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

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 01-01-2012 , 2012, and ending 12-31-2012
BCheck if applicable:
CName of organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
ONE KAISER PLAZA 15L
 
Room/suite
City or town, state or country, and ZIP + 4
OAKLAND, CA94612
D Employer identification number

52-0954463
E Telephone number

G Gross receipts $ 2,618,675,595
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
N/A
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1972
M State of legal domicile: MD
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTH CARE SERVICES TO IMPROVE THE HEALTH OF OUR MEMBERS AND THE COMMUNITIES WE SERVE
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 15
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 12
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 6,536
6 Total number of volunteers (estimate if necessary) ............. 6 678
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 218,917
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) ......... 16,275 344,247
9 Program service revenue (Part VIII, line 2g) ......... 2,272,514,533 2,388,129,639
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 7,423,339 6,947,254
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 587,969 831,446
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 2,280,542,116 2,396,252,586
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 6,464,946 1,926,096
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) 509,803,098 566,568,795
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).... 1,817,965,316 1,848,484,469
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 2,334,233,360 2,416,979,360
19 Revenue less expenses. Subtract line 18 from line 12....... -53,691,244 -20,726,774
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 985,638,340 1,184,225,388
21 Total liabilities (Part X, line 26)............. 1,007,449,179 1,298,675,195
22 Net assets or fund balances. Subtract line 21 from line 20..... -21,810,839 -114,449,807
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 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTH CARE SERVICES TO IMPROVE THE HEALTH OF OUR MEMBERS AND THE COMMUNITIES WE SERVE
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations 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 $ 2,175,339,308 including grants of $ 1,926,096 ) (Revenue $ 2,385,151,394 )
member health care services and medical training for care improvement Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP of MAS) provides medical and surgical care, including urgent care services, extended care and home health care, for its members without regards to age, sex, race, religion or national origin or the ability to pay. KFHP of MAS educates and trains medical students and other health care professionals and promotes scientific and nursing education in order to improve care. Additional information about Mid-Atlantic States Health Plan's charitable activities can be found in Community Benefits Report.
4b (Code:   ) (Expenses $ 50,234,096 including grants of $ 0 ) (Revenue $ 2,696,281 )
Charitable Care (Medical Financial Assistance and Charitable Health Coverage) Mid-Atlantic States Health Plan provides charity care to low-income vulnerable patients through the Medical Financial Assistance (MFA) and Charitable Health Coverage (CHC) Programs. Mid-Atlantic States Health Plan offers financial assistance through our MFA program to help families and individuals that are unable to pay for all or part of the cost of urgent or emergent care provided in Kaiser Permanente facilities. In 2012, this program assisted more than 1,300 qualifying applicants. The CHC programs are available to low income adults and children who are not eligible for other public or privately sponsored coverage. More than 8,400 individuals were receiving comprehensive care through these programs at the end of 2012. Additional information about Mid-Atlantic States Health Plan's charitable activities can be found in Community Benefits Report.
4c (Code:   ) (Expenses $ 15,683,863 including grants of $ 0 ) (Revenue $ 281,964 )
Medicaid and Other Government Sponsored Programs Mid-Atlantic States Health Plan is committed to improving the way beneficiaries of our Medicaid and other government sponsored programs receive care, not only in our facilities, but also in the communities we serve. In 2012, Mid-Atlantic States Health Plan participated in a number of government programs to support the provision of primary and specialty care to residents of the communities we serve. At the end of 2012, approximately 1,200 individuals were receiving the benefits of full membership in KFHP's managed care programs in the Mid-Atlantic region. Additional information about Mid-Atlantic States Health Plan's charitable activities can be found in Community Benefits Report.
(Code:   ) (Expenses $ 10,400,076 including grants of $ 0 ) (Revenue $ 0 )
SEE COMMUNITY BENEFIT REPORT
4d Other program services (Describe in Schedule O.)
(Expenses $ 10,400,076 including grants of $ 0 ) (Revenue $ 0 )
4e Total program service expensesMediumBullet2,251,657,343
Form 990 (2012)
Form 990 (2012)
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
 
