grants of $ 15,427,948 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet2,476,625,416
Form 990 (2014)
Form 990 (2014)
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 (see instructions)? 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 IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
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 for escrow or custodial account liability; 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, line 10?
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 VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIIClick 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 IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick 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 XClick 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 and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII 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, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions) ....
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 hospital facilities? If "Yes," complete Schedule H....
20a
 
No
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2014)
Form 990 (2014)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government 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 or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) 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
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? 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 direct or indirect 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
 
No
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part 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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2014)
Form 990 (2014)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
3,190
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
6,903
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” to line 3b, 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, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
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 as charitable contributions?...
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.
Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?.........................
8
 
 
9a
Did the sponsoring organization make any taxable distributions under section 4966?...
9a
 
 
b
Did the sponsoring 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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2014)
Form 990 (2014)
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 or note to any line in this Part VI ..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
15
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
13
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
 
No
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
Yes
 
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
Yes
 
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
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
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 this 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
DC , MD , VA
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you 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, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletSVP CC AND CAO
ONE KAISER PLAZA 15L
OAKLAND,CA94612 (510) 271-6385
Form 990 (2014)
Form 990 (2014)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) Christine K Cassel........................................................................
Director
 2.0
.......................12.0 		X           0 173,500 0
(2) Thomas W Chapman........................................................................
Director
 3.0
.......................11.0 		X           0 261,807 17,500
(3) Jeffrey E Epstein........................................................................
Director
 0.5
.......................7.0 		X           0 197,467 0
(4) Daniel P Garcia........................................................................
SVP, Chief Compliance Officer
 2.0
.......................48.0 		X           0 1,357,344 175,853
(5) William R Graber........................................................................
Director
 0.5
.......................7.0 		X           0 231,434 0
(6) J Eugene Grigsby III........................................................................
Director
 1.0
.......................7.0 		X           0 207,925 0
(7) David Hoffmeister........................................................................
Director
 0.25
.......................7.0 		X           0 31,577 0
(8) Judith Johansen........................................................................
Director
 0.5
.......................7.0 		X           0 222,508 0
(9) Kim J Kaiser........................................................................
Director
 0.5
.......................7.0 		X           0 212,852 0
(10) Philip Marineau........................................................................
Director
 0.58
.......................5.86 		X           0 214,967 0
(11) Jenny J Ming........................................................................
Director
 0.25
.......................2.5 		X           0 48,477 0
(12) Edward Y W Pei........................................................................
Director
 0.25
.......................6.75 		X           0 217,904 17,500
(13) Margaret E Porfido........................................................................
Director
 1.0
.......................5.5 		X           0 232,533 0
(14) Richard Shannon MD........................................................................
Director
 0.5
.......................6.0 		X           0 83,501 0
(15) Cynthia A Telles........................................................................
Director
 0.5
.......................7.0 		X           0 222,456 0
(16) Bernard J Tyson........................................................................
Chairman & CEO
 6.0
.......................44.0 		X   X       0 4,687,312 624,702
(17) Gregory A Adams........................................................................
EVP,GP & Region President NCAL
 0.0
.......................50.0 		    X       0 1,913,278 752,529
Form 990 (2014)
Form 990 (2014)
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 (list any hours for related organizations below dotted line) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Maryann M Bodayle........................................................................
Board Governance Administrator
 1.0
.......................49.0 		    X       0 158,433 17,837
(19) Kimberly K Horn........................................................................
Region President - MAS
 50.0
.......................0.0 		    X       0 1,293,151 513,693
(20) Kathryn Lancaster........................................................................
EVP & CFO
 4.0
.......................46.0 		    X       0 2,244,260 698,565
(21) Thomas R Meier........................................................................
SVP, Corporate Treasurer
 2.0
.......................48.0 		    X       0 864,149 183,340
(22) Donald H Orndoff........................................................................
SVP, NFS
 5.0
.......................45.0 		    X       0 863,698 167,586
(23) Rochelle M Roth........................................................................
Dir, Health Plan QCSO
 4.0
.......................46.0 		    X       0 228,471 150,768
(24) Jacqueline Sellers........................................................................
Sr Counsel/Assistant Secretary
 2.0
.......................48.0 		    X       0 252,345 191,723
(25) Arthur M Southam........................................................................
EVP, Health Plan Operations
 5.0
.......................45.0 		    X       0 2,501,640 595,175
(26) Susan Spurlark........................................................................
VP, Regional Counsel - MAS
 50.0
.......................0.0 		    X       0 419,754 269,983
(27) Deborah Stokes........................................................................
SVP,Corporate Controller & CAO
 4.0
.......................46.0 		    X       0 762,279 294,052
(28) Victoria B Zatkin........................................................................
VP, Off of Brd & Corp Gov Svcs
 5.0
.......................45.0 		    X       0 347,803 242,808
(29) Mark S Zemelman........................................................................
SVP,General Counsel &Secretary
 2.0
.......................48.0 		    X       0 1,511,815 433,272
(30) Russell K Bradley........................................................................
VP, HP Services & Admin
 30.0
.......................20.0 		      X     0 209,341 44,853
(31) Linda M Collins........................................................................
COO - MAS
 30.0
.......................20.0 		      X     0 210,264 51,864
(32) DeAnne Petersen........................................................................
VP, CFO - MAS
 50.0
.......................0.0 		      X     0 437,333 205,085
(33) Mark Ruszczyk........................................................................
VP, MSBD - MAS
 50.0
.......................0.0 		      X     0 353,134 95,135
(34) Frank Titus........................................................................
VP, Health Plan Svcs Admin-MAS
 50.0
.......................0.0 		      X     0 516,838 156,116
(35) Karen Elizabeth Blair........................................................................
VP,PR/Communications/Brand Mgt
 30.0
.......................20.0 		        X   0 299,118 125,734
(36) George F Buchness Jr........................................................................
VP, Strategic Business Develop
 50.0
.......................0.0 		        X   0 280,698 58,552
(37) Kay W Lewis........................................................................
VP, Quality CA Behavioral Hlth
 30.0
.......................20.0 		        X   0 325,170 160,021
(38) Michael Rovinsky........................................................................
Exec Dir, Strat Planning - MAS
 50.0
.......................0.0 		        X   0 455,149 64,218
(39) Tamsen Lee Westmoreland........................................................................
Region Compliance Officer -MAS
 30.0
.......................20.0 		        X   0 291,721 182,788
(40) George C Halvorson........................................................................
Chairman
 0.0
.......................0.0 		          X 0 10,399,970 46,427
(41) Marilyn Kawamura........................................................................
Region President - MAS
 0.0
.......................0.0 		          X 0 145,309 0
(42) Ruben J Burnett........................................................................
VP, Natl Consultant Relations
 0.0
.......................0.0 		          X 0 408,477 160,501
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 36,297,162 6,698,180
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1,081
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
MID-ATLANTIC PERMANENTE MEDICAL GRO,
2101 EAST JEFFERSON STREET
ROCKVILLE,MD20852 		PHYSICIAN SERVICES 515,741,261
VIRGINIA HOSPITAL CENTER,
PO BOX 1494
MERRIFIELD,VA22116 		HOSPITAL SERVICES 61,285,123
CHILDREN'S HOSPITAL,
PO BOX 37215
BALTIMORE,MD21297 		HOSPITAL SERVICES 56,226,390
HOLY CROSS HEALTH INC,
PO BOX 64099
BALTIMORE,MD21264 		HOSPITAL SERVICES 55,134,675
WASHINGTON HOSPITAL CENTER,
PO BOX 631290
BALTIMORE,MD21263 		HOSPITAL SERVICES 49,307,281
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet211
Form 990 (2014)
Form 990 (2014)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		14,500
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 14,500
Program Service RevenueAmt Business Code
2a MBR HLTH CARE PREM 621400 2,232,977,457 2,232,977,457    
b MEDICARE/MEDICAID 621400 340,479,909 340,479,909    
c SUPPL CHARGE/PHARM 621400 114,212,239 114,182,352 29,887  
d NON-PLAN & IND REV 621400 2,036,568 1,640,811 395,757  
e OTHER PRGM SERVICE 621400 26,947,322 26,947,322    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 2,716,653,495
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 3,452,408     3,452,408
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 180,424  
b Less: rental expenses    
c Rental income or (loss) 180,424 0
d Net rental income or (loss).......MediumBullet 180,424     180,424
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 140,136,698 96,198
b Less: cost or other basis and sales expenses 139,587,261 356,118
c Gain or (loss) 549,437 -259,920
d Net gain or (loss)..........MediumBullet 289,517     289,517
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a PARKING REVENUE   30,000   30,000  
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 30,000
12 Total revenue. See Instructions......MediumBullet 2,720,620,344 2,716,227,851 455,644 3,922,349
Form 990 (2014)
Form 990 (2014)
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).Check if Schedule O contains a response or note to any line 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 domestic organizations and domestic governments. See Part IV, line 21 .... 15,427,948 15,427,948
2 Grants and other assistance to domestic individuals. See Part IV, line 22 .... 0  
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. 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 .... 428,772,849 390,900,708 37,872,141 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 59,711,746 59,711,746    
9 Other employee benefits ....... 85,901,257 71,299,128 14,602,129  
10 Payroll taxes ........... 33,717,163 33,468,749 248,414  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 1,077,187   1,077,187  
c Accounting ........... 1,580,289   1,580,289  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 164,023   164,023  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) .... 0      
12 Advertising and promotion .... 11,771,740 386,356 11,385,384  
13 Office expenses ....... 9,949,020 8,682,912 1,266,108  
14 Information technology ...... 155,048,463 113,311,748 41,736,715  
15 Royalties .. 0      
16 Occupancy ........... 32,758,114 32,758,114    
17 Travel ............ 2,220,044 1,748,949 471,095  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 1,739,975   1,739,975  
20 Interest ........... 9,662,509 9,662,509    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 70,794,509 70,794,509    
23 Insurance .............. 22,823,531 22,789,384 34,147  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a CONTRACTUAL PAYMENTS 830,827,489 830,827,489    
b PURCHASED MEDICAL SERVICES 250,677,284 250,677,284    
c SUPPLIES 393,558,522 351,691,478 41,867,044  
d INTER-REGIONAL CHARGES 105,186,887 95,239,545 9,947,342  
e All other expenses 201,124,998 117,246,860 83,878,138  
25 Total functional expenses. Add lines 1 through 24e 2,724,495,547 2,476,625,416 247,870,131 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 (2014)
Form 990 (2014)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 0 1 0
2 Savings and temporary cash investments ......... 7,741,713 2 106,330,686
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 118,200,294 4 119,617,458
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 28,564,152 8 33,732,240
9 Prepaid expenses and deferred charges .......... 4,956,742 9 5,853,157
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,292,638,502
b Less: accumulated depreciation ..... 10b 528,385,423 796,012,863 10c 764,253,079
11 Investments—publicly traded securities .......... 242,251,370 11 245,841,062
12 Investments—other securities. See Part IV, line 11 ..... 0 12 0
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 0 14 0
15 Other assets. See Part IV, line 11 ........... 3,290,525 15 121,168,680
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 1,201,017,659 16 1,396,796,362
Liabilities 17 Accounts payable and accrued expenses ......... 178,462,284 17 218,901,391
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 4,423,563 19 14,105,248
20 Tax-exempt bond liabilities ............. 12,863,090 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Loans and other 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 .. 0 23 0
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.................... 1,026,146,981 25 1,305,181,832
26 Total liabilities. Add lines 17 through 25......... 1,221,895,918 26 1,538,188,471
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), 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 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........ 8,301,762 30 8,301,762
31 Paid-in or capital surplus, or land, building or equipment fund ..... 0 31 0
32 Retained earnings, endowment, accumulated income, or other funds -29,180,021 32 -149,693,871
33 Total net assets or fund balances ........... -20,878,259 33 -141,392,109
34 Total liabilities and net assets/fund balances ........ 1,201,017,659 34 1,396,796,362
Form 990 (2014)
Form 990 (2014)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
2,720,620,344
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
2,724,495,547
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-3,875,203
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
-20,878,259
5
Net unrealized gains (losses) on investments ...............
5
-654,407
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-115,984,240
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
-141,392,109
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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
 
