Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 16,275 | 344,247 | 22,290 | 14,500 | 28,275 | 425,587 |
| 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...... | 2,272,514,533 | 2,388,129,639 | 2,508,061,602 | 2,716,227,851 | 3,075,698,789 | 12,960,632,414 |
| 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. | 2,272,530,808 | 2,388,473,886 | 2,508,083,892 | 2,716,242,351 | 3,075,727,064 | 12,961,058,001 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 12,961,058,001 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 2,272,530,808 | 2,388,473,886 | 2,508,083,892 | 2,716,242,351 | 3,075,727,064 | 12,961,058,001 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 6,430,418 | 6,743,020 | 3,392,544 | 3,632,832 | 3,930,224 | 24,129,038 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 6,430,418 | 6,743,020 | 3,392,544 | 3,632,832 | 3,930,224 | 24,129,038 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 280,000 | 280,000 | ||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 2,278,961,226 | 2,395,216,906 | 2,511,476,436 | 2,719,875,183 | 3,079,937,288 | 12,985,467,039 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2015 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
||||
|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 4 | - Significant Changes to Governing Documents - The Bylaws of the Corporation were amended in 2015 with the following significant change: On March 12, 2015, Article D, Directors, Section D-2, Number was amended to change the number of Directors from "up to 15" to "a range of 13 to 17". |
| FORM 990, PART VI, LINE 6 | KAISER FOUNDATION HEALTH PLAN, INC. IS THE SOLE MEMBER. Upon dissolution, remaining assets shall be distributed to a 501(c)(3) organization. |
| FORM 990, PART VI, LINE 7A | - Appointment of Governing Body - KAISER FOUNDATION HEALTH PLAN, INC. appoints the directors (and fills vacancies and has authority to remove directors). THE SAME INDIVIDUALS WHO COMPRISE THE BOARD OF DIRECTORS OF KFHP ALSO SERVE AS THE DIRECTORS OF KFHP COLORADO, NORTHWEST AND MID-ATLANTIC STATES. |
| FORM 990, PART VI, LINE 7B | - Approval of Certain Governance Decisions - The following actions of the corporation require approval of the sole member: a) REMOVAL OF THE CHAIRMAN OF THE BOARD OR THE PRESIDENT, THE GROUP PRESIDENT OR REGIONAL PRESIDENT; b) Amendments to Articles C (MEMBER), D (DIRECTORS) and H of the Bylaws may be amended only by the member; 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. PRIOR TO FINALIZATION, THE RETURN IS REVIEWED BY AN EXTERNAL TAX ADVISOR. 4. ONCE SIGNED BY AN EXTERNAL TAX ADVISOR, THE RETURN AND UNDERLYING DATA ARE REVIEWED BY AN OFFICER OR A MEMBER OF MANAGEMENT DESIGNATED BY AN OFFICER FOR SIGNATURE AND FILING. 5. COPIES ARE THEN PROVIDED TO BOARD MEMBERS PRIOR TO FILING. |
| Form 990, Part VI, Line 12C | - Compliance Enforcement - A. REGULARLY AND CONSISTENTLY MONITORS COMPLIANCE WITH THE CONFLICTS OF INTEREST POLICY - KAISER PERMANENTE REGULARLY MONITORS COMPLIANCE WITH THE CONFLICTS OF INTEREST POLICY IN 3 KEY WAYS: A1. THE KAISER PERMANENTE COMPLIANCE HOTLINE IS AVAILABLE TO ALL EMPLOYEES AND VENDORS TO REPORT ACTUAL OR POTENTIAL CONFLICTS OF INTEREST. ALL CALLS ARE ANSWERED BY A THIRD PARTY AND PROVIDED TO KAISER PERMANENTE'S NATIONAL COMPLIANCE OFFICE FOR REVIEW AND APPROPRIATE ACTION. EMPLOYEES CAN REPORT ANONYMOUSLY. RETALIATION IS PROHIBITED. REPORTS OF ACTUAL OR POTENTIAL CONFLICTS OF INTEREST ARE GENERATED AND INVESTIGATIONS ARE CONDUCTED AS REQUIRED AND INFORMATION IS TRACKED AND TRENDED TO DETERMINE IF ADDITIONAL GUIDANCE IS REQUIRED TO AVOID OR MANAGE CONFLICTS OF INTEREST. COMPLIANCE HOTLINE REPORTS ARE PROVIDED FOR REVIEW AND ACTION TO THE KAISER FOUNDATION HEALTH PLAN/HOSPITALS BOARDS OF DIRECTORS ANNUALLY. A2. THE NATIONAL COMPLIANCE OFFICE AND INTERNAL AUDIT SERVICES ANNUALLY REVIEW THE DIRECTORS', OFFICERS', KEY EMPLOYEES', AND EXECUTIVES' ANNUAL CONFLICTS OF INTEREST QUESTIONNAIRE DISCLOSURES AND PROVIDE DIRECTION ON ANY INVESTIGATIONS REQUIRED. INVESTIGATIONS ARE DOCUMENTED, TRACKED AND TRENDED TO DETERMINE IF ADDITIONAL CONTROLS OR EDUCATION IS REQUIRED. IN ADDITION, CONFLICTS OF INTEREST QUESTIONNAIRE REPORTS ARE PROVIDED FOR REVIEW AND ACTION TO THE KAISER FOUNDATION HEALTH PLAN/HOSPITALS BOARDS OF DIRECTORS ANNUALLY; AND A3. ANNUALLY, AS A COMPONENT OF THE EXTERNAL AUDIT, AN OUTSIDE CERTIFIED PUBLIC ACCOUNTING FIRM REVIEWS THE ANNUAL CONFLICTS OF INTEREST QUESTIONNAIRES PROCESS COMPLETED BY DIRECTORS, OFFICERS, KEY EMPLOYEES, AND EXECUTIVES, AND ACTIONS TAKEN AS A RESULT OF THE DISCLOSURES. THE RESULTS OF THE ANNUAL AUDIT, INCLUDING ANY FINDINGS IN THIS AREA ARE PRESENTED TO THE KAISER FOUNDATION HEALTH PLAN/HOSPITALS AUDIT AND COMPLIANCE COMMITTEE. B. REGULARLY AND CONSISTENTLY ENFORCES COMPLIANCE WITH THE CONFLICTS OF INTEREST POLICY - TO ENSURE CONSISTENCY IN THE ENFORCEMENT OF THE POLICY KAISER PERMANENTE USES THE FOLLOWING STEPS AS A GENERAL GUIDELINE: B1. REPRESENTED EMPLOYEES ARE SUBJECT TO ANY CORRECTIVE/DISCIPLINARY ACTION PROVISIONS DESCRIBED IN SPECIFIC REGIONAL/NATIONAL COLLECTIVE BARGAINING AGREEMENTS AND/OR ORGANIZATIONAL POLICIES AND PRACTICES. B2. KAISER PERMANENTE NOTIFIES EMPLOYEES OF THE NATIONAL HUMAN RESOURCES POLICY NO. 14. CORRECTIVE/DISCIPLINARY ACTION POLICY DURING NEW EMPLOYEE ORIENTATION AND IN ANNUAL COMPLIANCE TRAINING. B3. IN THE EVENT THAT IT IS NECESSARY TO DISCIPLINE ANY EMPLOYEE BECAUSE OF, BUT NOT LIMITED TO, FAILURE TO COMPLY WITH APPLICABLE LEGAL/REGULATORY REQUIREMENTS, KAISER PERMANENTE POLICIES AND PROCEDURES,OR THE PRINCIPLES OF RESPONSIBILITY, OR FOR UNSATISFACTORY PERFORMANCE OR MISCONDUCT, COACHING/COUNSELING AND/OR CORRECTIVE/DISCIPLINARY ACTION MAY INCLUDE, BUT IS NOT LIMITED TO: - ORAL DISCUSSION AND/OR WARNING BY THE EMPLOYEE'S IMMEDIATE SUPERVISOR OR HIGHER LEVEL MANAGER TO CORRECT THE PROBLEM; - WRITTEN NOTICE, WITH OR WITHOUT FINAL WARNING; - PAID OR UNPAID SUSPENSION, WITH OR WITHOUT FINAL WARNING; - TERMINATION OF EMPLOYMENT. |