No
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 assistance to any organization or entity located outside the United States? 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 assistance to individuals located outside the United States? 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 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
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 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or 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 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
4,820
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
6,536
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, 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 Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible 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 and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. 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 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
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
12
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
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, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletVP - NATIONAL TAX COMPLIANCEONE KAISER PLAZA 15LOAKLANDCA94612 (510) 271-6385
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. 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; Officer; Key Employee; Highest compensated employee; Former;
(1) Christine Cassel........................................................................
Director
 1.0
.......................10.0 		X           0 203,500 0
(2) Thomas Chapman........................................................................
Director
 2.0
.......................11.0 		X           0 214,108 17,000
(3) Daniel P Garcia........................................................................
SVP, Chief Compliance Officer
 2.0
.......................48.0 		X   X       0 1,424,272 106,893
(4) William Graber........................................................................
director
 .5
.......................7.0 		X           0 240,823 0
(5) J Eugene Grigsby III........................................................................
director
 1.0
.......................7.5 		X           0 221,000 0
(6) George C Halvorson........................................................................
Chairman and CEO
 5.0
.......................45.0 		X   X       0 9,800,351 112,560
(7) Judith Johansen........................................................................
director
 .5
.......................5.8 		X           0 207,146 0
(8) Kim J Kaiser........................................................................
director
 .5
.......................8.0 		X           0 228,500 0
(9) Philip Marineau........................................................................
director
 .58
.......................6.34 		X           0 225,618 0
(10) Jenny Ming........................................................................
director
 .3
.......................4.8 		X           0 214,323 0
(11) Edward Pei........................................................................
director
 .5
.......................7.5 		X           0 206,641 17,000
(12) Margaret Porfido........................................................................
director
 .5
.......................9.0 		X           0 237,779 0
(13) J Neal Purcell........................................................................
director
 .5
.......................8.5 		X           0 251,464 0
(14) Cynthia Telles........................................................................
director
 .5
.......................6.6 		X           0 226,717 0
(15) Bernard J Tyson........................................................................
President & COO
 5.0
.......................45.0 		X   X       0 4,087,093 246,726
(16) Marilyn Kawamura........................................................................
Region President - MAS
 40.0
.......................10.0 		    X       0 913,029 159,370
(17) Kathryn Lancaster........................................................................
EVP & CFO
 4.0
.......................46.0 		    X       0 2,779,989 235,528
Form 990 (2012)
Form 990 (2012)
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; Officer; Key Employee; Highest compensated employee; Former;
(18) Thomas R Meier........................................................................
SVP, Corporate Treasurer
 3.0
.......................47.0 		    X       0 816,082 125,506
(19) Donald H Orndoff........................................................................
SVP, NFS
 5.0
.......................45.0 		    X       0 766,341 179,878
(20) DeAnne Petersen........................................................................
VP, CFO - MAS
 30.0
.......................20.0 		    X       0 372,576 143,319
(21) ROCHELLE M Roth........................................................................
EXEC. DIR, HP QCSO
 3.0
.......................47.0 		    X       0 245,044 103,178
(22) Arthur M Southam........................................................................
EVP, HP Operations
 4.0
.......................46.0 		    X       0 3,350,376 119,108
(23) Susan Spurlark........................................................................
VP, Regional Counsel
 30.0
.......................20.0 		    X       0 352,450 147,846
(24) Deborah Stokes........................................................................
SVP, CC & CAO
 4.0
.......................46.0 		    X       0 690,493 184,332
(25) Victoria Zatkin........................................................................
VP. Off of Brd & corp gov svcs
 4.0
.......................46.0 		    X       0 339,271 192,592
(26) Mark S Zemelman........................................................................
SVP, Gen Counsel & Secretary
 3.0
.......................47.0 		    X       0 1,019,066 181,919
(27) Gregory Adams........................................................................
Group president
 6.0
.......................44.0 		    X       0 1,910,063 297,803
(28) Kimberly Horn........................................................................
Region President - MAS
 30.0
.......................20.0 		    X       0 112,249 119,076
(29) Russell K Bradley........................................................................
VP, HP Services & Admin
 30.0
.......................20.0 		      X     0 284,005 83,553
(30) Ruben J Burnett........................................................................
VP, Natl Consultant Relations
 30.0
.......................20.0 		      X     0 471,098 124,509
(31) Linda M Collins........................................................................
COO - MAS
 30.0
.......................20.0 		      X     0 440,040 220,995
(32) Mary Elizabeth Jaeger........................................................................
VP, HR - MAS
 30.0
.......................20.0 		        X   0 292,325 75,955
(33) Kay W Lewis........................................................................
VP, UM, Risk Mgmt & Quality
 30.0
.......................20.0 		        X   0 355,377 111,451
(34) Ferial G Maghami........................................................................
Exec Dir, Provider Affairs
 30.0
.......................20.0 		        X   0 485,980 79,935
(35) Jane W Lewis........................................................................
Dir, HP Reg Clinical Svcs Exec
 50.0
.......................0.0 		        X   0 212,900 152,479
(36) Jeffrey A Goldman........................................................................
VP, STRAT PLAN & PERFORM - MAS
 50.0
.......................0.0 		        X   0 257,706 97,316
(37) Steven R Zatkin........................................................................
Former Gen Counsel, Consultant
 0.0
.......................0.0 		          X 0 323,501 0
(38) Kendall D Hunter........................................................................
Former SVP Health Ins Exchange
 0.0
.......................0.0 		          X 0 651,595 194,704
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 0 35,430,891 3,830,531
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet864
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 STREETROCKVILLEMD20852 PHYSICIAN SERVICES 472,497,676
INOVA GROUP OF HOSPITALS, PO BOX 37019BALTIMOREMD21297 HOSPITAL SERVICES 60,833,042
HOLY CROSS HOSPITAL, 9805 DAMERON DRIVESILVER SPRINGMD20902 HOSPITAL SERVICES 56,276,250
WASHINGTON HOSPITAL CENTER, PO BOX 631290BALTIMOREMD21263 HOSPITAL SERVICES 59,622,963
VIRGINIA HOSPITAL CENTER, PO BOX 1494MERRIFIELDMD22116 HOSPITAL SERVICES 45,581,215
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet394
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 313,647
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		30,600
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 344,247
Program Service Revenue Business Code
2a MBR HLTH CARE PREM 621400 1,983,070,458 1,983,070,458    
b SUPPL CHARGE/PHARM 621400 102,395,601 102,256,146 139,455  
c NON-PLAN & IND REV 621400 3,960,347 3,960,347    
d OTHER PRGM SERVICE 621400 19,642,220 19,562,758 79,462  
e MEDICARE/MEDICAID 621400 279,061,013 279,061,013    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 2,388,129,639
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 5,911,574     5,911,574
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 831,446  
b Less: rental expenses    
c Rental income or (loss) 831,446 0
d Net rental income or (loss).......MediumBullet 831,446     831,446
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 223,451,964 6,725
b Less: cost or other basis and sales expenses 222,174,225 248,784
c Gain or (loss) 1,277,739 -242,059
d Net gain or (loss)..........MediumBullet 1,035,680     1,035,680
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            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet 0
12 Total revenue. See Instructions......MediumBullet 2,396,252,586 2,387,910,722 218,917 7,778,700
Form 990 (2012)
Form 990 (2012)
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 to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 1,926,096 1,926,096
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 0  
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 0      
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 398,099,193 359,450,059 38,649,134 0
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 59,213,443 59,213,443    
9 Other employee benefits ....... 79,702,014 79,292,837 409,177  
10 Payroll taxes ........... 29,554,145 12,216,138 17,338,007  
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 2,029,332   2,029,332  
c Accounting ........... 1,203,384   1,203,384  
d Lobbying ........... 618,518   618,518  
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 153,418   153,418  
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 .... 9,978,364 527,552 9,450,812  
13 Office expenses ....... 8,686,103 7,597,158 1,088,945  
14 Information technology ...... 139,501,851 110,560,643 28,941,208  
15 Royalties .. 0      
16 Occupancy ........... 49,967,377 49,967,377    
17 Travel ............ 2,441,956 1,738,010 703,946  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 1,234,366   1,234,366  
20 Interest ........... 8,664,884 8,664,884    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 53,106,381 53,106,381    
23 Insurance .............. 22,728,904 22,660,610 68,294  
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 704,152,133 704,152,133    
b PURCHASED MEDICAL SERVICES 314,482,462 314,482,462    
c SUPPLIES 329,471,817 300,147,457 29,324,360  
d INTER-REGIONAL CHARGES 91,012,168 91,012,168    
e All other expenses 109,051,051 74,941,935 34,109,116  
25 Total functional expenses. Add lines 1 through 24e 2,416,979,360 2,251,657,343 165,322,017 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 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 8,202,358 1 8,391,431
2 Savings and temporary cash investments ......... 0 2 0
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 70,625,433 4 101,127,836
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 .............. 22,901,293 8 25,010,224
9 Prepaid expenses and deferred charges .......... 6,011,700 9 6,539,876
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 1,215,143,183
b Less: accumulated depreciation ..... 10b 455,944,854 581,134,560 10c 759,198,329
11 Investments—publicly traded securities .......... 292,101,623 11 280,946,152
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 ........... 4,661,373 15 3,011,540
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 985,638,340 16 1,184,225,388
Liabilities 17 Accounts payable and accrued expenses ......... 241,645,685 17 246,820,670
18 Grants payable ................. 0 18 0
19 Deferred revenue ................ 17,315,489 19 12,711,369
20 Tax-exempt bond liabilities ............. 12,913,877 20 12,888,484
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.................... 735,574,128 25 1,026,254,672
26 Total liabilities. Add lines 17 through 25......... 1,007,449,179 26 1,298,675,195
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 ........ 6,795,610 30 6,795,610
31 Paid-in or capital surplus, or land, building or equipment fund ..... 0 31 0
32 Retained earnings, endowment, accumulated income, or other funds -28,606,449 32 -121,245,417
33 Total net assets or fund balances ........... -21,810,839 33 -114,449,807
34 Total liabilities and net assets/fund balances ........ 985,638,340 34 1,184,225,388
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
2,396,252,586
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
2,416,979,360
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-20,726,774
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
-21,810,839
5
Net unrealized gains (losses) on investments ...............
5
-359,514
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
-71,552,680
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
-114,449,807
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
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
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
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 See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
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 in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No 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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (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 IV.)..            
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 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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 0 1,000 0 16,275 344,247 361,522
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...... 2,001,419,294 2,072,423,301 2,167,352,747 2,272,514,533 2,388,129,639 10,901,839,514
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. 2,001,419,294 2,072,424,301 2,167,352,747 2,272,530,808 2,388,473,886 10,902,201,036
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.)           10,902,201,036
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6... 2,001,419,294 2,072,424,301 2,167,352,747 2,272,530,808 2,388,473,886 10,902,201,036
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 16,584,560 13,960,781 11,014,664 6,430,418 6,743,020 54,733,443
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.           0
c Add lines 10a and 10b. 16,584,560 13,960,781 11,014,664 6,430,418 6,743,020 54,733,443
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 IV.) ..           0
13 Total support. (Add lines 9, 10c, 11, and 12.).. 2,018,003,854 2,086,385,082 2,178,367,411 2,278,961,226 2,395,216,906 10,956,934,479
14
Section C. Computation of Public Support Percentage
15
15
99.501 %
16
16
99.391 %
Section D. Computation of Investment Income Percentage
17
17
0.500 %
18
18
0.609 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
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 Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
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
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


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

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
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) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
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., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


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

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

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

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

1
Provide a description of the organization’s direct and indirect political campaign activities 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) 2012