No
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
 
 
Form 990 (2014)
Form 990 (2014)
Page 13
Form 990, Special Condition Description:
Special Condition Description
Form 990 (2014)
Form 990 (2014)
Page 14
Additional Data


Software ID:  
Software Version:  
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 Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
a
b
c
d
e
f
Enter the number of supported organizations .............................  
g
Provide the following information about the supported organization(s).
(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 listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total    

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support Add lines 7 through 10.  
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 0 16,275 344,247 22,290 14,500 397,312
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...... 2,167,352,747 2,272,514,533 2,388,129,639 2,508,061,602 2,716,227,851 12,052,286,372
3 Gross receipts from activities that are not an unrelated trade or business under section 513..           0
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...           0
5 The value of services or facilities furnished by a governmental unit to the organization without charge..           0
6 Total. Add lines 1 through 5. 2,167,352,747 2,272,530,808 2,388,473,886 2,508,083,892 2,716,242,351 12,052,683,684
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...           0
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.           0
c Add lines 7a and 7b..           0
8 Public support (Subtract line 7c from line 6.) 12,052,683,684
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2010 (b) 2011 (c) 2012 (d) 2013 (e) 2014 (f) Total
9 Amounts from line 6... 2,167,352,747 2,272,530,808 2,388,473,886 2,508,083,892 2,716,242,351 12,052,683,684
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 11,014,664 6,430,418 6,743,020 3,392,544 3,632,832 31,213,478
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b. 11,014,664 6,430,418 6,743,020 3,392,544 3,632,832 31,213,478
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.           0
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..           0
13 Total support. (Add lines 9, 10c, 11, and 12.).. 2,178,367,411 2,278,961,226 2,395,216,906 2,511,476,436 2,719,875,183 12,083,897,162
14
Section C. Computation of Public Support Percentage
15
15
99.742 %
16
16
99.637 %
Section D. Computation of Investment Income Percentage
17
17
0.258 %
18
18
0.363 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described in (a) above?
11b
 
 
c
A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.
11c
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 5
Part IV
Supporting Organizations (continued)

Section B. Type I Supporting Organizations
Yes
No
1
Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer (a) and (b) below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer (a) and (b) below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 6
Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1.   Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    

Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors (explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by .035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    

Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7   Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990 or 990-EZ) 2014
Schedule A (Form 990 or 990-EZ) 2014
Page 7
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity		  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations  
4 Amounts paid to acquire exempt-use assets  
5 Qualified set-aside amounts (prior IRS approval required)  
6 Other distributions (describe in Part VI). See instructions  
7Total annual distributions. Add lines 1 through 6.  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions		  
9 Distributable amount for 2014 from Section C, line 6  
10 Line 8 amount divided by Line 9 amount  

Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2014 		(iii)
Distributable
Amount for 2014
1 Distributable amount for 2014 from Section C, line
6 		 
2 Underdistributions, if any, for years prior to 2014
(reasonable cause required--see instructions)		  
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2014 distributable amount  
i Carryover from 2009 not applied (see
instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.  
4Distributions for 2014 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2014 distributable amount  
c Remainder. Subtract lines 4a and 4b from 4.  
5 Remaining underdistributions for years prior to
2014, if any. Subtract lines 3g and 4a from line 2
(if amount greater than zero, see instructions)		  
6 Remaining underdistributions for 2014. Subtract
lines 3h and 4b from line 1 (if amount greater than
zero, see instructions)		  
7 Excess distributions carryover to 2015. Add lines
3j and 4c.		  
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......  
e From 2014.......  
Schedule A (Form 990 or 990-EZ) (2014)
Schedule A (Form 990 or 990-EZ) 2014
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990 or 990-EZ) 2014