| Form 990, Part VI, Line 15A/B | - Compensation Determination - THE EXECUTIVE COMPENSATION PROGRAM AS ADMINISTERED BY KAISER FOUNDATION HEALTH PLAN, INC. 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 AND THE MANAGEMENT COMMITTEE ON COMPENSATION. PRIOR TO PAYMENT, ALL PROGRAMS AND PAYMENTS TO THE CEO, EXECUTIVE DIRECTOR, AND TOP MANAGEMENT OFFICIALS (EXECUTIVES) ARE REVIEWED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS AND THE MANAGEMENT COMMITTEE ON COMPENSATION. BASE PAY FOR EXECUTIVE POSITIONS IS ESTABLISHED AT A LEVEL COMPARABLE TO THE RELEVANT MARKET. IN ADDITION, OTHER COMPONENTS OF THE COMPENSATION PROGRAM BEAR 'AT-RISK' FEATURES DESIGNED TO FOCUS ON STRATEGICALLY IMPORTANT PERFORMANCE GOALS AND TO ASSIST IN ATTRACTING AND RETAINING TOP PERFORMERS. THE EXECUTIVE COMPENSATION PROGRAM IS TARGETED TO BE COMPETITIVE TO THE COMPARABLE EXTERNAL MARKET IN WHICH THE ORGANIZATION COMPETES FOR EXECUTIVE LEADERSHIP. EVALUATION OF COMPARABLE PAY DATA IS PERFORMED BY AN INDEPENDENT COMPENSATION, BENEFIT & HUMAN RESOURCE CONSULTING FIRM. THE COMPENSATION PROGRAM FOCUSES ON OBJECTIVES IN THE AREAS OF QUALITY OF MEMBER CARE AND SERVICE, MEMBERSHIP GROWTH, FINANCIAL SOUNDNESS, AND THE COMMUNITY AND SOCIAL MISSION OF THE ORGANIZATION. |
| Form 990, Part VI, Line 18 | Forms 990 are available on www.guidestar.org. |
| Form 990, Part VI, Line 19 | - Public Inspection - Governing documents, conflict of interest policy are available upon request as disclosed to other regulatory bodies. 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 Independent Auditors' Report. To request copies contact: Vice President, Government Relations Kaiser Foundation Health Plan and Hospitals One Kaiser Plaza, 18th Floor Oakland, CA 94612 |
| Form 990, Part VII, Section A, Column B | - Hours for Related Organizations - Individuals who are both officers and members of Boards of Directors work full time as employees as well as fulfill their board assignment. All officers work full time in their employee capacity. Full time work may require in excess of the traditional 40 hour week. Given the integrated nature of our organization, employees may provide support for various Kaiser Permanente companies. The average hours per week reported for the filing organization and related organizations was estimated. |
| Form 990, Part XI, Line 9 | - Other changes in net assets or fund balances - CHANGE IN PENSION AND OTHER RETIREMENT LIABILITIES $ 18,966,757 OTHER THAN TEMPORARY IMPAIRMENTS (1,056,053) GAIN ON SALE OF INVESTMENTS - TAX (194,214) GAIN ON SALE OF INVESTMENTS - BOOK 419,364 ------------ TOTAL $ 18,135,854 |
| FORM 990, PART III, LINE 4A-4D | 2015 Community Benefit Report Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.s Commitment to the Community Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. (Mid-Atlantic Health Plan or KFHP-MAS) provides and arranges comprehensive health care services for members on a predominantly prepaid basis. Its contractual obligations to group and individual members are fulfilled by contracting with local hospitals and Permanente Medical Group physicians to provide health care services for its members. KFHP-MAS strives for excellence in serving its members through market-leading performance in quality and service. As a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP, Inc.), membership is available without regard to age, sex, race, religion, or national origin, or to the individuals ability to pay. Mid-Atlantic Health Plan members are broadly representative of the communities served. Once enrolled, a member may maintain membership regardless of health or employment status. Mid-Atlantic Health Plan provides and coordinates complete health care services serving communities in Maryland, Virginia, and Washington, D.C. As related nonprofit organizations, Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. are committed to improving the health of communities beyond enrolled membership. Annual investments in a range of Community Benefit programs are a fundamental embodiment of the organizations ongoing commitment to improve general wellbeing within the broader community. These investments result in intentional, planned, measurable, and accountable benefits intended to address many of the health challenges faced at the individual, local, state, and national levels. In 2007, Kaiser Foundation Health Plan, Inc.s board of directors refined the focus of the organizations Community Benefit program and established the following four priority areas which have come to be known as "Streams of Work": A. Care and Coverage for Low-Income People Creates and supports programs that lower