Schedule C (Form 990 or 990-EZ) 2012
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 instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (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) 2012


Schedule C (Form 990 or 990-EZ) 2012
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
 
18,000
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
370,022
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
 
i
Other activities? ..........................
Yes
 
230,496
j
Total. Add lines 1c through 1i ...............................
618,518
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
Complete this part to 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, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
LOBBYING ACTIVITY BY NONELECTING PUBLIC CHARITIES SCHEDULE C, PART II-B, LINE 1A THROUGH 1I The Organization is a member of the Kaiser Permanente Medical Care Program and participated in and benefited from lobbying activities conducted at the regional and national levels for the benefit of its enrolled members 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 internal involvement in any political campaigns. This policy is closely monitored for compliance. During the year this Organization may have made comments or statements concerning legislation which may affect the health care industry. Health Plan may have engaged in 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 and its members by performing the following activities: (I) Collecting, analyzing and distributing within the Organization, public and private policy recommendations regarding proposed legislation that affect the operation of Health Plan and its ability to provide quality health and medical care services to its members in a cost effective environment. (II) Providing appropriate informational materials to legislators and to their staffs that pertain to matters of common interest in the health care community and in the not-for-profit community. (III) Also by preparing written and oral testimony, these individuals appear at legislative hearings, monitor legislative proceedings and meet with legislators and/or their staffs regarding issues pertinent to the mission of Health Plan. Those individuals appearing at such hearings and meetings for and on behalf of Health Plan often are representing the interests of common interest groups as well as the interests of the members of Health Plan. (IV) 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) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds 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)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
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? .....................
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. 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 .................   69,588,980 69,588,980
b Buildings ................   602,471,890 221,714,171 380,757,719
c Leasehold improvements ............   148,545,924 62,428,006 86,117,918
d Equipment ................   232,612,909 151,387,220 81,225,689
e Other .................   161,923,480 20,415,457 141,508,023
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 759,198,329
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








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








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








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
DUE TO RELATED ENTITIES 316,931,242
SELF-INSURED RISKS 120,262,211
MEDICARE COST REPORT RESERVE 34,825,079
PENSION & POST-RETIREMENT BENEFITS 350,882,919
OTHER CURRENT LIABILITIES 32,086,668
OTHER LONG-TERM LIABILITIES 171,266,553



Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 1,026,254,672
2. Fin 48 (ASC 740) Footnote. 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) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 2,392,083,992
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -359,514
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d -490,457
e Add lines 2a through 2d ..................... 2e -849,971
3 Subtract line 2e from line 1..................... 3 2,392,933,963
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 2,055,550
b Other (Describe in Part XIII.) ........... 4b 1,263,073
c Add lines 4a and 4b....................... 4c 3,318,623
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 2,396,252,586
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 2,412,925,866
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 248,784
e Add lines 2a through 2d...................... 2e 248,784
3 Subtract line 2e from line 1..................... 3 2,412,677,082
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 153,418
b Other (Describe in Part XIII.) ............ 4b 4,148,860
c Add lines 4a and 4b....................... 4c 4,302,278
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 2,416,979,360
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
RECONCILIATION OF REVENUE PER AUDITED FIN. STMT. WITH REVENUE PER RETURN SCHEDULE D, PART XI LINE 2D: Gain on sale of investments - book $ 1,756,271 Bad Debt Reclass <2,093,310> INVESTMENT MANAGEMENT RECLASS <153,468> TOTAL $ <490,457> LINE 4A: INTEREST EXPENSE - RECLASS 2,055,550 LINE 4B: Gain on sale of investments - tax $ 1,277,739 Fixed assets loss - reclass <248,784> OTTI (See Note 1) 234,118 TOTAL $ 1,263,073 Note 1: other than temporary impairment (OTTI) of investment recognized for financial statement purposes, which will be tax reported when realized.
RECONCILIATION OF EXPENSES PER AUDITED FIN. STMT. WITH EXPENSES PER RETURN SCHEDULE D, PART XII LINE 2D: FIXED ASSET LOSS - RECLASS $ 248,784 LINE 4A: INVESTMENT MANAGEMENT EXPENSES - RECLASS $ 153,418 LINE 4B: BAD DEBT EXPENSES - RECLASS $ 2,093,310 INTEREST EXPENSE - RECLASS 2,055,550 TOTAL $ 4,148,860
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) 2012

Additional Data


Software ID:  
Software Version:  




Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number
52-0954463
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) Access Carroll Inc
2 Locust Lane 301
Westminister,MD21157 		20-2146701 501(c)(3) 48,024       Uninsured Project Access Coordinator and Medication Coordinator
(2) Act for Alexandria
1421 Prince St 400
Alexandria,VA22314 		26-4322369 501(c)(3) 69,215       Food & Play Support
(3) Alexandria Neighborhood Health Services
2445 Army Navy Dr 104
Alexandria,VA22206 		54-1849881 501(c)(3) 50,000       Improving Access
(4) American University
4400 Massachusetts Ave
NW Gray Hall
Washington,DC20016 		53-0196549 501(c)(3) 68,967       Measuring the Impact
(5) Arlington Free Clinic
2921 11th St South
Arlington,VA22204 		54-1671883 501(c)(3) 52,800       Voila Paris Gala
(6) Arlington Pediatric Center Inc
1701 N George Mason Dr
Arlington,VA22205 		54-1998631 501(c)(3) 72,300       Pediatric center
(7) Baltimore Office of Promotion and The Arts
7 East Redwood St 500
Baltimore,MD21202 		90-0091850 501(c)(3) 16,000       Eat Fresh@Baltimore
(8) Bread for the City Inc
1525 Seventh St NW
Washington,DC20001 		52-1138207 501(c)(3) 55,000       DC Food Support
(9) Catoctin Foundation Inc
224B Cornwall St NW
Leesburg,VA20176 		54-1921059 501(c)(3) 50,000       Loudoun Free Clinic Collaborative
(10) Chase Brexton Health Services Inc
1001 Cathedral St
Baltimore,MD21201 		52-1638592 501(c)(3) 50,000       Implementation Ptn
(11) Crossroads Community Food Network Inc
6930 Carroll Ave 426
Takoma Park,MD20912 		36-4635237 501(c)(3) 50,000       Fresh Checks:Healthy
(12) DC Central Kitchen Inc
425 2nd St NW
Washington,DC20001 		52-1584936 501(c)(3) 75,000       Healthy Corners
(13) Engaged Community Offshoots Inc
3901 Livingston St
Hyattsville,MD20781 		26-4196401 501(c)(3) 75,000       Cultivating Wellness
(14) Everybody Wins DC
1213 K Street NW
Washington,DC20005 		52-1938281 501(c)(3) 40,000       Lead MentorCorporate
(15) Fairfax County Park Foundation Inc
12055 Government Ctr Pkwy
Suite 404
Fairfax,VA22035 		54-2019179 501(c)(3) 10,000       Take 12 for Health
(16) Family & Medical Counseling Service Inc
2041 MLK Jr Ave SE
Washington,DC20020 		52-1073362 501(c)(3) 42,194       PCMH Recognition
(17) Food & Friends Inc
219 Riggs Road NE
Washington,DC20011 		52-1648941 501(c)(3) 20,000       Food & Friends Thank
(18) Food Research & Action Center Inc
1875 Connecticut Ave NW
540
Washngton,DC20009 		23-7200739 501(c)(3) 155,000       Fighting Hunger Mary
(19) Fredericksburg Area Regional Health Inc
1301 Sam Perry Bld
Fredericksburg,VA22401 		54-1677934 501(c)(3) 50,000       Electronic MedRecord
(20) Inquiring Systems Inc
PO Box 2037
Sonoma,CA95476 		94-2524840 501(c)(3) 15,703       Farm to Desk:Wrap Up
(21) Interfaith Works Inc
114 W Montgomery Ave
Rockville,MD20854 		52-1072684 501(c)(3) 7,500       Fables & Tables
(22) Joint Center PoliticalEconomic Studies
805 Fifteenth St NW
2nd Floor
Washington,DC20005 		52-1069070 501(c)(3) 10,000       PLACE MATTERS
(23) Junior Achievement of National Capital Area
1725 I St NW 200
Washington,DC20006 		54-0788947 501(c)(3) 25,000       Jr Achieve Finance
(24) Lexington Market Inc
400 West Lexington St
Baltimore,MD21201 		52-1163034 501(c)(3) 50,230       Get Fresh Lexington Nation's Capital
(25) Loudoun Community Health Center
224 Cornwall St NW
Leesburg,VA20176 		20-2379419 501(c)(3) 51,700       Blue Jean Ball Fund
(26) Meals on Wheels of Central Maryland Inc
515 South Haven St
Baltimore,MD21224 		52-6074723 501(c)(3) 9,650       20th Annual Culinary
(27) Medical Care For Children Partnership Fdn
1616 Anderson Road
McLean,VA22102 		26-1756738 501(c)(3) 8,670       Dress Up w/Grown-Ups
(28) Mission Life Center
10721 Main St 1200
Fairfax,VA22030 		75-2999280 501(c)(3) 15,000       Annual Fundraiser
(29) Montgomery Cty Business Round for Education
6010 Executive Blvd
Suite 708
Rockville,MD20852 		41-2047342 501(c)(3) 16,000       Comprehensive Prog
(30) National Trust Hist Preservation the US
1785 Massachusetts Ave NW
Washgtn,DC20036 		53-0210807 501(c)(3) 50,000       Acadias Mobile Mrket
(31) Parks & People Fdn For Baltimore R & P
800 Wyman park Dr 010
Baltimore,MD21211 		52-1349346 501(c)(3) 13,410       Docs in Park Events
(32) Playworks Education Energized
380 Washington St
Oakland,CA94607 		94-3251867 501(c)(3) 50,000       Playworks Project Gala
(33) Prince William Health Partners Inc
2296 Opitz Blvd 200
Woodbridge,VA22191 		03-0444689 501(c)(3) 49,380       Chronic Dis Prevent
(34) SOME Inc
71 O Street NW
Washington,DC20001 		23-7098123 501(c)(3) 10,000       Direct Service Sup
(35) St Agnes Hospital Foundation Inc
900 Caton Ave MS 123
Baltimore,MD21229 		52-1415083 501(c)(3) 6,750       Caritas: Saint Agnes Career Success Program graduates
(36) Suitland Family and Life Development Corp
14416 Old Mill Rd
SUITE 101
Upper Marlboro,MD20772 		52-2052386 501(c)(3) 50,000       Farmer's Market
(37) The Community Foundation Northern Virginia
8283 Greensboro Dr
McLean,VA22102 		51-0232459 501(c)(3) 10,000       Mission Mercy 2012
(38) The Community Foundation Natl Capital Reg
1201 15th St NW 420
Washington,DC20005 		23-7343119 501(c)(3) 10,000       2012 CivicLeadership
(39) The Friends of the National Arboretum Inc
3501 New York Ave NE
Washington,DC20002 		52-1257712 501(c)(3) 75,000       School Garden Well children to medical homes
(40) Ulman Fund Inc
921 E Fort Ave 325
Baltimore,MD21230 		52-2057636 501(c)(3) 8,000       Blue Jeans Ball
(41) United Research and Education Foundation
1901 Pennsylvania Ave NW 1100
Washington,DC20006 		54-1880528 501(c)(3) 50,000       Let's Move SaladBars
(42) Us Helping Us-People Into Living Inc
3636 Georgia Ave NW
Washington,DC20010 		52-1628279 501(c)(3) 10,000       Fall Reception
(43) Virginia Hospital Center Foundation
1701 N George Mason Dr
Arlington,VA22205 		20-4129901 501(c)(3) 9,880       A Signature Evening Sciences Students
(44) Virginia Hospital Research and Ed Foundation
PO Box 31394
Richmond,VA23294 		54-0801059 501(c)(3) 25,000       Health Innovation Luncheon
(45) Washington Regional Assoc of Grantmakers
1400 16th St NW 740
Washington,DC20036 		52-1756853 501(c)(3) 110,000       WRAG's Health Works
(46) Washington Urban League Inc
2901 14th St NW
Washington,DC20009 		53-0208981 501(c)(3) 23,400       75 Years We're Just patients
(47) Whitman-Walker Clinic
1701 14th St NW
Washington,DC20009 		52-1122122 501(c)(3) 50,000       PrimaryCare Medical
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
47
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
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.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I, PART I, LINE 2 Grantees are required to sign a memorandum of understanding with Health plan prior to grant funds 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) 2012


Additional Data


Software ID:  
Software Version:  