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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
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 its Form 990PF, Part I, line 2, 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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 2
Name of organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC 		Employer identification number

52-0954463
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


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 3
Name of organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC 		Employer identification number

52-0954463
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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)
Page 4
Name of organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC 		Employer identification number

52-0954463
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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) (2014)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

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

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

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

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

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










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2014

Schedule C (Form 990 or 990-EZ) 2014
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2011 (b) 2012 (c) 2013 (d) 2014 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2014


Schedule C (Form 990 or 990-EZ) 2014
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
20,000
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
190,000
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
88,554
j
Total. Add lines 1c through 1i ...............................
298,554
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
SCHEDULE C, PART II-B, LINE 1A THROUGH 1I LOBBYING ACTIVITY BY NONELECTING PUBLIC CHARITIES THE ORGANIZATION IS A MEMBER OF THE KAISER PERMANENTE MEDICAL CARE PROGRAM AND PARTICIPATED IN AND BENEFITED FROM LOBBYING ACTIVITIES CONDUCTED AT THE REGIONAL AND NATIONAL LEVELS FOR THE BENEFIT OF ITS ENROLLED MEMBERS, THE BROADER COMMUNITY AND FOR THE HEALTH CARE INDUSTRY AS A WHOLE. AS AN ORGANIZATION EXEMPT FROM INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), HEALTH PLAN HAS A POLICY PROHIBITING ANY OF HEALTH PLAN'S RESOURCES BEING USED IN ANY POLITICAL CAMPAIGNS. THIS POLICY IS CLOSELY MONITORED FOR COMPLIANCE. DURING THE YEAR THIS ORGANIZATION MADE COMMENTS OR STATEMENTS CONCERNING LEGISLATION AND BALLOT INITIATIVES WHICH MAY AFFECT THE HEALTH CARE INDUSTRY. HEALTH PLAN ENGAGED IN CONVERSATIONS WITH AND/OR WRITTEN COMMUNICATIONS TO VARIOUS FEDERAL, STATE, AND LOCAL OFFICIALS REGARDING MATTERS WHICH AFFECTED THE HEALTHCARE INDUSTRY AS A WHOLE. THE AMOUNT OF TIME AND MONEY INVOLVED IN THE ACTIVITIES IS DETAILED ON LINES A THROUGH I. HEALTH PLAN EMPLOYS INDIVIDUALS, INCLUDING ONE OR MORE REGISTERED LOBBYISTS AND/OR MAY RETAIN ONE OR MORE PROFESSIONAL CONSULTANTS TO REPRESENT HEALTH PLAN'S INTERESTS IN VARIOUS LEGISLATIVE AND REGULATORY BODIES AND FROM TIME-TO-TIME TO KEEP INFORMED ABOUT FEDERAL AND STATE LEGISLATION HAVING AN IMPACT ON HEALTH PLAN'S CHARITABLE ACTIVITIES AS AN EXEMPT HEALTH MAINTENANCE ORGANIZATION. THESE INDIVIDUALS ATTEMPT TO ENSURE THAT PROPOSED LEGISLATION AND ENACTED LAWS ARE COMPATIBLE WITH THE INTERESTS OF HEALTH PLAN, ITS MEMBERS AND ITS PATIENTS BY PERFORMING THE FOLLOWING ACTIVITIES: - COLLECTING, ANALYZING AND DISTRIBUTING WITHIN THE ORGANIZATION, PUBLIC AND PRIVATE POLICY RECOMMENDATIONS REGARDING PROPOSED LEGISLATION THAT AFFECT THE OPERATION OF HEALTH PLAN AND ITS ABILITY TO PROVIDE QUALITY HEALTH AND MEDICAL CARE SERVICES TO ITS MEMBERS AND THE BROADER COMMUNITY IN A COST EFFECTIVE MANNER. - PROVIDING APPROPRIATE INFORMATIONAL MATERIALS TO LEGISLATORS AND THEIR STAFFS THAT PERTAIN TO MATTERS OF COMMON INTEREST IN THE HEALTH CARE COMMUNITY AND IN THE NOT-FOR-PROFIT COMMUNITY. - PREPARING WRITTEN AND ORAL TESTIMONY, APPEARING AT LEGISLATIVE HEARINGS, MONITORING LEGISLATIVE PROCEEDINGS AND MEETING WITH LEGISLATORS AND/OR THEIR STAFFS REGARDING ISSUES PERTINENT TO THE MISSION OF HEALTH PLAN. INDIVIDUALS APPEARING AT SUCH HEARINGS AND MEETINGS FOR AND ON BEHALF OF HEALTH PLAN OFTEN ARE REPRESENTING THE INTERESTS OF COMMON INTEREST GROUPS AS WELL AS THE INTERESTS OF THE MEMBERS AND PATIENTS OF HEALTH PLAN. OTHER EMPLOYEES AND OFFICERS PERFORM SERVICES BY DELIVERING SPEECHES AT VARIOUS PUBLIC AND PRIVATE FUNCTIONS AND IN SERVING AS FACULTY IN HEALTHCARE RELATED EDUCATIONAL PROGRAMS THROUGHOUT THE COMMUNITY.
Schedule C (Form 990 or 990EZ) 2014

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.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of 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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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)
Revenue 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
Revenue included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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, for escrow or custodial account liability?
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (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 current year end balance (line 1g, column (a)) 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 XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. 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 .................   69,500,150 69,500,150
b Buildings ................   820,525,471 284,270,359 536,255,112
c Leasehold improvements ............   148,523,073 77,747,707 70,775,366
d Equipment ................   228,752,295 159,548,848 69,203,447
e Other .................   25,337,513 6,818,509 18,519,004
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 764,253,079
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) STATUTORY DEPOSITS 1,987,481
(2) BROKER RECEIVABLE 2,162,146
(3) LONG-TERM DUE FROM AFFILIATES 115,746,756
(4) OTHER LONG-TERM ASSETS 1,272,297





Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 121,168,680
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
DUE TO RELATED ENTITIES 405,065,422
BROKER PAYABLE 3,161,488
MEDICARE RESERVES 27,905,621
OTHER CURRENT LIABILITIES 25,957,201
SELF-INSURED RISKS 140,962,853
PENSION & POST-RETIREMENT BENE 403,463,698
SUBORDINATED DEBT 264,247,009
OTHER LONG-TERM LIABILITIES 34,418,540

Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,305,181,832
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2014

Schedule D (Form 990) 2014
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1 2,710,252,869
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a -654,407
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 152,581
e Add lines 2a through 2d ..................... 2e -501,826
3 Subtract line 2e from line 1..................... 3 2,710,754,695
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 164,023
b Other (Describe in Part XIII.) ........... 4b 9,701,626
c Add lines 4a and 4b....................... 4c 9,865,649
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 2,720,620,344
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1 2,830,766,719
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 XIII.) ............ 2d 115,941,172
e Add lines 2a through 2d...................... 2e 115,941,172
3 Subtract line 2e from line 1..................... 3 2,714,825,547
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 164,023
b Other (Describe in Part XIII.) ............ 4b 9,505,977
c Add lines 4a and 4b....................... 4c 9,670,000
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 2,724,495,547
Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
SCHEDULE D, PART XI RECONCILIATION OF REVENUE PER AUDITED FIN. STMT. WITH REVENUE PER RETURN LINE 2D: Gain on sale of investments - book $ 648,660 OTTI (See Note 1) (496,079) TOTAL 152,581 LINE 4B: Bad Debt Reclass $ 9,505,977 Fixed assets loss - reclass (353,788) Gain on sale of investments - tax 549,437 TOTAL 9,701,626 Note 1: other than temporary impairment (OTTI) of investment recognized for financial statement purposes, which will be tax reported when realized.
SCHEDULE D, PART XII RECONCILIATION OF EXPENSES PER AUDITED FIN. STMT. WITH EXPENSES PER RETURN LINE 2D: FIXED ASSET LOSS - RECLASS $ 353,788 CHANGE IN PENSION & OTHER COMPREHENSIVE INCOME 115,587,384 Total 115,941,172 LINE 4B: BAD DEBT EXPENSES - RECLASS $ 9,505,977
SCHEDULE D, PART X, Line 2 FIN 48 FOOTNOTE THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE UNDER FIN 48.
Schedule D (Form 990) 2014