the financial barriers for the under- and uninsured. B. Community Health Initiatives (CHI) Seeks to measurably improve the health of the communities we serve. Designs, delivers, and sustains long-term programs that engage communities in work to improve conditions in their neighborhoods. C. Safety Net Partnerships Builds partnerships with community clinics, local health departments, and public hospitals. Provides funding, technical assistance, dissemination of care management, and quality improvements technology to help improve care and expand treatment capacity for vulnerable populations. D. Developing and Disseminating Knowledge Improves health care by sharing our knowledge educating practitioners, advancing research, empowering consumers, and informing policymakers about evidence-based care and health. In addition to the streams of work above, KFHP-MAS also made contributions to benefit the communities served in the following areas: E. Other Community Benefit Investments - support Community Benefit activities and programs beyond the national streams of work, including the administrative expenses of regional Community Benefit departments dedicated to supporting the organizations Community Benefit programs and services and coordinating related initiatives. F. Environmental Stewardship - protecting and improving the natural environment is a key component of KFHP-MASs mission to improve the health of the community it serves. Although costs associated with this initiative are not included in the dollars reported as Community Benefit investments, efforts in this area contribute to advancing a broader vision emphasizing healthy people and healthy environments while also improving health care quality and affordability. The following are details of the Community Benefit activities provided by Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.: In 2015, Mid-Atlantic Health Plan served nearly 616,000 members and expended approximately $101 million (at cost, net of $116 million of related revenues) to support Community Benefit activities. The following summarizes many of the signature Community Benefit programs and services grouped according to the national Streams of Work. A. Care and Coverage for Low-Income People Improving health care access for those with limited incomes and resources is fundamental to Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.s mission. In 2015, Mid-Atlantic Health Plan expended approximately $90 million (at cost, net of $116 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 KFHP-MAS facility or by a Permanente provider. A.1. Charitable Care (Medical Financial Assistance and Charitable Health Coverage Programs) KFHP-MAS provides charity care to low-income vulnerable populations through the Medical Financial Assistance (MFA) and Charitable Health Coverage (CHC) Programs. In 2015, Mid-Atlantic Health Plan spent approximately $59.4 million (at cost, net of $236 thousand of related revenues) to support under- and uninsured patients. A.1.1. Medical Financial Assistance (MFA) Program Mid-Atlantic Health Plans Medical Financial Assistance program provides financial assistance for emergency and medically necessary services, medications, and supplies to patients with a demonstrated financial need. Patients must receive health care services at facilities operated by Kaiser Permanente and/or from a Kaiser Permanente provider. Eligibility is based upon prescribed levels of income to patients who have exhausted other private and public sources of support. In 2015, KFHP-MAS provided $30.5 million (at cost, net of related revenues of $0) of services under this program. At KFHP-MAS, uninsured patients receive a discount on hospital and professional charges for emergency or other medically necessary care without application and regardless of income level. The discount is provided to ensure that an uninsured individual is not charged more for emergency or other medically necessary services than the amounts generally billed to insured individuals receiving equivalent care. Contracted collection agency practices are aligned with the organizations social values and IRC section 501(r). Additionally, any patient experiencing financial hardship due to high medical expenses relative to their income level may qualify for the program under special circumstances. In Maryland, Virginia, and Washington D.C., the MFA programs eligibility criteria allows patients falling at or below 350% of the Federal Poverty Guidelines (FPG) to receive full (100%) write off of patient out-of-pocket costs. In 2015, the MFA program assisted over 40,000 qualifying applicants in Maryland, Virginia, and the District of Columbia. This population received full or partial forgiveness for nearly 550,000 outpatient visits and approximately 270,000 prescriptions. A.1.2. Charitable Health Coverage (CHC) Program Charitable Health Coverage is a unique approach to caring for low-income uninsured persons in the community. Eligible participants receive a regular Kaiser Permanente Health Plan membership card and access to the full range of services and providers a much better alternative to potentially costly emergency room visits or hospitalization. Additionally, Mid-Atlantic Health Plan also participates as a pediatric primary care provider for a local access-to-care program for