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
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 officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the 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
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
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
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)Russell K BradleyVP, HP Services & Admin (i)
(ii)		 0
187,718 		0
78,299 		0
17,988 		0
63,260 		0
20,293 		0
367,558 		0
0
(2)Ruben J BurnettVP, Natl Consultant Relations (i)
(ii)		 0
238,603 		0
137,746 		0
94,749 		0
109,098 		0
15,411 		0
595,607 		0
21,447
(3)Christine CasselDirector (i)
(ii)		 0
203,500 		0
0 		0
0 		0
0 		0
0 		0
203,500 		0
0
(4)Thomas ChapmanDirector (i)
(ii)		 0
214,108 		0
0 		0
0 		0
17,000 		0
0 		0
231,108 		0
0
(5)Linda M CollinsCOO - MAS (i)
(ii)		 0
278,731 		0
73,579 		0
87,730 		0
205,467 		0
15,528 		0
661,035 		0
0
(6)Daniel P GarciaSVP, Chief Compliance Officer (i)
(ii)		 0
577,139 		0
815,322 		0
31,811 		0
78,965 		0
27,928 		0
1,531,165 		0
0
(7)William Graberdirector (i)
(ii)		 0
240,823 		0
0 		0
0 		0
0 		0
0 		0
240,823 		0
0
(8)J Eugene Grigsby IIIdirector (i)
(ii)		 0
221,000 		0
0 		0
0 		0
0 		0
0 		0
221,000 		0
0
(9)George C HalvorsonChairman and CEO (i)
(ii)		 0
1,242,168 		0
6,949,670 		0
1,608,513 		0
80,547 		0
32,013 		0
9,912,911 		0
1,500,000
(10)Mary Elizabeth JaegerVP, HR - MAS (i)
(ii)		 0
198,706 		0
70,181 		0
23,438 		0
58,736 		0
17,219 		0
368,280 		0
0
(11)Judith Johansendirector (i)
(ii)		 0
207,146 		0
0 		0
0 		0
0 		0
0 		0
207,146 		0
0
(12)Kim J Kaiserdirector (i)
(ii)		 0
228,500 		0
0 		0
0 		0
0 		0
0 		0
228,500 		0
0
(13)Marilyn KawamuraRegion President - MAS (i)
(ii)		 0
320,565 		0
406,594 		0
185,870 		0
144,819 		0
14,551 		0
1,072,399 		0
145,043
(14)Kathryn LancasterEVP & CFO (i)
(ii)		 0
650,287 		0
1,297,450 		0
832,252 		0
221,210 		0
14,318 		0
3,015,517 		0
261,310
(15)Kay W LewisVP, UM, Risk Mgmt & Quality (i)
(ii)		 0
199,962 		0
67,208 		0
88,207 		0
94,555 		0
16,896 		0
466,828 		0
68,602
(16)Ferial G MaghamiExec Dir, Provider Affairs (i)
(ii)		 0
46,634 		0
121,571 		0
317,775 		0
72,795 		0
7,140 		0
565,915 		0
0
(17)Philip Marineaudirector (i)
(ii)		 0
225,618 		0
0 		0
0 		0
0 		0
0 		0
225,618 		0
0
(18)Thomas R MeierSVP, Corporate Treasurer (i)
(ii)		 0
318,951 		0
459,975 		0
37,156 		0
98,090 		0
27,416 		0
941,588 		0
1,075
(19)Jenny Mingdirector (i)
(ii)		 0
214,323 		0
0 		0
0 		0
0 		0
0 		0
214,323 		0
0
(20)Donald H OrndoffSVP, NFS (i)
(ii)		 0
390,840 		0
352,750 		0
22,751 		0
156,068 		0
23,810 		0
946,219 		0
0
(21)Edward Peidirector (i)
(ii)		 0
206,641 		0
0 		0
0 		0
17,000 		0
0 		0
223,641 		0
0
(22)DeAnne PetersenVP, CFO - MAS (i)
(ii)		 0
232,853 		0
123,855 		0
15,868 		0
125,020 		0
18,299 		0
515,895 		0
0
(23)Margaret Porfidodirector (i)
(ii)		 0
237,779 		0
0 		0
0 		0
0 		0
0 		0
237,779 		0
0
(24)J Neal Purcelldirector (i)
(ii)		 0
251,464 		0
0 		0
0 		0
0 		0
0 		0
251,464 		0
0
(25)ROCHELLE M RothEXEC. DIR, HP QCSO (i)
(ii)		 0
167,060 		0
32,120 		0
45,864 		0
89,409 		0
13,769 		0
348,222 		0
0
(26)Arthur M SouthamEVP, HP Operations (i)
(ii)		 0
755,588 		0
1,530,102 		0
1,064,686 		0
97,089 		0
22,019 		0
3,469,484 		0
333,769
(27)Susan SpurlarkVP, Regional Counsel (i)
(ii)		 0
233,895 		0
98,639 		0
19,916 		0
135,884 		0
11,962 		0
500,296 		0
0
(28)Deborah StokesSVP, CC & CAO (i)
(ii)		 0
347,253 		0
278,496 		0
64,744 		0
167,539 		0
16,793 		0
874,825 		0
43,578
(29)Cynthia Tellesdirector (i)
(ii)		 0
226,717 		0
0 		0
0 		0
0 		0
0 		0
226,717 		0
0
(30)Bernard J TysonPresident & COO (i)
(ii)		 0
932,699 		0
2,087,352 		0
1,067,042 		0
221,647 		0
25,079 		0
4,333,819 		0
449,238
(31)Steven R ZatkinFormer Gen Counsel, Consultant (i)
(ii)		 0
0 		0
288,225 		0
35,276 		0
0 		0
0 		0
323,501 		0
16,632
(32)Victoria ZatkinVP. Off of Brd & corp gov svcs (i)
(ii)		 0
196,294 		0
106,133 		0
36,844 		0
189,027 		0
3,565 		0
531,863 		0
3,175
(33)Mark S ZemelmanSVP, Gen Counsel & Secretary (i)
(ii)		 0
465,119 		0
387,152 		0
166,795 		0
159,780 		0
22,139 		0
1,200,985 		0
126,344
(34)Gregory AdamsGroup president (i)
(ii)		 0
645,713 		0
1,012,443 		0
251,907 		0
278,755 		0
19,048 		0
2,207,866 		0
227,742
(35)Jane W LewisDir, HP Reg Clinical Svcs Exec (i)
(ii)		 0
184,186 		0
22,055 		0
6,659 		0
133,462 		0
19,017 		0
365,379 		0
0
(36)Kimberly HornRegion President - MAS (i)
(ii)		 0
96,154 		0
0 		0
16,095 		0
117,530 		0
1,546 		0
231,325 		0
0
(37)Jeffrey A GoldmanVP, STRAT PLAN & PERFORM - MAS (i)
(ii)		 0
205,640 		0
18,920 		0
33,146 		0
88,400 		0
8,916 		0
355,022 		0
0
(38)Kendall D HunterFormer SVP Health Ins Exchange (i)
(ii)		 0
312,045 		0
172,750 		0
166,800 		0
175,306 		0
19,398 		0
846,299 		0
52,134
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to 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.
Identifier Return Reference Explanation
SCHEDULE J, PART I, LINE 3 Top Management Officials' Compensation Kaiser Foundation Health Plan of the Mid-Atlantic States relied on Kaiser Foundation Health Plan, Inc. that used one or more of the methods described below to establish the top management officials' compensation: - Compensation committee - Independent compensation consultant - Form 990 of other organizations - Written employment contract - Compensation survey or study, and - Approval by the board or compensation committee.
SCHEDULE J, PART I, LINE 4a SEVERANCE PAYMENTS Ferial Maghami $ 177,188 Listed persons participated in arrangements entitling them to severance benefits in the event of termination by the organization without cause or due to job elimination. Depending on position level, tenure, and termination reason, severance benefits payable under these arrangements provide for pay and health benefits continuation plus payment of accrued obligations. In addition, for some of the listed persons, severance benefits payable include prorated incentive awards for performance periods not yet ended. None of the listed persons participated in arrangements entitling them to change-of-control payments.
SCHEDULE J, PART I, LINE 4b SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN George Halvorson $ 1,500,000 Mark Zemelman 126,344 Marilyn Kawamura 145,043 Kay Lewis 68,602 Deborah Stokes 43,578 Steven Zatkin 16,632 Victoria Zatkin 3,175 Thomas Meier 1,075 ferial maghami 115,547 bernard tyson 1,036,741 arthur southam 1,021,889 gregory adams 227,113 Kathryn Lancaster 790,314 Ruben Burnett 74,728 Kendall Hunter 147,584 Some of the listed persons participated in nonqualified supplemental retirement plans. Under these plans, the organization makes annual contributions to accounts held in the name of individual participants. Contributions vary by position level and pay, and vest over time based on age and/or service. Participant accounts are credited with actual investment returns from up to four mutual funds and/or with a fixed rate of interest or a combination thereof. Unvested amounts are subject to risk of forfeiture.
SCHEDULE J, PART I, LINE 7 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 II   Steven Zatkin - general counsel to 06/30/2010; consultant 3/4/2011 to present. Bernard Tyson - Board of Directors effective 12/06/2012. J Neil Purcell - Board of Directors to 12/31/2012. Marilyn Kawamura - President to 10/15/2012. Kimberly Horn - President effective 10/15/2012.
Schedule J (Form 990) 2012