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.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number
52-0954463
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC 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) American Heart Association Mid-Atlantic
4217 Park Place Court
Glen Allen,VA23060 		13-5613797 501(c)(3) 109,550       Event Support
(2) American University
4400 Massachusetts Avenue NW
NW Gray Hall
Washington,DC20016 		53-0196549 501(c)(3) 165,524       Event Support
(3) Arlington County Virginia
3308 S Stafford St 1st Floor
Arlington,VA22206 		54-6001123 Government 17,750       Event Support
(4) Arlington Pediatric Center Inc
1701 N George Mason Drive
Arlington,VA22205 		54-1998631 501(c)(3) 8,800       Event Support
(5) Associated Black Charities
1114 Cathedral Street
Baltimore,MD21201 		52-1427774 501(c)(3) 6,763       Conference Support
(6) Baltimore City Community College
2901 Liberty Heights Avenue
Baltimore,MD21215 		52-1361023 501(c)(3) 27,000       Operating Support Special Health Care Needs
(7) Baltimore City Health Department
1001 E Fayette Street
Baltimore,MD21202 		52-6000769 Government 10,000       Event Support Collaborative
(8) Baltimore Community Foundation Inc
2 East Read Street 9th Floor
Baltimore,MD21202 		23-7180620 501(c)(3) 115,000       Operating Support
(9) Capitol Hill Village
725 8th Street SE
Washington,DC20003 		20-5150809 501(c)(3) 6,400       Event Support
(10) Children's Hospital Foundation
111 Michigan Avenue NW
Washington,DC20010 		52-1640402 501(c)(3) 10,000       Event Support
(11) College of Southern Maryland Foundation
PO Box 910
La Plata,MD20646 		23-7279944 501(c)(3) 27,000       Event Support
(12) CommonHealth ACTION
1301 Connecticut Avenue NW Suite 2
Suite 404
Washington,DC20036 		83-0398572 501(c)(3) 374,988       Event Support
(13) Coppin State College
2500 West North Avenue
Baltimore,MD21216 		52-6002033 Government 27,000       Operating Support
(14) County of Fairfax
10777 Main Street Ste 203
Fairfax,VA22030 		54-0787833 Government 20,394       Event Support
(15) Dc Public Education Fund
3407 14th Street NW
Washington,DC20010 		26-1607955 501(c)(3) 24,830       Conference Support
(16) Everybody Wins DC
1213 K Street NW
Washington,DC20005 		52-1938281 501(c)(3) 80,000       Event Support
(17) Food Research & Action Center Inc
1200 18th Street NW Suite 400
2nd Floor
Washington,DC20036 		23-7200739 501(c)(3) 62,500       Event Support
(18) FoodCorps Inc
281 Park Avenue South
New York,NY10010 		27-3990987 501(c)(3) 35,000       Operating Support
(19) Generation Hope
415 Michigan Avenue NE Suite 250
Washington,DC20017 		27-3554088 501(c)(3) 84,650       Event Support
(20) George Mason University Foundation Inc
4400 University Drive MS 1A3
Fairfax,VA22030 		54-1603842 Government 7,500       Conference Support
(21) Greater Baden Medical Services Inc
7450 Albert Rd 3rd Floor
Brandywine,MD20613 		52-0961414 501(c)(3) 5,170       Operating Support
(22) Health Care for the Homeless
421 Fallsway
Baltimore,MD21202 		52-1576404 501(c)(3) 18,170       Conference Support school based healthcare
(23) Holy Cross Hospital Foundation Inc
11801 Tech Road
Silver Spring,MD20904 		20-8428450 501(c)(3) 23,380       Event Support
(24) Holy Cross Hospital of Silver Spring Inc
1500 Forest Glen Road
Suite 708
SilverSpring,MD20910 		52-0738041 501(c)(3) 40,000       Operating Support
(25) Howard Community Educational Foundation
10901 Little Patuxent Parkway
Columbia,MD21044 		52-1272329 501(c)(3) 27,000       Operating Support
(26) Institute for Public Health Innovation
1301 Connecticut Ave NW Suite 200
Washington,DC20036 		46-3039129 501(c)(3) 235,000       Event Support
(27) Leukemia & Lymphoma Society Inc
5845 Richmond Highway Suite 800
SUITE 101
Alexandria,VA22303 		13-5644916 501(c)(3) 43,000       Event Support
(28) Living Classrooms Foundation
802 S Caroline Street
Baltimore,MD21231 		52-1369524 501(c)(3) 53,900       Event Support
(29) Maryland Association of Nonprofit
1500 Union Avenue Suite 2500
Baltimore,MD21211 		52-1749231 501(c)(3) 7,000       Project Support
(30) Maryland Farmers Market Association
PO Box 6355
Annapolis,MD21401 		80-0874086 501(c)(3) 70,000       Operating Support children to medical homes
(31) Maryland Food Bank Inc
2200 Halethorpe Farms Rd
Baltimore,MD21227 		52-1135690 501(c)(3) 15,000       Operating Support
(32) Mary's Center for Maternal
2333 Ontario Road NW
Washington,DC20009 		52-1594116 501(c)(3) 75,000       Event Support
(33) Medical Care For Children Partnership
1616 Anderson Road
McLean,VA22102 		26-1756738 501(c)(3) 13,670       Conference Support
(34) Medical Education Cooperation with Cuba
1814 Franklin Street Suite 820
Oakland,CA94612 		31-1603765 501(c)(3) 10,000       Event Support
(35) Medical Society of Virginia Foundation
2924 Emerywood Parkway
Richmond,VA23294 		52-1394768 501(c)(3) 9,280       Conference Support
(36) Mid-Atlantic Association of Community
4319 Forbes Blvd
Lanham,MD20706 		52-1344933 501(c)(3) 6,000       Operating Support
(37) Montgomery College Foundation Inc
40 West Gude Drive Suite 220
Rockville,MD20850 		52-1267008 501(c)(3) 27,000       Operating Support
(38) Montgomery County Public Schools
850 Hungerford Drive Room 50
Rockville,MD20850 		52-1804509 501(c)(3) 10,000       Event Support
(39) Northern Virginia Community College
7630 Little River Turnpike Suite 8
Annandale,VA22003 		51-0249730 501(c)(3) 27,000       Operating Support
(40) Playworks Education Energized
2601 N Howard St Suite 310
Baltimore,MD21218 		94-3251867 501(c)(3) 35,000       Event Support
(41) Prevention Connections
701 E Franklin Street Suite 500
Richmond,VA23219 		42-1609865 501(c)(3) 9,250       Conference Support
(42) Prince George's Community College
301 Largo Road Accokeek Hall 312
Largo,MD20774 		52-1429938 501(c)(3) 30,500       Conference Support
(43) Prince George's County Board
14201 School Lane
Upper Marlboro,MD20772 		52-6000992 Government 24,500       Conference Support
(44) Rappahannock RefugeInc
902 Lafayette Blvd
Fredericksburg,VA22401 		52-1419314 501(c)(3) 30,000       Conference Support
(45) REAL School Gardens
5520 Connecticut Avenue NW Suite 2
Washington,DC20015 		20-5946552 501(c)(3) 75,000       Event Support
(46) Safe Routes to School National
2323 Broadway Suite 109B
Oakland,CA94612 		46-2694434 501(c)(3) 100,000       Event Support
(47) Suburban Hospital Foundation Inc
8600 Old Georgetown Road
Bethesda,MD20814 		52-2019696 501(c)(3) 8,000       Event Support
(48) The Community College of Baltimore
7200 Sollers Point Road
Dundalk,MD21222 		20-3246676 501(c)(3) 37,000       Operating Support
(49) The Community Foundation
1201 15th Street NW Suite 420
Washington,DC20005 		23-7343119 501(c)(3) 12,825,000       Operating Support
(50) The Family League of Baltimore
2305 N Charles Street Suite 200
Baltimore,MD21218 		52-1734848 501(c)(3) 10,000       Operating Support
(51) The Washington Center For Internships
1333 16th Street NW
Washington,DC20036 		52-1019820 501(c)(3) 20,000       Operating Support
(52) University of Maryland College Park
2242 SPH Building 255
College Park,MD20742 		52-2197313 501(c)(3) 29,755       Conference Support
(53) University System of Maryland
9636 Gudelsky Dr
Rockville,MD20850 		52-1125663 501(c)(3) 27,000       Operating Support
(54) Virginia Center for Health Innovation
919 East Main Street Suite 900
Richmond,VA23219 		80-0796077 501(c)(3) 25,000       Conference Support
(55) Virginia Hospital Center Foundation
1701 N George Mason Drive
Arlington,VA22205 		20-4129901 501(c)(3) 9,400       Event Support
(56) Washington Regional Association
1400 16th St NW Ste 740
Washington,DC20036 		52-1756853 501(c)(3) 24,000       Event Support
(57) Washington Urban League Inc
2901 14th Street NW
Washington,DC20009 		53-0208981 501(c)(3) 23,600       Event Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
57
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF GRANTS Grantees are required to sign a memorandum of understanding with Health plan prior to grant funds dispersal. grantees are required to submit a final report which delineates accomplishments, relates to stated objectives, and describes the evaluation method used to assess accomplishments.
Schedule I (Form 990) 2014