low income children. This allows Mid-Atlantic Health Plan to invest in the longer term health of patients and the community. KFHP-MASs CHC programs have a long history of making a real difference in the lives of persons who might otherwise have no permanent health care coverage. During 2015, KFHP-MAS invested approximately $28.9 million (at cost, net of $236 thousand of related revenues) to support the CHC program. The CHC program includes a separately administered premium subsidy that CHC members use for the purchase of a standard off-exchange Kaiser Permanente Individual/Family (KPIF) gold level plan. To ensure that patient cost share obligations do not become a barrier to care, a Medical Financial Assistance award is provided to CHC members at the time of enrollment in the CHC program. Recertification takes place about every two years to confirm that members remain eligible to participate. Prospective members are invited to apply during limited annual enrollment periods and after experiencing triggering events. |
| A.1.2.1. Community Health Access Program (CHAP) | CHAP is a Charitable Health Coverage program that provides low-income individuals and families with access to health coverage. Participants must meet certain eligibility requirements. Total household income must be at or below 300% of the Federal Poverty Level (FPL) and applicants must not have access to other forms of health care coverage. Once eligibility requirements are met, CHAP members receive a KFHP MAS subsidy that helps pay for enrollment in a standard off-exchange KFHP MAS individual and family product (gold level). These members are also provided with medical financial assistance that covers the cost sharing for most services if provided at KFHP MAS facilities. More than 6,900 members who did not have access to other publicly or privately offered forms of health coverage were enrolled in this program at the end of 2015. A.1.2.2. Medical Care for Children Partnership (MCCP) Program Mid-Atlantic Health Plans long-standing participation as a pediatric primary care provider in the MCCP program continued throughout 2015. This program is administered through local governmental agencies and non-profit organizations serving Fairfax and Prince William counties in Virginia, and Prince George and Montgomery counties in Maryland. Approximately 3,700 children were receiving medical care under this program at the end of 2015. A.2. Participation in Medicaid and Other Government-Sponsored Programs Mid-Atlantic Health Plan has a long history of participating in publicly financed health programs as a nonprofit organization. KFHP-MAS participates in Medicaid and other government-sponsored programs depending on the structure of these programs in the states of Virginia and Maryland. In 2015, Mid-Atlantic Health Plan provided coverage and services valued at $30.8 million (at cost, net of $116 million of related revenues) for members and nonmembers in programs sponsored by the federal and state governments. As of December 2015, KFHP-MASs membership in Medicaid programs reached close to 40,000. This represents an increase of 22,000 or 120% from year-end 2014. The Affordable Care Act is having a continuing far-reaching impact on the landscape of government-sponsored programs, as these options are poised to become the key source of health coverage for a significant portion of the American population. KFHP-MAS has responded to this challenge by developing organizational strategies to enable individuals whose coverage is changing due to personal or financial circumstances to enroll in a Medicaid program offered by KFHP-MAS. Realized and anticipated growth in the organizations Medicaid offerings closely aligns with and supports Mid-Atlantic Health Plans core mission, tax exempt status, credibility in state and federal policy arenas, and community health needs focusing on access to care. To better cope with the expansion of KFHP-MASs Medicaid program, a Medicaid Assistance Center (MAC) was opened for operation in 2014. With an emphasis on delivering bilingual support, the representatives in this center provide specialized enrollment services by assisting callers in understanding Medicaid eligibility in their state and the qualifications to enroll in Medicaid with KFHP-MAS. A proactive follow-up process has been implemented to nurture a good foundational relationship with those prospects that elect to receive communications. A.2.1. Medicaid Managed Care In 2014, Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. became a participating fully capitated Managed Care Organization (MCO) in the state of Maryland bringing nationally recognized quality, preventive care, and convenience to the states individuals and families enrolled in Medicaid. The region had previously expanded their Medicaid presence into Virginia as a fully capitated MCO in 2013. In 2015, KFHP-MAS ended the year with approximately 40,000 members in the Medicaid Managed Care program. Three value-added services provided to these members included dental and vision coverage, as well as transportation reimbursement. A.2.2. Medicaid Fee-for-Service Mid-Atlantic Health Plan provides health care on a fee-for-service basis for Medicaid beneficiaries who are not enrolled as KFHP-MAS members. These services are provided in partnership as a pediatric