Additional Data


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

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

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Identifier Return Reference Explanation
Form 990, Heading, Item B, Amended Return   Part VII and Schedule J of the return have been amended to reflect updated compensation information regarding certain deferred compensation calculations. Form 990, PART I, LINE 7B Net Unrelated Business Taxable Income from Form 990-T, Line 34 TOTAL UBI (FORM 990-T, LINE 30) $ 33,674 NET OPERATING LOSS (NOL) APPLIED (33,674) UBTI WITH NOL (FORM 990-T, LINE 34) NONE
form 990, PART III, LINE 4A-D   2012 COMMUNITY BENEFIT REPORT KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES, INC. KAISER FOUNDATION HEALTH PLAN'S COMMITMENT TO THE COMMUNITY IN 2007, KAISER FOUNDATION HEALTH PLAN'S BOARD OF DIRECTORS REFINED THE FOCUS OF THE ORGANIZATION'S COMMUNITY BENEFIT PROGRAM AND ESTABLISHED THE FOLLOWING FOUR PRIORITY AREAS WHICH HAVE COME TO BE KNOWN AS "STREAMS OF WORK": 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 THE EVIDENCE BASE FOR CARE AND HEALTH. THE FOLLOWING ARE DETAILS OF COMMUNITY BENEFIT ACTIVITIES PROVIDED BY KAISER FOUNDATION HEALTH PLAN OF THE MID-ATLANTIC STATES: IN 2012, THE MID-ATLANTIC HEALTH PLAN SERVED 481,986 MEMBERS AND EXPENDED $75.6 MILLION (AT COST, NET OF $2.9 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 IN 2012, THE MID-ATLANTIC HEALTH PLAN EXPENDED $62.9 MILLION (AT COST, NET OF $2.9 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. 1. CHARITABLE CARE (MEDICAL FINANCIAL ASSISTANCE AND CHARITABLE HEALTH COVERAGE PROGRAMS) IN THE MID-ATLANTIC REGION, HEALTH PLAN PROVIDES CHARITY CARE TO LOW-INCOME VULNERABLE POPULATIONS THROUGH THE MEDICAL FINANCIAL ASSISTANCE AND CHARITABLE HEALTH COVERAGE PROGRAMS. IN 2012, THE MID-ATLANTIC STATES HEALTH PLAN SPENT $47.5 MILLION (AT COST, NET OF $2.7 MILLION OF RELATED REVENUES) ON UNDER- AND UNINSURED PATIENTS. MEDICAL FINANCIAL ASSISTANCE PROGRAM THE MEDICAL FINANCIAL ASSISTANCE (MFA) PROGRAM HELPS LOW-INCOME, UNINSURED, AND UNDERSERVED PATIENTS RECEIVE ACCESS TO CARE. THE PROGRAM PROVIDES TEMPORARY FINANCIAL ASSISTANCE OR FREE CARE TO PATIENTS WHO RECEIVE HEALTH CARE SERVICES FROM OUR PROVIDERS, REGARDLESS OF WHETHER THEY HAVE HEALTH COVERAGE OR ARE UNINSURED. MID-ATLANTIC HEALTH PLAN FUNDED APPROXIMATELY $7.6 MILLION (AT COST, NET OF RELATED REVENUES) TO THIS PROGRAM IN 2012, BENEFITTING OVER 1,300 QUALIFIED APPLICANTS. CHARITABLE HEALTH COVERAGE CHARITABLE HEALTH COVERAGE (CHC) IS A UNIQUE APPROACH TO CARING FOR LOW-INCOME UNINSURED PERSONS IN THE COMMUNITY. ELIGIBLE PARTICIPANTS RECEIVE A REGULAR KAISER PERMANENTE MEMBERSHIP CARD AND ACCESS TO THE FULL RANGE OF SERVICES AND PROVIDERS - A MUCH BETTER ALTERNATIVE TO A BRIEF AND COSTLY EMERGENCY ROOM VISIT OR HOSPITALIZATION. THIS ALLOWS US TO INVEST IN THE LONGER TERM HEALTH OF PATIENTS AND THE COMMUNITY. SINCE INCEPTION IN THE EARLY 1980S, CHC PROGRAMS HAVE MADE A REAL DIFFERENCE IN THE LIVES OF PERSONS WHO MIGHT OTHERWISE HAVE NO OTHER SOURCE OF CARE. THE FOLLOWING DESCRIBES TWO CHC PROGRAMS IN THE MID-ATLANTIC REGION. MORE THAN 8,400 MEMBERS WERE RECEIVING COMPREHENSIVE CARE THROUGH THESE PROGRAMS AT THE END OF 2012. APPROXIMATELY $40.0 MILLION (AT COST, NET OF RELATED REVENUES) WAS SPENT ON THESE PROGRAMS DURING THE YEAR. - BRIDGE PROGRAM - THIS PROGRAM ALLOWS LOW-INCOME INDIVIDUALS AT LESS THAN 300% OF FEDERAL POVERTY GUIDELINES WHO ARE FACING FINANCIAL DIFFICULTIES TO APPLY FOR SUBSIDIZED COVERAGE. IN ORDER TO QUALIFY FOR BRIDGE COVERAGE, INDIVIDUALS MUST NOT BE ELIGIBLE FOR ANY OTHER PUBLIC OR PRIVATE HEALTH CARE COVERAGE. - MEDICAL CARE FOR CHILDREN PARTNERSHIP PROGRAM - MID-ATLANTIC HEALTH PLAN PARTICIPATES AS A PRIMARY CARE PROVIDER WITHIN OUR FACILITIES FOR THE FIVE COMMUNITY PARTNERSHIPS WHO ADMINISTER THIS PROGRAM FOR ELIGIBLE CHILDREN IN MARYLAND AND VIRGINIA. THE PROGRAMS ARE ADMINISTERED THROUGH LOCAL GOVERNMENTAL AGENCIES AND NON-PROFIT ORGANIZATIONS. ELIGIBILITY IS RESTRICTED TO THOSE CHILDREN UNDER 300% OF FEDERAL POVERTY GUIDELINES WHO ARE NOT ELIGIBLE FOR ANY OTHER PUBLIC OR PRIVATE HEALTHCARE. 2. PARTICIPATION IN MEDICAID AND OTHER GOVERNMENT-SPONSORED PROGRAMS IN 2012, MID-ATLANTIC HEALTH PLAN CONTRIBUTED $15.4 MILLION (AT COST, NET OF $200 THOUSAND OF RELATED REVENUES) TO SUPPORT THE PROVISION OF MEDICAL CARE SERVICES TO INDIVIDUALS IN THE FOLLOWING GOVERNMENT-SPONSORED PROGRAMS: - THE MARYLAND MEDICAL ASSISTANCE PROGRAM PROVIDES RESOURCES THAT SUPPORT HEALTHCARE TO VULNERABLE POPULATIONS BY INCREASING THE NUMBER OF PROVIDERS WILLING TO SERVE MEDICAID PATIENTS. - MEDICAID - KAISER PERMANENTE SERVED APPROXIMATELY 1,200 NON-MEMBER MEDICAID PEDIATRIC PATIENTS AS A PRIMARY CARE PROVIDER THROUGH PRIORITY PARTNERS AT EIGHT MEDICAL OFFICES IN 2012. THE MID-ATLANTIC HEALTH PLAN IS ALSO ON THE PATH TO BECOME A MEDICAID MANAGED CARE ORGANIZATION (MCO). MUCH OF 2012 WAS SPENT ON IMPLEMENTATION AND EXECUTION FOR A PLANNED GO-LIVE DATE IN JULY 2013 FOR VIRGINIA AND JANUARY 1, 2014 FOR MARYLAND. IN 2012, THE MID-ATLANTIC HEALTH PLAN FUNDED COST-BASED LOSSES OF $873 THOUSAND UNDER THE PROGRAM WITH MEDICAID MCO START UP COSTS OF $3.4 MILLION.
B. COMMUNITY HEALTH INITIATIVES (CHI)   THE MID-ATLANTIC HEALTH PLAN SPENT APPROXIMATELY $1.0 MILLION ON COMMUNITY HEALTH INITIATIVES DURING 2012 BY AWARDING CHARITABLE CONTRIBUTIONS TO NONPROFIT ORGANIZATIONS AND GOVERNMENT AGENCIES. THE FOLLOWING ARE EXAMPLES OF THE RESOURCES CONTRIBUTED BY THE MID-ATLANTIC STATES HEALTH PLAN TO SUPPORT COMMUNITY HEALTH INTIATIVES IN THE AREA. HEALTHY EATING ACTIVE LIVING (HEAL) PROGRAMS MID-ATLANTIC HEALTH PLAN SUPPORTS EFFORTS TO INCREASE ACCESS TO HEALTHY FOODS IN NEIGHBORHOODS, SCHOOLS, AND WORKPLACES ACROSS THE REGION, WITH A FOCUS ON VULNERABLE POPULATIONS. THIS INCLUDES FUNDING AND OTHER RESOURCES PROVIDED TO FOOD POLICY COUNCILS, FARMERS MARKETS, COMMUNITY FARMS AND GARDENS, HEALTHY GROCERY AND CORNER STORE INITIATIVES, HEALTHY FOOD BANKING, ETC. KAISER PERMANENTE IS A FOUNDING MEMBER OF THE MID-ATLANTIC REGIONAL CONVERGENCE PARTNERSHIP OF WASHINGTON REGIONAL AREA GRANTMAKERS, A COLLABORATION OF FUNDERS DEDICATED TO HELPING CREATE SUSTAINABLE AND EQUITABLE FOOD SYSTEMS TO SERVE THE REGION. - THE MID-ATLANTIC HEALTH PLAN IS HOST TO A FARMERS MARKET AT OUR BALTIMORE CITY PLAZA MEDICAL CENTER, FARM STANDS AT OUR LARGO, CAMP SPRINGS, AND MARLOW HEIGHTS MEDICAL CENTERS AND OUR REGIONAL OFFICE BUILDING, AND A COMMUNITY GARDEN AT THE WHITE MARSH MEDICAL CENTER. - KEY HEAL PARTNERSHIPS INCLUDE: THE PORT TOWNS COMMUNITY HEALTH PARTNERSHIP, PLAYWORKS, SAFE ROUTES TO SCHOOLS, FOOD RESEARCH ACTION CENTER, DC CENTRAL KITCHEN, BALTIMORE CITY OFFICE OF SUSTAINABILITY, AND THE INSTITUTE FOR PUBLIC HEALTH INNOVATION. - THE PORT TOWNS COMMUNITY HEALTH PARTNERSHIP WAS LAUNCHED IN 2008 BY KAISER PERMANENTE IN COLLABORATION WITH OTHER ORGANIZATIONS. THIS IS A 5-7 YEAR INVESTMENT THAT PROVIDES TECHNICAL ASSISTANCE, PROJECT MANAGEMENT, AND EVALUATION SUPPORT TO IMPROVE POLICIES, PRACTICES, AND PROGRAMS THAT INFLUCENCE HEALTH IN A COUNTY THAT SUFFERS SOME OF THE HIGHEST RATES OF CHRONIC ILLNESS IN THE STATE. IN 2012, THIS INITIATIVE HELPED ATTRACT MORE THAN $4 MILLION IN FEDERAL GRANTS TO THE COUNTY, AND HAS BEEN CITED AS A MODEL FOR THE COUNTY'S HEALTH IMPROVEMENT PLAN. C. SAFETY NET PARTNERSHIPS THE MID-ATLANTIC HEALTH PLAN SPENT APPROXIMATELY $944 THOUSAND ON SAFETY NET PARTNERSHIPS DURING 2012 BY AWARDING CHARITABLE CONTRIBUTIONS TO NONPROFIT ORGANIZATIONS AND GOVERNMENT AGENCIES. THE FOLLOWING ARE HIGHLIGHTS FROM A FEW OF OUR SIGNATURE SAFETY NET PARTNERSHIPS: - 2012 WAS THE FOURTH YEAR OF THE COMMUNITY AMBASSADOR PROGRAM WHICH GREW FROM TWO NURSE PRACTITIONERS (NPS) TO A TOTAL OF 38 NPS AND PHYSICIAN ASSISTANTS PLACED IN 19 SAFETY NET CLINICS IN WASHINGTON DC, SUBURBAN MARYLAND AND NORTHERN VIRGINIA. THE PURPOSE OF THE PROGRAM IS TO EXPAND THE CAPACITY OF LOCAL SAFETY NET CLINICS