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, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of 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
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used 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
 
No
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), 501(c)(4), and 501(c)(29) organizations 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
Yes
 
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
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 (E) amounts for that individual.
(A) Name and Title (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 in column(B) reported as deferred in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
1Gregory A AdamsEVP,GP & Region President NCAL (i)
(ii)		 0
...............................
679,096 		0
...............................
977,269 		0
...............................
256,913 		0
...............................
731,611 		0
...............................
20,918 		0
...............................
2,665,807 		0
...............................
0
2Karen Elizabeth BlairVP,PR/Communications/Brand Mgt (i)
(ii)		 0
...............................
194,541 		0
...............................
70,776 		0
...............................
33,801 		0
...............................
101,158 		0
...............................
24,576 		0
...............................
424,852 		0
...............................
0
3Maryann M BodayleBoard Governance Administrator (i)
(ii)		 0
...............................
142,083 		0
...............................
15,000 		0
...............................
1,350 		0
...............................
9,356 		0
...............................
8,481 		0
...............................
176,270 		0
...............................
0
4Russell K BradleyVP, HP Services & Admin (i)
(ii)		 0
...............................
64,132 		0
...............................
120,046 		0
...............................
25,163 		0
...............................
37,435 		0
...............................
7,418 		0
...............................
254,194 		0
...............................
0
5George F Buchness JrVP, Strategic Business Develop (i)
(ii)		 0
...............................
195,295 		0
...............................
78,214 		0
...............................
7,189 		0
...............................
40,953 		0
...............................
17,599 		0
...............................
339,250 		0
...............................
0
6Ruben J BurnettVP, Natl Consultant Relations (i)
(ii)		 0
...............................
239,492 		0
...............................
149,037 		0
...............................
19,948 		0
...............................
147,562 		0
...............................
12,939 		0
...............................
568,978 		0
...............................
0
7Christine K CasselDirector (i)
(ii)		 0
...............................
173,500 		0
...............................
0 		0
...............................
0 		0
...............................
0 		0
...............................
0 		0
...............................
173,500 		0
...............................
0
8Thomas W ChapmanDirector (i)
(ii)		 0
...............................
243,148 		0
...............................
0 		0
...............................
18,659 		0
...............................
17,500 		0
...............................
0 		0
...............................
279,307 		0
...............................
53,148
9Linda M CollinsCOO - MAS (i)
(ii)		 0
...............................
82,172 		0
...............................
102,053 		0
...............................
26,039 		0
...............................
46,236 		0
...............................
5,628 		0
...............................
262,128 		0
...............................
0
10Jeffrey E EpsteinDirector (i)
(ii)		 0
...............................
190,000 		0
...............................
0 		0
...............................
7,467 		0
...............................
0 		0
...............................
0 		0
...............................
197,467 		0
...............................
0
11Daniel P GarciaSVP, Chief Compliance Officer (i)
(ii)		 0
...............................
575,436 		0
...............................
732,710 		0
...............................
49,198 		0
...............................
143,894 		0
...............................
31,959 		0
...............................
1,533,197 		0
...............................
0
12William R GraberDirector (i)
(ii)		 0
...............................
220,000 		0
...............................
0 		0
...............................
11,434 		0
...............................
0 		0
...............................
0 		0
...............................
231,434 		0
...............................
0
13J Eugene Grigsby IIIDirector (i)
(ii)		 0
...............................
207,500 		0
...............................
0 		0
...............................
425 		0
...............................
0 		0
...............................
0 		0
...............................
207,925 		0
...............................
0
14George C HalvorsonChairman (i)
(ii)		 0
...............................
0 		0
...............................
10,372,909 		0
...............................
27,061 		0
...............................
46,427 		0
...............................
0 		0
...............................
10,446,397 		0
...............................
0
15Kimberly K HornRegion President - MAS (i)
(ii)		 0
...............................
510,413 		0
...............................
309,257 		0
...............................
473,481 		0
...............................
494,018 		0
...............................
19,675 		0
...............................
1,806,844 		0
...............................
151,505
16Judith JohansenDirector (i)
(ii)		 0
...............................
211,000 		0
...............................
0 		0
...............................
11,508 		0
...............................
0 		0
...............................
0 		0
...............................
222,508 		0
...............................
0
17Kim J KaiserDirector (i)
(ii)		 0
...............................
207,500 		0
...............................
0 		0
...............................
5,352 		0
...............................
0 		0
...............................
0 		0
...............................
212,852 		0
...............................
0
18Marilyn KawamuraRegion President - MAS (i)
(ii)		 0
...............................
0 		0
...............................
137,547 		0
...............................
7,762 		0
...............................
0 		0
...............................
0 		0
...............................
145,309 		0
...............................
2,980
19Kathryn LancasterEVP & CFO (i)
(ii)		 0
...............................
704,458 		0
...............................
1,248,561 		0
...............................
291,241 		0
...............................
681,278 		0
...............................
17,287 		0
...............................
2,942,825 		0
...............................
189
20Kay W LewisVP, Quality CA Behavioral Hlth (i)
(ii)		 0
...............................
214,039 		0
...............................
90,603 		0
...............................
20,528 		0
...............................
137,253 		0
...............................
22,768 		0
...............................
485,191 		0
...............................
707
21Philip MarineauDirector (i)
(ii)		 0
...............................
207,500 		0
...............................
0 		0
...............................
7,467 		0
...............................
0 		0
...............................
0 		0
...............................
214,967 		0
...............................
0
22Thomas R MeierSVP, Corporate Treasurer (i)
(ii)		 0
...............................
326,884 		0
...............................
440,788 		0
...............................
96,477 		0
...............................
150,921 		0
...............................
32,419 		0
...............................
1,047,489 		0
...............................
1,478
23Donald H OrndoffSVP, NFS (i)
(ii)		 0
...............................
403,330 		0
...............................
437,678 		0
...............................
22,690 		0
...............................
139,375 		0
...............................
28,211 		0
...............................
1,031,284 		0
...............................
0
24Edward Y W PeiDirector (i)
(ii)		 0
...............................
205,000 		0
...............................
0 		0
...............................
12,904 		0
...............................
17,500 		0
...............................
0 		0
...............................
235,404 		0
...............................
0
25DeAnne PetersenVP, CFO - MAS (i)
(ii)		 0
...............................
240,333 		0
...............................
135,906 		0
...............................
61,094 		0
...............................
187,164 		0
...............................
17,921 		0
...............................
642,418 		0
...............................
34,957
26Margaret E PorfidoDirector (i)
(ii)		 0
...............................
215,000 		0
...............................
0 		0
...............................
17,533 		0
...............................
0 		0
...............................
0 		0
...............................
232,533 		0
...............................
0
27Rochelle M RothDir, Health Plan QCSO (i)
(ii)		 0
...............................
164,534 		0
...............................
41,624 		0
...............................
22,313 		0
...............................
132,829 		0
...............................
17,939 		0
...............................
379,239 		0
...............................
0
28Michael RovinskyExec Dir, Strat Planning - MAS (i)
(ii)		 0
...............................
220,302 		0
...............................
42,334 		0
...............................
192,513 		0
...............................
18,648 		0
...............................
45,570 		0
...............................
519,367 		0
...............................
0
29Mark RuszczykVP, MSBD - MAS (i)
(ii)		 0
...............................
259,015 		0
...............................
78,758 		0
...............................
15,361 		0
...............................
55,419 		0
...............................
39,716 		0
...............................
448,269 		0
...............................
0
30Jacqueline SellersSr Counsel/Assistant Secretary (i)
(ii)		 0
...............................
188,039 		0
...............................
58,756 		0
...............................
5,550 		0
...............................
179,755 		0
...............................
11,968 		0
...............................
444,068 		0
...............................
0
31Arthur M SouthamEVP, Health Plan Operations (i)
(ii)		 0
...............................
780,801 		0
...............................
1,384,773 		0
...............................
336,066 		0
...............................
571,937 		0
...............................
23,238 		0
...............................
3,096,815 		0
...............................
7,255
32Susan SpurlarkVP, Regional Counsel - MAS (i)
(ii)		 0
...............................
239,813 		0
...............................
115,252 		0
...............................
64,689 		0
...............................
256,727 		0
...............................
13,256 		0
...............................
689,737 		0
...............................
35,350
33Deborah StokesSVP,Corporate Controller & CAO (i)
(ii)		 0
...............................
348,937 		0
...............................
336,625 		0
...............................
76,717 		0
...............................
272,898 		0
...............................
21,154 		0
...............................
1,056,331 		0
...............................
0
34Cynthia A TellesDirector (i)
(ii)		 0
...............................
215,500 		0
...............................
0 		0
...............................
6,956 		0
...............................
0 		0
...............................
0 		0
...............................
222,456 		0
...............................
0
35Frank TitusVP, Health Plan Svcs Admin-MAS (i)
(ii)		 0
...............................
238,204 		0
...............................
144,976 		0
...............................
133,658 		0
...............................
132,140 		0
...............................
23,976 		0
...............................
672,954 		0
...............................
79,221
36Bernard J TysonChairman & CEO (i)
(ii)		 0
...............................
1,191,890 		0
...............................
2,757,589 		0
...............................
737,833 		0
...............................
593,465 		0
...............................
31,237 		0
...............................
5,312,014 		0
...............................
0
37Tamsen Lee WestmorelandRegion Compliance Officer -MAS (i)
(ii)		 0
...............................
205,221 		0
...............................
72,651 		0
...............................
13,849 		0
...............................
160,584 		0
...............................
22,204 		0
...............................
474,509 		0
...............................
0
38Victoria B ZatkinVP, Off of Brd & Corp Gov Svcs (i)
(ii)		 0
...............................
201,172 		0
...............................
108,856 		0
...............................
37,775 		0
...............................
237,758 		0
...............................
5,050 		0
...............................
590,611 		0
...............................
2,368
39Mark S ZemelmanSVP,General Counsel &Secretary (i)
(ii)		 0
...............................
505,424 		0
...............................
697,669 		0
...............................
308,722 		0
...............................
403,607 		0
...............................
29,665 		0
...............................
1,945,087 		0
...............................
108,241
Schedule J (Form 990) 2014