provider under the Priority Partners Managed Care Organization (part of Johns Hopkins Medicine). KFHP-MAS expended approximately $880,000 (at cost, net of $372 thousand of related revenues) to subsidize patient care under this program. Approximately 1,000 Priority Partners members received care under fee-for-service arrangements. A.3. Prior Year Contributions for Care and Coverage In prior years, KFHP-MAS made contributions to several donor advised funds under the direction of various foundations operating in our local communities. These funds were intended to identify and support nonprofit organizations that meet community needs in the area of care and coverage. In 2015, the following initiatives were funded through disbursements issued by the community foundations based upon recommendations informed by KFHP-MAS's expertise. A.3.1. Care and Coverage Outreach in Northern Virginia Studies show that a significant portion of the population of Northern Virginia have remained uninsured even after two years of the Affordable Care Act, with minorities making up a disproportionately small segment of the insured. In 2015, Northern Virginia Family Services received $50,000 from a prior year contribution to a community foundation donor advised fund to help fund part-time bi-lingual application counselors, interpreters, and volunteer coordinators providing 560 in-person assistance appointments. A.3.2. Care and Coverage Outreach in Maryland In 2015, Baltimore Health Care Access received $50,000 from a prior year contribution to a community foundation donor advised fund to support outreach to Latino and low income families in Marylands central region. Activities included 41 radio spots, 40 transit ads, and 1,000 pamphlets for community organizations in Marylands central region. B. Community Health Initiatives The Community Health Initiatives (CHI) strategy aims to improve the health of individuals, families, and communities by addressing the social, economic, and environmental determinants of health. The role of the community is vital to creating the conditions of health as well as the importance of non-medical resources in communities that promote well-being and prevent disease. The central premise of this approach is that excellent medical care alone is not sufficient to create healthy communities. Evidence underscores the importance of changing community environments as a critical community health strategy. Guided by this evidence, Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. supports comprehensive initiatives that focus on policy and environmental changes to promote healthy eating and active living (HEAL), community safety, economic stability, and social and emotional wellness. KFHP-MAS Community Health Initiatives engaged communities in addressing the root causes of obesity. The focus of KFHP-MASs initiatives target policy and systems reform to achieve equity in healthy food availability across its service areas, with emphasis on neighborhoods, schools, and food banks. It has contributed guidance to multiple initiatives and collaboratives dedicated to building strong and sustainable regional food systems and creating safe spaces for physical activity. KFHP MAS did not recognize significant financial investments in 2015. However, its deep commitment continued through sharing of technical expertise for capacity building. B.1. Community Health Initiatives Programs and Services B.1.1. Prior Year Contributions for CHI Investments In prior years, KFHP-MAS made contributions to several donor advised funds under the direction of various foundations operating in our local communities. These funds were intended to identify and support nonprofit organizations that meet community needs in the area of community health initiatives. In 2015, the following initiatives were funded through disbursements issued by the community foundations based upon recommendations informed by KFHP-MAS's expertise. B.1.1.1. Sustainable Farming Chesapeake Bay Foundation, Inc received $150,000 in 2015 from a prior year contribution to a community foundation donor advised fund for Clagett Farm to showcase sustainable agricultural practices to farmers, promote healthy eating of local foods to consumers, and provide fresh vegetables to low-income families. Clagett Farm will feed approximately 550 local families in 2015, including 200 low-income families in the Washington Metro Area. Clagett Farm welcomes 3,000 visitors a year, fostering a better understanding of the connection between land use, water quality and public health-spreading knowledge that you can help save the bay with what you put on your plate. |