TO INCREASE HEALTHCARE ACCESS TO THE UNDER/UNINSURED. - THE HYPERTENSION INITIATIVE IS A PILOT PROGRAM DEVELOPED IN 2011 BETWEEN KAISER PERMANENTE AND THREE FEDERALLY QUALIFIED HEALTH CENTERS, ONE IN WASHINGTON DC, AND TWO IN MARYLAND. THE PROGRAM IS INTENDED TO BUILD A BRIDGE BETWEEN KP AND COMMUNITY CLINICS BY PROVIDING SPECIALTY CARE SPECIFIC TO REFRACTORY HYPERTENSIVE PATIENTS. FULL ROLLOUT IS EXPECTED IN 2013. - IN 2012, THE MID-ATLANTIC REGION COORDINATED WITH THE DIVERSITY DEPARTMENT TO PROVIDE A CULTURALLY-COMPETENT TRAIN THE TRAINER FORUM FOR THE SAFETY NET COMMUNITY. THIS PROJECT RESULTED IN THE CERTIFICATION OF ELEVEN SAFETY NET FACILIATORS FROM OUTSIDE OUR ORGANIZATION. D. DEVELOPING AND DISSEMINATING KNOWLEDGE 1. CLINICAL AND HEALTH SERVICES RESEARCH THE MID-ATLANTIC DEPARTMENT OF RESEARCH CONDUCTS POPULATION-BASED STUDIES, HEALTH SERVICES RESEARCH AND CLINICAL TRIALS TO ANSWER IMPORTANT HEALTH POLICY AND PUBLIC HEALTH QUESTIONS. THESE PROJECTS ARE FUNDED BOTH INTERNALLY AND EXTERNALLY THROUGH FEDERAL AND STATE GOVERNMENT AGENCIES AND OTHER NONPROFIT ORGANIZATIONS SUCH AS UNIVERSITIES AND FOUNDATIONS. BESIDES GUIDING OUR CLINICIANS' PRACTICE PATTERNS AND ENHANCING THE HEALTH AND MEDICAL CARE OF OUR MEMBERS, THIS RESEARCH ALSO CONTRIBUTES TO THE WEALTH OF MEDICAL KNOWLEDGE SHARED THROUGH WIDELY-DISSEMINATED PUBLICATIONS AND PRESENTATIONS. IN 2012, THE MID-ATLANTIC HEALTH PLAN FUNDED APPROXIMATELY $1.4 MILLION TOWARDS MEDICAL RESEARCH PROJECTS. 2. EDUCATIONAL THEATRE PROGRAMS (ETP) THE MID ATLANTIC HEALTH PLAN SPENT APPROXIMATELY $1.0 MILLION IN 2012 TO SUPPORT EDUCATIONAL THEATRE PROGRAMS (ETP) IN THE REGION. THESE PROGRAMS HAVE PROVIDED PROFESSIONAL, AWARD-WINNING HEALTH EDUCATION FOR PRE-KINDERGARTEN TO 12TH GRADE STUDENTS FOR OVER 25 YEARS IN MARYLAND, VIRGINIA, AND THE DISTRICT OF COLUMBIA. IN 2012, ETP GAVE MORE THAN 400 PERFORMANCES FOR APPROXIMATELY 63,000 CHILDREN AND ADULTS AT 173 DIFFERENT SCHOOLS AND OTHER LOCATIONS. ADDITIONALLY, ETP PRODUCED A MUSIC VIDEO DESCRIBING THE BENEFITS OF AND DISPELLING THE MYTHS SURROUNDING SEASONAL FLU SHOTS. E. OTHER COMMUNITY BENEFIT INVESTMENTS IN 2012, THE MID-ATLANTIC HEALTH PLAN SPENT APPROXIMATELY $7.9 MILLION ON OTHER COMMUNITY BENEFITS BEYOND THE NATIONAL STREAMS OF WORK.
form 990, part vi, line 4 Changes to governing documents The Articles of Incorporation of the Corporation were amended in 2012 as follows: Articles Third and Sixth were amended to (a) revise the purpose section for consistency with the Articles of Incorporation of Kaiser Foundation Health Plan, Inc. (the member of the Corporation) and its other Health Plan subsidiaries, including making a reference to the Internal Revenue Code (Section 501(c)(3)) consistent with other references in the Articles; and (b) expressly state that the corporation is prohibited from engaging in activities not permitted by Section 501(c)(3) of the Internal Revenue Code and to specifically state that the corporation shall not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. Second Articles of Amendment to Restated Articles of Incorporation of the Corporation were filed May 15, 2012. Minor, non-substantive changes were made to Articles Fourth, Seventh, Eighth and Ninth to: (a) update the information therein (including the names of the current Directors, and the registered agent); (b) make them more consistent with the articles of the Corporation's member, and the articles were fully restated to integrate into one document all of the provisions of the articles currently on file. Second Articles of Amendment and Restatement were submitted for filing and are currently pending regulatory approval. The Bylaws of the Corporation were amended in 2012 as follows: On December 6, 2012, Article D, Directors and Article E, Officers were amended to provide for up to fifteen directors and up to three inside directors, and the possibility of the Chairman of the Board and the Chief Executive Officer not being the same person. 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   KFHP 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, OH, NW, and MAS.
form 990, PART VI, LINE 7B   The following actions of the corporation require approval of the sole member: a) removal of the chairman of the board or the regional president; b) amendments to the bylaws that pertain to the member, the board of directors, or procedures for amending the bylaws (articles c, d, and h of the bylaws); c) amendment of the articles of incorporation.
form 990, PART VI, LINE 11B 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. Executive compensation details are presented to the compensation committee of the board for review. 4. The complete tax return is reviewed and signed by a Pricewaterhousecoopers LLP tax advisor. 5. The complete tax return is reviewed and signed by an officer or a member of management designated by an officer. 6. 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: 1. The Kaiser Permanente Compliance Hotline is available to all employees and vendors to report actual or potential conflicts of interest. All calls are answered by a third party and provided to Kaiser Permanente's National Compliance office for review and appropriate action. Employees can report anonymously and without fear of retaliation. Reports of actual or potential Conflicts of Interest are generated and investigations are conducted as required and information is tracked and trended to determine if additional guidance is required to avoid conflicts of interest. Compliance Hotline Reports are provided for review and action to the Kaiser Foundation Health Plan/Hospitals Boards of Directors annually. 2. The 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 3. Annually, as a component of the external audit, KPMG reviews the Annual Conflicts of Interest Questionnaires completed by Directors, Officers, Key Employees, and Executives, and actions taken as a result of the disclosures. The results of the annual audit, including any findings in this area are presented to the Kaiser Foundation Health Plan/Hospitals Audit and Compliance Committee. 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: 1. Represented employees are subject to any corrective/disciplinary action provisions described in specific regional/national collective bargaining agreements and/or organizational policies and practices. 2. 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. 3. 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 annually by the Compensation Committee of the Board of Directors which evaluates and approves, prior to payment, all programs and payments to CEO, Executive Director and top management officials (executives). Base pay for executive positions is established at a level comparable to the relevant market. In addition, other components of the compensation program bear 'at-risk' features designed to focus on strategically important performance goals and to assist in attracting and retaining top performers. The executive compensation program is targeted at the median of the comparable external market in which the organization competes for executive leadership. Evaluation of comparable pay data is performed by an Independent Compensation, Benefit & Human Resource Consulting firm. The compensation program focuses on objectives in the areas of quality of member care and service, financial soundness, and the community and social mission of the organization.
Form 990, Part VI, Line 18   Available on GuideStar.org website
form 990, Part VI, Line 19 Public Inspection Copy 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 - NATIONAL Tax COMPLIANCE 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 Organization 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 $ (71,797,094) OTHER THAN TEMPORARY IMPAIRMENTS (234,118) GAIN ON SALE OF INVESTMENTS - TAX (1,277,739) GAIN ON SALE OF INVESTMENTS - BOOK 1,756,271 TOTAL $ (71,552,680)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