Schedule J (Form 990) 2014
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
SCHEDULE J, PART I, LINE 3 - METHODS USED TO ESTABLISH CONSIDERATION OF CEO/EXECUTIVE DIRECTOR - Kaiser Foundation Health Plan of the Mid-Atlantic States relied on Kaiser Foundation Health Plan, Inc. that used one or more of the methods described below to establish the top management officials' compensation: - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Written employment contract - Compensation survey or study, and - Approval by the board or compensation committee.
SCHEDULE J, PART I, LINE 4b - Supplemental Nonqualified Retirement Plan Payment - Gregory A Adams $ 232,137 Marilyn Kawamura 2,980 Kathryn Lancaster 248,666 Kay W Lewis 707 Thomas R Meier 59,750 DeAnne Petersen 44,056 Arthur M Southam 292,904 Susan Spurlark 44,722 Deborah Stokes 55,423 Frank Titus 100,986 Bernard J Tyson 568,604 Victoria B Zatkin 2,368 Mark S Zemelman 265,554 Some of the participants listed in schedule J, part II participated in nonqualified supplemental retirement plans. Under these plans, the organization makes annual contributions to a notional account on behalf of each participant. Contributions vary by position, level and pay, and vest over time based on age and/or service. Participant accounts are credited with a fixed rate of interest, invested in available mutual funds or a combination of both. Certain officers accrue a benefit that vests based on age and service and targets a percentage of final average pay less prior plan offsets. Unvested amounts are subject to risk of forfeiture.
SCHEDULE J, PART I, LINE 7 - Non-Fixed Payments - 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 I, LINE 8 KIMBERLY K HORN PAID IN 2014 - RETENTION PAYMENT: $250,000 FUTURE RETENTION PAYMENT - JANUARY 2015 $150,000
Schedule J (Form 990) 2014

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 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Return Reference Explanation
FORM 990, PART VI, LINE 6 KAISER FOUNDATION HEALTH PLAN, INC. IS THE SOLE MEMBER. Upon dissolution, remaining assets shall be distributed to a 501(c)(3) organization.
FORM 990, PART VI, LINE 7A - Appointment of Governing Body - KAISER FOUNDATION HEALTH PLAN, INC. appoints the directors (and fills vacancies and has authority to remove directors). The same 15 individuals who comprise the board of directors of KFHP also serve as the 15 directors of KFHP-CO, NW, and MAS.
FORM 990, PART VI, LINE 7B - Approval of Certain Governance Decisions - The following actions of the corporation require approval of the sole member: a) removal of the chairman of the board or the regional president; b) amendments to the bylaws that pertain to the member, the board of directors, or procedures for amending the bylaws (articles c, d, and h of the bylaws); c) amendment of the articles of incorporation.
Form 990, Part VI, Line 11B - Form 990 Review Process - 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. The complete tax return is reviewed and signed by a PRICEWATERHOUSECOOPERS LLP tax advisor. 4. The complete tax return is reviewed and signed by an officer or a member of management designated by an officer. 5. A copy of the return is provided to each board member prior to filing.
Form 990, Part VI, Line 12C - Compliance Enforcement - A. 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: A1. The Kaiser Permanente Compliance Hotline is available to all employees and vendors to report actual or potential conflicts of interest. All calls are answered by a third party and provided to Kaiser Permanente's National Compliance office for review and appropriate action. Employees can report anonymously and without fear of retaliation. Reports of actual or potential Conflicts of Interest are generated and investigations are conducted as required and information is tracked and trended to determine if additional guidance is required to avoid conflicts of interest. Compliance Hotline Reports are provided for review and action to the Kaiser Foundation Health Plan/Hospitals Boards of Directors annually. A2. The National Compliance Office and 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 A3. Annually, as a component of the external audit, KPMG reviews the Annual Conflicts of Interest Questionnaires completed by Directors, Officers, Key Employees, and Executives, and actions taken as a result of the disclosures. The results of the annual audit, including any findings in this area are presented to the Kaiser Foundation Health Plan/Hospitals Audit and Compliance Committee. B. 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: B1. Represented employees are subject to any corrective/disciplinary action provisions described in specific regional/national collective bargaining agreements and/or organizational policies and practices. B2. Kaiser Permanente notifies employees of the National Human Resources Policy No. 14. Corrective/Disciplinary Action Policy during new employee orientation and in annual compliance training. B3. 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.
Form 990, Part VI, Line 15A/B - Compensation Determination - 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 ANNUAL BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS AND THE MANAGEMENT COMMITTEE ON COMPENSATION, PRIOR TO PAYMENT, ALL PROGRAMS AND PAYMENTS TO THE 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 TO BE COMPETITIVE TO THE COMPARABLE EXTERNAL MARKET IN WHICH THE ORGANIZATION COMPETES FOR EXECUTIVE LEADERSHIP. Evaluation of comparable pay data is performed by an Independent Compensation, Benefit & Human Resource Consulting firm. The compensation program focuses on objectives in the areas of quality of member care and service, financial soundness, and the community and social mission of the organization.
Form 990, Part VI, Line 18 Forms 990 are available on www.guidestar.org.
Form 990, Part VI, Line 19 - Public Inspection - Governing documents - are available from the Department of Insurance and maintained on the state agency website or upon request. Conflict of Interest - is available on KP website under vendor Principles of Responsibility or upon request. Financial Statements - are on file with state insurance agency on a statutory basis (stand alone entity). Combined data is published for Kaiser Foundation Health Plan Inc. and subsidiaries and Kaiser Foundation Hospitals and Subsidiaries with audit opinion by KPMG and is available upon request. To request copies contact: Vice President - TAX SERVICES Kaiser Foundation Health Plan and Hospitals One Kaiser Plaza, Suite 15L Oakland, CA 94612
Form 990, Part VII, Section A, Column B - Hours for Related Organizations - Individuals who are both officers and members of Boards of Directors work full time as employees as well as fulfill their board assignment. All officers work full time in their employee capacity. Full time work may require in excess of the traditional 40 hour week. Given the integrated nature of our organization, employees may provide support for various Kaiser Permanente companies. The average hours per week reported for the filing organization and related organizations was estimated.
Form 990, Part XI, Line 9 - Other changes in net assets or fund balances - CHANGE IN OTHER COMPREHENSIVE INCOME $ (115,587,384) OTHER THAN TEMPORARY IMPAIRMENTS (496,079) GAIN ON SALE OF INVESTMENTS - TAX (549,437) GAIN ON SALE OF INVESTMENTS - BOOK 648,660 TOTAL $ (115,984,240)
Form 990, Part III, Line 4A-4D 2014 Community Benefit Report Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.'s Commitment to the Community Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Mid-Atlantic Health Plan or KFHP-MAS) provides and arranges comprehensive health care services for members on a predominantly prepaid basis. Its contractual obligations to group and individual members are fulfilled by contracting with local hospitals and Permanente Medical Group physicians to provide health care services for its members. KFHP-MAS strives for excellence in serving its members through market-leading performance in quality and service. As a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP, Inc.), membership is available without regard to age, sex, race, religion, or national origin, or to the individual's ability to pay. Mid-Atlantic Health Plan members are broadly representative of the communities served. Once enrolled, a member may maintain membership regardless of health or employment status. Mid-Atlantic Health Plan provides and coordinates complete health care services with 31 medical offices, serving communities in Maryland, Virginia, and Washington, D.C. As related nonprofit organizations, Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. are committed to improving the health of communities beyond enrolled membership. Annual investments in a range of Community Benefit programs are a fundamental embodiment of the organizations' ongoing commitment to improve general wellbeing within the broader community. These investments result in intentional, planned, measurable, and accountable benefits intended to address many of the health challenges faced at the individual, local, state, and national levels. In 2007, Kaiser Foundation Health Plan, Inc.'s board of directors refined the focus of the organizations' Community Benefit program and established the following four priority areas which have come to be known as "Streams of Work": A. Care and Coverage for Low-Income People - Creates and supports programs that lower the financial barriers for the under- and uninsured. B. Community Health Initiatives (CHI) - Seeks to measurably improve the health of the communities we serve. Designs, delivers, and sustains long-term programs that engage communities in work to improve conditions in their neighborhoods. C. 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. D. Developing and Disseminating Knowledge - Improves health care by sharing our knowledge - educating practitioners, advancing research, empowering consumers, and informing policymakers about evidence-based care and health. The following are details of the Community Benefit activities provided by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.: In 2014, Mid-Atlantic Health Plan served over 530,000 members and expended approximately $81.0 million (at cost, net of $21.3 million of related revenues) to support Community Benefit activities. The following summarizes many of the signature Community Benefit programs and services grouped according to the national Streams of Work. A. Care and Coverage for Low-Income People Improving health care access for those with limited incomes and resources is fundamental to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.'s mission. In 2014, Mid-Atlantic Health Plan expended approximately $54.7 million (at cost, net of $21.3 million of related revenues) 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. A.1. Charitable Care (Medical Financial Assistance and Charitable Health Coverage Programs) KFHP-MAS provides charity care to low-income vulnerable populations through the Medical Financial Assistance (MFA) and Charitable Health Coverage (CHC) Programs. In 2014, Mid-Atlantic Health Plan spent approximately $35.6 million (at cost, net of $932 thousand of related revenues) to support under- and uninsured patients. A.1.1. Medical Financial Assistance (MFA) Program Mid-Atlantic Health Plan's Medical Financial Assistance program provides financial assistance for emergency and medically necessary services, medications, and supplies to patients with a demonstrated financial need. Patients must receive health care services at facilities operated by Kaiser Permanente and/or from a Kaiser Permanente provider. Eligibility is based upon prescribed levels of income to patients who have exhausted other private and public sources of support. In 2014, KFHP-MAS provided $19.7 million (at cost, net of related revenues of $0) of services under this program. At KFHP-MAS, uninsured patients receive a discount on hospital and professional charges for emergency or other medically necessary care without application and regardless of income level. The discount is provided to ensure that an uninsured individual is not charged more for emergency or other medically necessary services than the amounts generally billed to insured individuals receiving equivalent care. Contracted collection agency practices are already aligned with the organization's social values and IRC section 501(r). This legislation was finalized in December 2014 and is fully effective for the 2016 tax year. Additionally, any patient experiencing financial hardship due to high medical expenses relative to their income level may qualify for the program under special circumstances. In Maryland, Virginia, and Washington D.C., the MFA program's eligibility criteria allows patients falling below 350% of the Federal Poverty Guidelines (FPG) to receive full write off of patient out-of-pocket costs. In 2014, the MFA program assisted almost 34,000 qualifying applicants in Maryland, Virginia, and the District of Columbia. This population received full or partial forgiveness for nearly 333,000 outpatient visits and approximately 65,000 prescriptions. A.1.2. Charitable Health Coverage (CHC) Program Charitable Health Coverage is a unique approach to caring for low-income uninsured persons in the community. Eligible participants receive a regular Kaiser Permanente Health Plan membership card and access to the full range of services and providers - a much better alternative to potentially costly emergency room visits or hospitalization. This allows Mid-Atlantic Health Plan to invest in the longer term health of patients and the community. KFHP-MAS's CHC programs have a long history of making a real difference in the lives of persons who might otherwise have no permanent medical home. During 2014, KFHP-MAS invested approximately $15.9 million (at cost, net of $932 thousand of related revenues) to support the CHC program. In order to meet the requirements of the Affordable Care Act, Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.'s CHC program was redesigned in 2014. The new CHC program includes a separately administered premium subsidy that CHC members use for the purchase of a standard off-exchange Kaiser Permanente Individual/Family (KPIF) gold level plan. To ensure that patient cost share obligations do not become a barrier to care, a Medical Financial Assistance award is provided to CHC members at the time of enrollment in the CHC program. Recertification takes place about every two years to confirm that members remain eligible to participate. Prospective members are invited to apply during limited annual enrollment periods and after experiencing triggering events. A.1.2.1. Community Health Access Program (CHAP) CHAP is a Charitable Health Coverage program that provides low-income individuals and families with access to health coverage. Participants must meet certain eligibility requirements. Total household income must be at or below 300% of the Federal Poverty Level (FPL) and applicants must not have access to other forms of health care coverage. Once eligibility requirements are met, CHAP members receive a KP monthly payment amount subsidy that helps pay for enrollment in a standard off-exchange KP individual and family product (gold level). These members are also provided with medical financial assistance that covers the cost sharing for most services if provided at KP facilities. More than 2,000 members who did not have access to other publicly or privately offered forms of health coverage were enrolled in this program at the end of 2014. A.1.2.2. Medical Care for Children Partnership (MCCP) Program Mid-Atlantic Health Plan's long-standing participation as a pediatric
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2014

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2014
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1) KAISER FOUNDATION HEALTH PLAN INC
ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-1340523 		HEALTH CARE CA 501(c)(3) 9 NA
 
 
No
(2) KAISER FOUNDATION HOSPITALS
ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-1105628 		HEALTH CARE CA 501(c)(3) 3 na
 
 
No
(3) KAISER FDN HEALTH PLAN OF COLORADO
ONE KAISER PLAZA 15L

OAKLAND,CA94612
84-0591617 		HEALTH CARE CO 501(c)(3) 9 KFHP INC
 
Yes
 
(4) KAISER FDN HEALTH PLAN OF GEORGIA INC
ONE KAISER PLAZA 15L

OAKLAND,CA94612
58-1592076 		HEALTH CARE GA 501(c)(3) 9 KFHP INC
 
Yes
 
(5) KAISER FDN HEALTH PLAN OF THE NORTHWEST
ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0798039 		HEALTH CARE OR 501(c)(3) 9 KFHP INC
 
Yes
 
(6) KAISER HEALTH PLAN ASSET MANAGEMENT INC
ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299124 		ASSET MGMT CA 501(c)(3) 11 - I KFHP INC
 
Yes
 
(7) LOKAHI ASSURANCE LTD
ONE KAISER PLAZA 15L

OAKLAND,CA94612
91-2171891 		WC PLACEMENT HI 501(c)(3) 11 - I KFHP INC
 
Yes
 
(8) KAISER HOSPITAL ASSET MANAGEMENT INC
ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299125 		ASSET MGMT CA 501(c)(3) 11 - I KFH
 
Yes
 
(9) CAMP BOWIE SERVICE CENTER
ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299123 		HEALTH CARE CA 501(c)(3) 11 - I KFHP INC
 
Yes
 
(10) OHP
ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0480268 		LEASING WA 501(c)(3) 11 - I KFHP INC
 
Yes
 
(11) KAISER HEALTH ALTERNATIVES
ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0954562 		HEALTH CARE WA 501(c)(3) 9 KFHP INC
 
Yes
 
(12) 1800 HARRISON FOUNDATION
ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3317484 		FINANCING CA 501(c)(3) 11 - II KFHP INC
 
Yes
 
(13) KAISER HOSPITAL ASSISTANCE CORPORATION
ONE KAISER PLAZA 15L

OAKLAND,CA94612
31-1779500 		FINANCING CA 501(c)(3) 11 - III-NF KFH
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
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) HEALTH CARE MANAGEMENT SOLUTIONS LLC

ONE KAISER PLAZA SUITE 15L
OAKLAND,CA94612
20-3924985 		CONSULTING CA NA
  		N/A                












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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) OAK TREE ASSURANCE LTD

ONE KAISER PLAZA 15L
OAKLAND,CA94612
03-0329760 		INSURANCE VT NA
  		C CORP 0 0   Yes  
(2) KAISER PERMANENTE INSURANCE COMPANY

ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3203402 		INSURANCE CA NA
  		C CORP 0 0   Yes  
(3) KAISER PROPERTIES SERVICES INC

ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3259432 		REAL ESTATE CA NA
  		C CORP 0 0   Yes  
(4) KAISER PERMANENTE INTERNATIONAL

ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3245176 		CONSULTING CA NA
  		C CORP 0 0   Yes  






Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) KAISER FOUNDATION HEALTH PLAN INC

 L 13,878,328 PER AGREEMENT
(2) KAISER FOUNDATION HEALTH PLAN INC

 M 93,770,741 PER AGREEMENT
(3) KAISER FOUNDATION HEALTH PLAN INC

 P 49,249,750 per agreement
(4) KAISER FOUNDATION HEALTH PLAN INC

 Q 90,286,637 per agreement
(5) KAISER FOUNDATION HOSPITALS

 a 4,545,011 PER AGREEMENT
(6) KAISER FOUNDATION HOSPITALS

 e 131,000,000 PER AGREEMENT
(7) KAISER FOUNDATION HOSPITALS

 L 3,063,151 PER AGREEMENT
(8) KAISER FOUNDATION HOSPITALS

 M 468,989,520 PER AGREEMENT
(9) KAISER FOUNDATION HOSPITALS

 p 250,957,883 PER AGREEMENT
(10) KAISER FOUNDATION HOSPITALS

 q 1,659,621 PER AGREEMENT
(11) CAMP BOWIE SERVICE CENTER

 L 252,000 PER AGREEMENT
(12) CAMP BOWIE SERVICE CENTER

 M 5,500,924 PER AGREEMENT
(13) CAMP BOWIE SERVICE CENTER

 q 22,272,629 PER AGREEMENT
(14) KAISER PERMANENTE INSURANCE COMPANY

 L 3,657,753 PER AGREEMENT
(15) KAISER PERMANENTE INSURANCE COMPANY

 M 16,770,784 PER AGREEMENT
(16) KAISER PERMANENTE INSURANCE COMPANY

 p 243,002 PER AGREEMENT
(17) KAISER PERMANENTE INSURANCE COMPANY

 q 3,359,184 PER AGREEMENT
(18) LOKAHI ASSURANCE LTD

 L 6,076,256 PER AGREEMENT
(19) LOKAHI ASSURANCE LTD

 m 19,600,000 PER AGREEMENT
(20) LOKAHI ASSURANCE LTD

 q 17,174,958 PER AGREEMENT
(21) LOKAHI ASSURANCE LTD

 r 1,786,000 per agreement
(22) KAISER FDN HEALTH PLAN OF THE NORTHWEST

 L 335,909 PER AGREEMENT
(23) KAISER FDN HEALTH PLAN OF THE NORTHWEST

 m 297,409 PER AGREEMENT
(24) KAISER FDN HEALTH PLAN OF THE NORTHWEST

 p 158,517 PER AGREEMENT
(25) KAISER FDN HEALTH PLAN OF THE NORTHWEST

 q 171,606 PER AGREEMENT
(26) KAISER FDN HEALTH PLAN OF COLORADO

 L 467,963 PER AGREEMENT
(27) KAISER FDN HEALTH PLAN OF COLORADO

 m 397,991 PER AGREEMENT
(28) KAISER FDN HEALTH PLAN OF COLORADO

 p 1,592,124 PER AGREEMENT
(29) KAISER FDN HEALTH PLAN OF COLORADO

 q 174,073 PER AGREEMENT
(30) KAISER FDN HEALTH PLAN OF GEORGIA INC

 L 820,480 PER AGREEMENT
(31) KAISER FDN HEALTH PLAN OF GEORGIA INC

 m 2,450,519 PER AGREEMENT
(32) KAISER FDN HEALTH PLAN OF GEORGIA INC

 p 142,431 PER AGREEMENT
(33) KAISER FDN HEALTH PLAN OF GEORGIA INC

 q 94,939 PER AGREEMENT
(34) OAK TREE ASSURANCE LTD

 m 660,600 PER AGREEMENT
Schedule R (Form 990) 2014
Schedule R (Form 990) 2014
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) 2014
Schedule R (Form 990) 2014
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2014
Additional Data


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