| B.1.1.2. Schools and Corner Stores | DC Central Kitchen received $50,000 in 2015 from a prior year contribution to a community foundation donor advised fund to partner with schools and corner stores to improve healthy food access at a neighborhood level in Wards 5, 7, and 8 in the District of Columbia. Support from this grant allowed DC Central Kitchen to serve more than 3,200 people, distribute 5,400 units of fresh produce, and provide healthy snacks at nine schools. B.1.1.3. Thriving Schools Program A grant of $45,000 from a prior year contribution to a community foundation donor advised fund to Food Corps in 2015 helped connect kids to healthy food options in schools. With thirteen corps members, Food Corps spent 580 hours in schools implementing a three-pillared approach to healthy kids, guiding 2,700 children through nutrition education, and gardening to harvest 634 pounds of produce. Food Corps also offered cooking lessons to foster skills and pride around healthy food. Almost 300 community volunteers gave nearly 800 hours to the project. C. Safety Net Partnerships C.1. Kaiser Foundation Health Plan of Mid-Atlantic States, Inc. is committed to building partnerships with the institutions that serve on the front lines of health care for the uninsured and underserved. By providing support to community health centers, public hospitals, and local health departments, Mid-Atlantic Health Plan helps them deliver care and treatment to the most vulnerable in our communities. C.2. Safety Net Partnerships Programs and Services C.2.1. Community Ambassador Program Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. supported the Safety Net Stream of Work primarily through an innovative Community Ambassador Program, in its 7th year. Details of this program are elaborated within the "Other Community Benefits" section below. C.2.2. Community Health Workers (CHW) in HIV/AIDS Partnership Washington AIDS Partnership of the Washington Regional Association of Grantmakers received $100,000 as part of a multi-year grant in support of Positive Pathways, an evidence-based intervention which addresses barriers to HIV medical care for African-Americans, primarily women, in Wards 5 to 8 of Washington, DC and Prince Georges County, MD. In the five years that KFHP MAS has funded this program, a cadre of twelve trained peer community health workers have served their community through an understanding of barriers associated with living with HIV, care and social services, and race/ethnicity. From March, 2014 through February, 2015, CHWs enrolled 365 out-of-care individuals. These health workers also worked with 242 ongoing clients from years one, two, and three, and re-engaged 52 clients from previous years who had fallen out of care. The total number of individuals served was 659. A review of data for a six month period showed that, among the clients who completed at least one assessment with a CHW, 96% attended at least one medical visit with a HIV provider, 92% are taking their HIV medications, and 61% are virally suppressed. C.2.3. Prior Year Contributions for Safety Net Partnerships In prior years, KFHP-MAS made contributions to several donor advised funds under the direction of various foundations operating in our local communities. These funds were intended to identify and support nonprofit organizations that meet community needs in the area of safety net partnerships. In 2015, the following initiative was funded through disbursements issued by the community foundations based upon recommendations informed by KFHP-MAS's expertise. C.2.3.1. Population Health Initiative in Cardiovascular Risk Reduction Two implementing organizations received a total of $222,500 in 2015 from a prior year contribution to a community foundation donor advised fund to continue the dissemination of the ALL/PHASE initiative, a keystone cardiovascular disease risk reduction and population management program developed from learnings across the Kaiser Permanente. Funding in 2015 supported participation for five new clinics. The ALL/PHASE initiative also provided infrastructure to support their implementations with a data reporting template, toolkit, and technical assistance. D. Developing and Disseminating Knowledge The Developing and Disseminating Knowledge Stream of Work supports activities that improve health care by sharing knowledge, educating practitioners, advancing research, empowering consumers and informing policymakers about evidence-based care and health. Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. spent $2.9 million in 2015 to support programs and services associated with the development and dissemination of knowledge. D.1. Medical Research At KFHP-MAS, research is an essential part of what it means to be a learning organization. Achievements realized under this program are made possible through a dedicated group of researchers, the comprehensive nature of KFHP, Inc.s electronic medical record system, and access to the health data of over 10 million Kaiser Foundation Health Plan, Inc. members. Through studies conducted at regional and national research centers, researchers address critical issues like cancer, cardiovascular conditions, diabetes, behavioral and mental health, and health care delivery improvements by leveraging the organizations research expertise, rich data sources, and delivery system environment. Mid-Atlantic Health Plan provided approximately $1.8 million for medical research projects in 2015. In 2015, Kaiser Foundation Health Plan, Inc. and its subsidiaries continued to expand its national biobank, the KP Research Bank, a research resource that will strengthen the ability to conduct cutting-edge studies. With this development, Mid-Atlantic Health Plan benefits from being part of a biobank that will be one of the largest non-governmental biobanks in the United States to examine the genetic and environmental factors that influence common diseases such as heart disease, cancer, diabetes, high blood pressure, Alzheimer's disease, asthma and many others. D.1.1. National Research Program Kaiser Foundation Health Plan, Inc. has a long history of conducting health services and medical research that addresses health care policy, quality of care, and quality of life. The results have yielded findings that affect not just the practice of medicine within the organization and its subsidiaries, but also for society-at-large. D.1.1.1. Kaiser Foundation Research Institute (KFRI) The Kaiser Foundation Research Institute provides administrative leadership and support for federally funded medical research conducted at regional research centers located in the Mid-Atlantic States as well as several others. KFRI personnel are designated as the Authorized Organizational Official for all federally funded research performed by both Kaiser Foundation Hospitals and Kaiser Foundation Health Plan, Inc., and its subsidiaries. In this capacity, KFRI submits applications for grants and executes contracts and sub-contracts for all federally funded research on behalf of the regional research programs described below. KFRI also manages invoicing and accounts receivable related to federally funded research, and distributes grant proceeds to the appropriate regional program. Additionally, KFRI supports the regional research centers on issues related to human participant protection and clinical trials research quality and compliance. D.1.1.2. The Center for Effectiveness and Safety Research (CESR) The Center for Effectiveness and Safety Research is a national research center that leverages the expertise of Kaiser Permanentes seven regional research centers to answer important comparative effectiveness and safety questions that affect health care delivery questions by relying on collaborations within the network. D.1.2. Mid-Atlantics Research Program The principal research activities conducted in the Mid-Atlantic States take place at the following regional research center: |
| D.1.2.1. The Mid-Atlantic Permanente Research Institute | Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. collaborates with the Mid-Atlantic Permanente Research Institute in addressing the clinical, health policy, and service challenges facing residents of the region. The institute's mission is to advance medical knowledge and improve the quality of care and health of our patients and communities we serve by conducting innovative scientific and clinical research. Through the network of providers, KFHP-MAS members, and the health care system itself, the Research Institute aims to improve the care experience of patients as well as the communities served by Mid-Atlantic Health Plan. Top Research Areas: - Economic Impact of Health Care - Epidemiology - Health Disparities - Health Information Technology - Health Services - Infectious Diseases Key Statistics: - Number of clinical trials in 2015: 11 - Number of active studies (clinical and non-clinical trials) in 2015: 99 - Number of research papers published in journals in 2015: 22 - Number of investigators: 5 - Number of support staff: 20 D.1.2.2. Major Areas of Funded Research The following are examples of research projects conducted by investigators at the Mid-Atlantic Permanente Research Institute in 2015: D.1.2.2.1. HIV Quality Improvement and Performance Program Research Area: Health Care Delivery and Comparative Health Systems Collaborating Kaiser Permanente sites: Colorado, Northwest, Hawaii, Southern California, Northern California and Georgia regions. This study is focused on determining quantitative measures of HIV care and outcomes in Kaiser Permanente. Researchers seek to initiate quality improvement programs where they determine there are opportunities for improvement. Primary Funding Provided By: Care Management Institute, The Permanente Federation and Kaiser Foundation Health Plan, Inc. D.2. Educational Theatre Programs (ETP) Confronted with an urgent need for preventive health information in the communities we serve, the Educational Theatre Programs (ETP) was created to inspire children, teens and adults to make informed decisions about their health and to build stronger, healthier communities. The Educational Theatre Program uses live theatre, music, comedy, and drama and these educational programs were developed with the advice of teachers, parents, students, health educators, medical professionals, and professional theatre artists. Performances are delivered by professional actors who are also trained as peer health educators, and are performed free of charge for the community. ETP also provides schools and organizations with supplementary educational materials, such as workbooks, parent and teacher guides, and student wallet cards to reinforce the messages presented on stage. Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.s Educational Theatre Program (ETP) provides professional, award-winning health education for Pre-K to 12 in Maryland, Virginia, and the District of Columbia. In 2015, Mid-Atlantic Health Plan spent approximately $953 thousand on this program. In 2015, ETP performed approximately 680 times at 140 different venues for nearly 48,000 children and adults at schools and other locations. Additionally, ETP performed three age-appropriate shows with supplemental resource materials for students, teachers, and parents that reinforce the presentation. The four scripted shows were Professor BodyWises Traveling Menagerie, The Amazing Food Detective, Rise, and Secrets. ETP also offered classroom workshops on Bullying Prevention, Obesity Prevention, and HIV/AIDS prevention. Throughout the year ETP conducted over 430 workshops to 13,000 students and adults, presented its Corner Store exhibit to educate youth and adults on ways to make healthy food shopping decisions and conducted a Poverty Simulations to inform the public on the challenges of low-income households. ETP distributed lesson plans and course materials that satisfied appropriate learning standards to educators for all of its educational programs. E. Other Community Benefit Investments During 2015, Mid-Atlantic Health Plan spent approximately $7.4 million to support Community Benefit activities and programs beyond the national streams of work. This included the administrative expenses of a Community Benefit department dedicated to supporting regional Community Benefit programs and services and coordinating related initiatives. The following are examples of programs funded in this area. E.1. Community Ambassador Program 2015 was the seventh year of the Community Ambassador program, which grew from two nurse practitioners (NPs) and one physician assistant to a total of 25 NPs and physician assistants placed in 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 health care access to the under and uninsured. Approximately $4.4 million was invested in this program in 2015. E.2 Prior Year Contributions for Workforce Development In prior years, KFHP-MAS made contributions to several donor advised funds under the direction of various foundations operating in our local communities. These funds were intended to identify and support nonprofit organizations that meet community needs in the area of workforce development. In 2015, the following initiative was funded through disbursements issued by the community foundations based upon recommendations informed by KFHP-MAS's expertise. E.2.1. Baltimore YouthWorks Paid Summer Program As the youth of Baltimore experience one of the highest unemployment rates in the country, Baltimore Community Foundation received $200,000 in 2015 from a prior year contribution to a community foundation donor advised fund for the YouthWorks summer jobs program, for 199 young adults age 14 to 21 to take on a five-week paid summer job program. Of the youth, 76% showed measurable gains in their workforce readiness at the conclusion of the program. E.2.2. Workforce Development Collaborative Community Foundation of the National Capital Region, a greater Washington, DC workforce collaborative received $90,000 in the final installment of a multi-year grant for the Accelerating Advancement Initiative (AAI). AAI assisted low-income, underemployed, and unemployed workers in preparing for family-sustaining careers in key industries like healthcare. More than 125 low-income workers participated in 2015 and were involved in the AAI learning network. F. Environmental Stewardship Poor environmental quality contributes to disease and economic insecurity. Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. has committed itself to protecting and improving the natural environment as a key component of its mission to improve the health of the communities it serves. Although costs associated with this initiative are not included in the dollars reported as Community Benefit investments, efforts in this area contribute to advancing a broader vision emphasizing healthy people and healthy environments while also improving health care quality and affordability. To fulfill the organizations commitment to the natural environment, KFHP-MAS maintains a governance structure for environmental stewardship that enables the organization to continually improve its environmental performance. This structure includes clearly defined roles, responsibilities, plans and routines, and has resulted in the following five organizational focus areas. These have been selected based on their ability to result in the greatest impact on the environmental forces that shape environmental and human health. - Finding safe alternatives to harmful industrial chemicals - Responding to climate change - Promoting sustainable farming and food choices - Reducing, reusing, and recycling to eliminate waste - Conserving water In each of these focus areas, KFHP-MAS has established ambitious goals (including a target to reduce total greenhouse gas emissions by 30% by 2020, compared to a 2008 baseline), implemented initiatives, achieved measurable improvements, and regularly reported progress to the board of directors, staff, and the general public. F.1. Performance Metrics During 2015, key performance indicators for Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. included: F.1.1. In Maryland, Virginia, and Washington, D.C.: F.1.1.1 Improved our water use intensity (gallons/rentable square foot) by 14% since our 2013 baseline year. F.1.1.2 Contracted to purchase approximately 57 million kilowatt-hours of Green-e Certified Renewable Energy Certificates, thus reducing our organizations annual greenhouse gas emissions by approximately 26,000 metric tons of CO2-equivalent. F.1.1.3 Responsibly reused or recycled over 1,300 tons of materials. |
| Software ID: | |
| Software Version: |