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

OMB No. 1545-0047
2012
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" to 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" to 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 KFHP INC
 
Yes
 
(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 FDN HEALTH PLAN OF OHIO

ONE KAISER PLAZA 15L

OAKLAND,CA94612
34-0922268 		HEALTH CARE OH 501(c)(3) 9 KFHP INC
 
Yes
 
(7) 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
 
(8) LOKAHI ASSURANCE LTD

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0954562 		HEALTH CARE WA 501(c)(3) 9 KFHP INC
 
Yes
 
(13) 1800 HARRISON FOUNDATION

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA

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) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



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

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




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



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

ONE KAISER PLAZA 15L
OAKLAND,CA94612
20-3924985 		CASE MGMT CA NA
  		NONE       No     No  
(2) kaiser permanente ventures LLC

one kaiser plaza 15L
oakland,CA94612
27-3339892 		investment CA na
  		NONE       No     No  










Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to 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       Yes  
(2) KAISER PERMANENTE INSURANCE COMPANY

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

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

ONE KAISER PLAZA 15L
OAKLAND,CA94612
20-3774729 		CONSULTING CA NA
  		C CORP       Yes  
(5) KAISER PERMANENTE INTERNATIONAL

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




Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to 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
 
No
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
 
 
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
 
No
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 other organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) KAISER FOUNDATION HOSPITALS

 E 89,371,302 PER AGREEMENT
(2) KAISER FOUNDATION HEALTH PLAN INC

 L 21,454,454 PER AGREEMENT
(3) kaiser foundation hospitals

 L 68,261,159 per agreement
(4) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 L 450,840 per agreement
(5) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 L 662,794 PER AGREEMENT
(6) KAISER FOUNDATION HEALTH PLAN OF THE NW

 L 312,613 PER AGREEMENT
(7) KAISER FOUNDATION HEALTH PLAN OF OHIO

 L 124,501 PER AGREEMENT
(8) CAMP BOWIE SERVICE CENTER

 L 8,395,015 PER AGREEMENT
(9) OAK TREE ASSURANCE LTD

 L 784,622 PER AGREEMENT
(10) KAISER FOUNDATION HEALTH PLAN INC

 M 269,926,917 PER AGREEMENT
(11) KAISER FOUNDATION HOSPITALS

 M 560,326,257 PER AGREEMENT
(12) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 M 297,306 PER AGREEMENT
(13) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 M 1,624,336 PER AGREEMENT
(14) KAISER FOUNDATION HEALTH PLAN OF THE NW

 M 121,281 PER AGREEMENT
(15) KAISER FOUNDATION HEALTH PLAN OF OHIO

 M 170,932 PER AGREEMENT
(16) camp bowie service center

 M 4,735,983 per agreement
(17) KAISER PERMANENTE INSURANCE COMPANY

 M 14,342,811 PER AGREEMENT
(18) LOKAHI ASSURANCE LTD

 M 26,571,152 PER AGREEMENT
(19) OAK TREE ASSURANCE LTD

 M 1,025,100 PER AGREEMENT
(20) KAISER FOUNDATION HEALTH PLAN INC

 P 94,293,687 PER AGREEMENT
(21) KAISER FOUNDATION HOSPITALS

 P 33,365,421 PER AGREEMENT
(22) KAISER FOUNDATION HEALTH PLAN OF COLORADO

 P 576,169 PER AGREEMENT
(23) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 P 168,555 PER AGREEMENT
(24) camp bowie service center

 P 406,047 per agreement
(25) OAK TREE ASSURANCE LTD

 P 589,515 PER AGREEMENT
(26) KAISER FOUNDATION HEALTH PLAN INC

 Q 398,427,382 PER AGREEMENT
(27) KAISER FOUNDATION HOSPITALS

 Q 242,696,352 PER AGREEMENT
(28) KAISER FOUNDATION HEALTH PLAN of colorado

 Q 59,336 PER AGREEMENT
(29) KAISER FOUNDATION HEALTH PLAN OF GEORGIA

 Q 69,646 PER AGREEMENT
(30) CAMP BOWIE SERVICE CENTER

 Q 7,481,984 PER AGREEMENT
(31) LOKAHI ASSURANCE LTD

 Q 18,359,569 PER AGREEMENT
(32) OAK TREE ASSURANCE LTD

 Q 330,877 PER AGREEMENT
(33) KAISER FOUNDATION HEALTH PLAN INC

 R 1,574,433 PER AGREEMENT
(34) KAISER FOUNDATION HEALTH PLAN INC

 S 10,319,252 PER AGREEMENT
(35) LOKAHI ASSURANCE LTD

 S 614,000 PER AGREEMENT
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to 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 section 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) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


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Software Version: