TY 2016 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) Ramon F Baez...................................................................... Director	0.25 ................. 4.75	X		152,591	0
(2) Regina M Benjamin...................................................................... Director	0.5 ................. 8.0	X		197,178	0
(3) Jeffrey E Epstein...................................................................... Director	0.5 ................. 7.5	X		206,871	0
(4) Leslie S Heisz...................................................................... Director	0.25 ................. 4.75	X		215,118	0
(5) David Hoffmeister...................................................................... Director	0.25 ................. 7.75	X		225,809	0
(6) Judith A Johansen JD...................................................................... Director	0.5 ................. 8.0	X		240,707	0
(7) Kim J Kaiser...................................................................... Director	0.5 ................. 7.0	X		216,547	0
(8) Philip A Marineau...................................................................... Director	0.58 ................. 5.86	X		229,371	0
(9) Edward Pei...................................................................... Director	0.25 ................. 7.25	X		226,739	18,000
(10) Margaret E Porfido JD...................................................................... Director	1.0 ................. 5.5	X		247,358	0
(11) Richard Shannon MD...................................................................... Director	0.5 ................. 5.0	X		212,000	0
(12) Cynthia A Telles PHD...................................................................... Director	0.5 ................. 7.0	X		223,809	0
(13) Bernard Tyson...................................................................... Chairman & CEO	6.0 ................. 44.0	X	X	8,529,498	720,185
(14) Eugene Washington...................................................................... Director	0.25 ................. 6.75	X		186,626	0
(15) Gregory Adams...................................................................... EVP, Group President	6.0 ................. 44.0		X	2,457,650	688,025
(16) Maryann Bodayle...................................................................... Assistant Secretary	1.0 ................. 49.0		X	166,251	33,529
(17) Kimberly Horn...................................................................... Regional President - MAS	40.0 ................. 10.0		X	1,288,042	617,297

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Kathryn Lancaster........................................................................ EVP & CFO	4.0 .......................46.0	X				2,681,226	588,601
(19) Thomas Meier........................................................................ SVP, Corporate Treasurer	2.0 .......................48.0	X				1,050,818	138,764
(20) Donald Orndoff........................................................................ SVP, NFS	5.0 .......................45.0	X				935,840	216,315
(21) Rochelle Roth........................................................................ Assistant Secretary	4.0 .......................46.0	X				274,594	117,866
(22) Jacqueline Sellers........................................................................ Assistant Secretary	2.0 .......................48.0	X				265,122	88,088
(23) Arthur Southam........................................................................ EVP, Health Plan Operations	5.0 .......................45.0	X				2,775,635	464,416
(24) Susan Spurlark........................................................................ Assistant Secretary	50.0 .......................0.0	X				639,359	111,026
(25) Deborah Stokes........................................................................ SVP,Corporate Controller & CAO	4.0 .......................46.0	X				503,944	3,920
(26) Alfonse Upshaw........................................................................ SVP,Corporate Controller & CAO	4.0 .......................46.0	X				616,612	108,314
(27) Hong-Sze Yu........................................................................ Assistant Secretary	5.0 .......................45.0	X				304,345	126,932
(28) Mark Zemelman........................................................................ SVP, General Counsel & Secy	1.0 .......................49.0	X				1,630,173	369,974
(29) Joseph Butz........................................................................ VP & COO - MAS	50.0 .......................0.0		X			900,725	138,773
(30) Jon Kunkle........................................................................ VP, CFO - Mid-Atlantic States	50.0 .......................0.0		X			568,144	146,832
(31) Mark Ruszczyk........................................................................ VP, MSBD - MAS	50.0 .......................0.0		X			503,757	147,932
(32) Frank Titus........................................................................ VP, HPSA - MAS	50.0 .......................0.0		X			501,949	131,514
(33) Karen Elizabeth Blair........................................................................ VP, PR, Comm & Brand Mgmt	50.0 .......................0.0			X		354,759	101,483
(34) Joan L Gelrud........................................................................ VP, Quality - MAS	50.0 .......................0.0			X		379,929	135,195
(35) Linda S Larch........................................................................ Reg Compliance Officer - MAS	50.0 .......................0.0			X		314,210	80,273
(36) Heidi S Veltman........................................................................ VP, Delivery System Opns-NOVA	50.0 .......................0.0			X		300,052	174,493
(37) Delinda Hastie Washington........................................................................ VP, HR - MAS	50.0 .......................0.0			X		356,303	93,331
(38) Thomas W Chapman........................................................................ Director	0.0 .......................0.0				X	513,713	0
(39) J Eugene Grisby III........................................................................ Director	0.0 .......................0.0				X	27,039	0
(40) George Halvorson........................................................................ Director	0.0 .......................0.0				X	37,258	4,120
(41) J Neal Purcell........................................................................ Director	0.0 .......................0.0				X	46,000	0
(42) Daniel Garcia........................................................................ SVP, CHief Compliance Officer	2.0 .......................48.0				X	1,137,595	2,170
(43) Victoria Zatkin........................................................................ VP, Off of Brd & Corp Gov Svcs	5.0 .......................45.0				X	216,783	1,728
(44) Ruben Burnett........................................................................ VP, Natl Consultant Relations	0.0 .......................50.0				X	406,562	91,505
(45) Marilyn Kawamura........................................................................ Region President - MAS	0.0 .......................0.0				X	190,164	0

(A) Name and business address	(B) Description of services	(C) Compensation
MID-ATLANTIC PERMANENTE MEDICAL GRO, 2101 EAST JEFFERSON STREET ROCKVILLE,MD20852	MEDICAL SERVICES	677,235,040
HOLY CROSS HOSPITAL, 1500 FOREST GLEN RD SILVER SPRING,MD20910	MEDICAL SERVICES	70,891,601
VIRGINIA HOSPITAL CENTER, PO BOX 1494 MERRIFIELD,VA22116	MEDICAL SERVICES	58,748,767
CHILDREN'S HOSPITAL, PO BOX 37215 BALTIMORE,MD21297	MEDICAL SERVICES	41,849,544
WASHINGTON HOSPITAL CENTER, PO BOX 418203 BOSTON,MA02241	MEDICAL SERVICES	35,931,108
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 217

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	344,247	22,290	14,500	28,275	0	409,312
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose	2,388,129,639	2,508,061,602	2,716,227,851	3,075,698,789	3,408,656,198	14,096,774,079
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	2,388,473,886	2,508,083,892	2,716,242,351	3,075,727,064	3,408,656,198	14,097,183,391
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.)						14,097,183,391

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...	2,388,473,886	2,508,083,892	2,716,242,351	3,075,727,064	3,408,656,198	14,097,183,391
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	6,743,020	3,392,544	3,632,832	3,930,224	4,333,472	22,032,092
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.						0
c	Add lines 10a and 10b.	6,743,020	3,392,544	3,632,832	3,930,224	4,333,472	22,032,092
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	317,240	597,240
13	Total support. (Add lines 9, 10c, 11, and 12.)..	2,395,216,906	2,511,476,436	2,719,875,183	3,079,937,288	3,413,306,910	14,119,812,723

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

99.840 %

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

99.812 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

0.156 %

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

0.186 %

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

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

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC

Employer identification number

52-0954463

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Yes

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Yes

16,280

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Yes

281,500

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

89,797

Total. Add lines 1c through 1i ....................................................................................................

387,577

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
SCHEDULE C, PART II-B, LINE 1A THROUGH 1I	LOBBYING ACTIVITY BY NONELECTING PUBLIC CHARITIES THE ORGANIZATION (HEALTH PLAN) IS A MEMBER OF THE KAISER PERMANENTE MEDICAL CARE PROGRAM AND PARTICIPATED IN AND BENEFITED FROM LOBBYING ACTIVITIES CONDUCTED AT THE REGIONAL AND NATIONAL LEVELS FOR THE BENEFIT OF ITS ENROLLED MEMBERS, THE BROADER COMMUNITY AND FOR THE HEALTH CARE INDUSTRY AS A WHOLE. AS AN ORGANIZATION EXEMPT FROM INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), HEALTH PLAN HAS A POLICY PROHIBITING ANY OF HEALTH PLAN'S RESOURCES BEING USED IN ANY POLITICAL CAMPAIGNS. THIS POLICY IS CLOSELY MONITORED FOR COMPLIANCE. DURING THE YEAR THIS ORGANIZATION MADE COMMENTS OR STATEMENTS CONCERNING LEGISLATION AND BALLOT INITIATIVES WHICH MAY AFFECT THE HEALTH CARE INDUSTRY. HEALTH PLAN ENGAGED IN CONVERSATIONS WITH AND/OR WRITTEN COMMUNICATIONS TO VARIOUS FEDERAL, STATE, AND LOCAL OFFICIALS REGARDING MATTERS WHICH AFFECTED THE HEALTHCARE INDUSTRY AS A WHOLE. THE AMOUNT OF MONEY INVOLVED IN THE ACTIVITIES IS DETAILED ON LINES A THROUGH I. HEALTH PLAN EMPLOYS INDIVIDUALS, INCLUDING ONE OR MORE REGISTERED LOBBYISTS AND/OR MAY RETAIN ONE OR MORE PROFESSIONAL CONSULTANTS TO REPRESENT HEALTH PLAN'S INTERESTS IN VARIOUS LEGISLATIVE AND REGULATORY BODIES AND FROM TIME-TO-TIME TO KEEP INFORMED ABOUT FEDERAL AND STATE LEGISLATION HAVING AN IMPACT ON HEALTH PLAN'S CHARITABLE ACTIVITIES AS AN EXEMPT HEALTH MAINTENANCE ORGANIZATION. THESE INDIVIDUALS ATTEMPT TO ENSURE THAT PROPOSED LEGISLATION AND ENACTED LAWS ARE COMPATIBLE WITH THE INTERESTS OF HEALTH PLAN, ITS MEMBERS AND ITS PATIENTS BY PERFORMING THE FOLLOWING ACTIVITIES: - COLLECTING, ANALYZING AND DISTRIBUTING WITHIN THE ORGANIZATION, PUBLIC AND PRIVATE POLICY RECOMMENDATIONS REGARDING PROPOSED LEGISLATION THAT AFFECT THE OPERATION OF HEALTH PLAN AND ITS ABILITY TO PROVIDE QUALITY HEALTH AND MEDICAL CARE SERVICES TO ITS MEMBERS AND THE BROADER COMMUNITY IN A COST EFFECTIVE MANNER. - PROVIDING APPROPRIATE INFORMATIONAL MATERIALS TO LEGISLATORS AND THEIR STAFFS THAT PERTAIN TO MATTERS OF COMMON INTEREST IN THE HEALTH CARE COMMUNITY AND IN THE NOT-FOR-PROFIT COMMUNITY. - PREPARING WRITTEN AND ORAL TESTIMONY, APPEARING AT LEGISLATIVE HEARINGS, MONITORING LEGISLATIVE PROCEEDINGS AND MEETING WITH LEGISLATORS AND/OR THEIR STAFFS REGARDING ISSUES PERTINENT TO THE MISSION OF HEALTH PLAN. INDIVIDUALS APPEARING AT SUCH HEARINGS AND MEETINGS FOR AND ON BEHALF OF HEALTH PLAN OFTEN ARE REPRESENTING THE INTERESTS OF COMMON INTEREST GROUPS AS WELL AS THE INTERESTS OF THE MEMBERS AND PATIENTS OF HEALTH PLAN. OTHER EMPLOYEES AND OFFICERS PERFORM SERVICES BY DELIVERING SPEECHES AT VARIOUS PUBLIC AND PRIVATE FUNCTIONS AND IN SERVING AS FACULTY IN HEALTHCARE RELATED EDUCATIONAL PROGRAMS THROUGHOUT THE COMMUNITY.

Return Reference

Explanation

SCHEDULE C, PART II-B, LINE 1A THROUGH 1I

LOBBYING ACTIVITY BY NONELECTING PUBLIC CHARITIES THE ORGANIZATION (HEALTH PLAN) IS A MEMBER OF THE KAISER PERMANENTE MEDICAL CARE PROGRAM AND PARTICIPATED IN AND BENEFITED FROM LOBBYING ACTIVITIES CONDUCTED AT THE REGIONAL AND NATIONAL LEVELS FOR THE BENEFIT OF ITS ENROLLED MEMBERS, THE BROADER COMMUNITY AND FOR THE HEALTH CARE INDUSTRY AS A WHOLE. AS AN ORGANIZATION EXEMPT FROM INCOME TAX UNDER INTERNAL REVENUE CODE SECTION 501(C)(3), HEALTH PLAN HAS A POLICY PROHIBITING ANY OF HEALTH PLAN'S RESOURCES BEING USED IN ANY POLITICAL CAMPAIGNS. THIS POLICY IS CLOSELY MONITORED FOR COMPLIANCE. DURING THE YEAR THIS ORGANIZATION MADE COMMENTS OR STATEMENTS CONCERNING LEGISLATION AND BALLOT INITIATIVES WHICH MAY AFFECT THE HEALTH CARE INDUSTRY. HEALTH PLAN ENGAGED IN CONVERSATIONS WITH AND/OR WRITTEN COMMUNICATIONS TO VARIOUS FEDERAL, STATE, AND LOCAL OFFICIALS REGARDING MATTERS WHICH AFFECTED THE HEALTHCARE INDUSTRY AS A WHOLE. THE AMOUNT OF MONEY INVOLVED IN THE ACTIVITIES IS DETAILED ON LINES A THROUGH I. HEALTH PLAN EMPLOYS INDIVIDUALS, INCLUDING ONE OR MORE REGISTERED LOBBYISTS AND/OR MAY RETAIN ONE OR MORE PROFESSIONAL CONSULTANTS TO REPRESENT HEALTH PLAN'S INTERESTS IN VARIOUS LEGISLATIVE AND REGULATORY BODIES AND FROM TIME-TO-TIME TO KEEP INFORMED ABOUT FEDERAL AND STATE LEGISLATION HAVING AN IMPACT ON HEALTH PLAN'S CHARITABLE ACTIVITIES AS AN EXEMPT HEALTH MAINTENANCE ORGANIZATION. THESE INDIVIDUALS ATTEMPT TO ENSURE THAT PROPOSED LEGISLATION AND ENACTED LAWS ARE COMPATIBLE WITH THE INTERESTS OF HEALTH PLAN, ITS MEMBERS AND ITS PATIENTS BY PERFORMING THE FOLLOWING ACTIVITIES: - COLLECTING, ANALYZING AND DISTRIBUTING WITHIN THE ORGANIZATION, PUBLIC AND PRIVATE POLICY RECOMMENDATIONS REGARDING PROPOSED LEGISLATION THAT AFFECT THE OPERATION OF HEALTH PLAN AND ITS ABILITY TO PROVIDE QUALITY HEALTH AND MEDICAL CARE SERVICES TO ITS MEMBERS AND THE BROADER COMMUNITY IN A COST EFFECTIVE MANNER. - PROVIDING APPROPRIATE INFORMATIONAL MATERIALS TO LEGISLATORS AND THEIR STAFFS THAT PERTAIN TO MATTERS OF COMMON INTEREST IN THE HEALTH CARE COMMUNITY AND IN THE NOT-FOR-PROFIT COMMUNITY. - PREPARING WRITTEN AND ORAL TESTIMONY, APPEARING AT LEGISLATIVE HEARINGS, MONITORING LEGISLATIVE PROCEEDINGS AND MEETING WITH LEGISLATORS AND/OR THEIR STAFFS REGARDING ISSUES PERTINENT TO THE MISSION OF HEALTH PLAN. INDIVIDUALS APPEARING AT SUCH HEARINGS AND MEETINGS FOR AND ON BEHALF OF HEALTH PLAN OFTEN ARE REPRESENTING THE INTERESTS OF COMMON INTEREST GROUPS AS WELL AS THE INTERESTS OF THE MEMBERS AND PATIENTS OF HEALTH PLAN. OTHER EMPLOYEES AND OFFICERS PERFORM SERVICES BY DELIVERING SPEECHES AT VARIOUS PUBLIC AND PRIVATE FUNCTIONS AND IN SERVING AS FACULTY IN HEALTHCARE RELATED EDUCATIONAL PROGRAMS THROUGHOUT THE COMMUNITY.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	83,316,425		83,316,425
b	Buildings ....	867,935,110	356,719,837	511,215,273
c	Leasehold improvements	157,165,931	94,381,043	62,784,888
d	Equipment ....	225,093,484	175,818,096	49,275,388
e	Other .....	62,101,449	7,182,080	54,919,369
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				761,511,343

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)STATUTORY DEPOSITS				1,965,026
(2)LONG-TERM DUE FROM AFFILIATES				124,244,459
(3)OTHER LONG-TERM ASSETS				716,667
(4)BROKER RECEIVABLE				45,267
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				126,971,419

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	1,217,835,176
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PART X, Line 2 - ASC 740 FOOTNOTE	THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE A FOOTNOTE UNDER ASC 740.

Schedule D (Form 990) 2019

Additional Data

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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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

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

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? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(h) Purpose of grant or assistance
(1) American Heart Association Inc 1 Almaden Blvd 500 San Jose,CA95113	13-5613797	501(c)(3)	125,000	Event Support\Luncheon
(2) AprilMay Foundation 100 M St 600-667 Washington,DC20003	27-4578342	501(c)(3)	8,500	General Operating Support
(3) Arlington Free Clinic 2921 11th St South Arlington,VA22204	54-1671883	501(c)(3)	6,000	Event Support\Annual Fundraiser
(4) Assn Of Baltimore Area Grantmakers Inc 2 E Read St 2nd Fl Baltimore,MD21202	52-1326863	501(c)(3)	7,360	Event Support\Luncheon
(5) Associated Black Charities 1114 Cathedral Street Baltimore,MD21201	52-1427774	501(c)(3)	8,983	Event Support\Annual Fundraiser
(6) Baltimore City Foundation 7 E Redwood St 9th Fl Baltimore,MD21202	52-1212473	501(c)(3)	20,000	Event Support\Annual Fundraiser
(7) Baltimore Community Foundation Inc 2000 West 41 Street Baltimore,MD21211	23-7180620	501(c)(3)	35,000	Event Support\Health Fair
(8) Black Mental Health Alliance for Edu 900 E Fayette 22111 Baltimore,MD21203	52-1359540	501(c)(3)	8,500	General Operating Support
(9) Catholic Charities Esperanza Center 320 Cathedral Street Baltimore,MD21201	52-0591538	501(c)(3)	178,890	General Operating Support
(10) CCI Health & Wellness Services 8630 Fenton St 1204 Silver Spring,MD20910	52-0988386	501(c)(3)	8,500	General Operating Support
(11) Children's Hospital Foundation 111 Michigan Ave NW Washington,DC20010	52-1640402	501(c)(3)	13,500	Event Support\Dinner
(12) CommonHealth ACTION 1301 CT NW 200 Washington,DC20036	83-0398572	501(c)(3)	100,000	Technical Assistance
(13) Community Fdn for the National Capital 1201 15st NW Washington,DC20005	23-7343119	501(c)(3)	99,225	Event Support\Cultural Event
(14) Community Svcs for Autistic Adults & Child 8615 E Village Mongomery Village,MD20886	52-1263443	501(c)(3)	10,000	Event Support\Annual Fundraiser
(15) Coppin State University Development Fdn 2500 West North Avenue Baltimore,MD21216	23-7127440	501(c)(3)	24,000	Conference Support
(16) Crittenton Services of Greater Washington 815 Silver Spring Silver Spring,MD20910	53-0196511	501(c)(3)	9,365	Event Support\Annual Fundraiser
(17) DC Central Kitchen Inc 425 Second Street NW Washington,DC20001	52-1584936	501(c)(3)	84,500	General Operating Support
(18) End Time Harvest Minsitries Inc 5808 Harland St New Carrollton,MD20784	52-1379809	501(c)(3)	10,000	Event Support\Awards Ceremony
(19) Equity Matters Inc 3613 Sequoia Avenue Baltimore,MD21215	80-0652861	501(c)(3)	15,000	General Operating Support
(20) Everybody Wins DC 1920 N St 350 Washington,DC20036	52-1938281	501(c)(3)	10,000	Event Support\Annual Fundraiser
(21) Fight For Children Inc 1029 Vermont Ave 300 Washington,DC20005	52-1706059	501(c)(3)	35,000	Event Support\Annual Fundraiser
(22) FoodCorps Inc 2544 NW Upshur St Portland,OR97210	27-3990987	501(c)(3)	65,000	General Operating Support
(23) Future Harvest Inc - Chesapeake Alliance 1114 Shawan Rd 1 Cockeysville,MD21030	52-2132982	501(c)(3)	7,500	Conference Support
(24) Generation Hope 415 Michigan Ste 250 Washington,DC20017	27-3554088	501(c)(3)	19,875	Event Support\Annual Fundraiser
(25) Greater Baltimore Medical Ctr Foundation 6701 N Charles St Baltimore,MD21204	52-1411935	501(c)(3)	5,952	Event Support\Cultural Event
(26) Greater Washington Urban League Comm 2901 14th Street NW Washington,DC20009	52-2357941	501(c)(3)	9,200	Event Support\Annual Fundraiser
(27) Holy Cross Health Foundation Inc 10720 Columbia Pike Silver Spring,MD20901	20-8428450	501(c)(3)	65,000	Event Support\Health Fair
(28) Independence Empowerment Center 8409 Dorsey Circle 102 Manassas,VA20110	54-1953287	501(c)(3)	75,000	General Operating Support
(29) Initiative For A Competitive Inner City 56 Warren St 300 Roxbury,MA02119	13-3772904	501(c)(3)	30,000	Conference Support
(30) James E Newby Jr MD Foundation 301 Riverview Ave 500 Norfolk,VA23510	26-4288692	501(c)(3)	50,000	General Operating Support
(31) Johns Hopkins University 2800 N Charles St 300 Baltimore,MD21218	52-0595110	501(c)(3)	9,000	Event Support\Cultural Event
(32) Jubilee Foundation 10408 Montgomery Ave Kensington,MD20895	52-1698505	501(c)(3)	13,400	Event Support\Annual Fundraiser
(33) Latin American Youth Center Inc 1419 Columbia Road NW Washington,DC20009	52-1023074	501(c)(3)	14,000	Event Support\Health Fair
(34) Living Classrooms Foundation 802 S Caroline Street Baltimore,MD21231	52-1369524	501(c)(3)	8,350	Event Support\Annual Fundraiser
(35) Medical Care For Children Partnership Fdn 1616 Anderson Rd McLean,VA22102	26-1756738	501(c)(3)	37,100	General Operating Support
(36) Medical Education Cooperation with Cuba 1814 Franklin 820 Oakland,CA94612	31-1603765	501(c)(3)	10,000	Conference Support
(37) Miriam's Kitchen 2401 Virginia Ave NW Washington,DC20037	52-1331552	501(c)(3)	8,500	General Operating Support
(38) National Urban League Inc 120 Wall St 8th Fl New York,NY10005	13-1840489	501(c)(3)	35,000	Conference Support
(39) NCS Systems Inc 3650 Camden Street SE Washington,DC20020	37-3600322	501(c)(3)	6,000	Event Support\Health Fair
(40) Network For Developing Conscious Comm 28 46th Place NE Washington,DC20019	46-4564310	501(c)(3)	7,125	Conference Support
(41) Northern Virginia Family Service 10455 White Granite 100 Oakton,VA22124	54-0791977	501(c)(3)	6,500	Event Support\Dinner
(42) NOVA Scripts Central Inc 6400 Arlington 120 Falls Church,VA22042	65-1275162	501(c)(3)	89,959	Event Support\Annual Fundraiser
(43) Playworks Education Energized 600 Pennsylvania SE Washington,DC20003	94-3251867	501(c)(3)	25,000	General Operating Support
(44) Roberta's House Inc 2510 St Paul Street Baltimore,MD21218	26-0517415	501(c)(3)	8,500	General Operating Support
(45) Saving Promise 641 S St NW 3rd Fl Washington,DC20001	80-0359858	501(c)(3)	8,500	General Operating Support
(46) Seabury Resources For Aging 6031 Kansas Avenue NW Washington,DC20011	53-0204693	501(c)(3)	8,500	General Operating Support
(47) Shepherd's Center Of Oakton-Vienna 541 Marshall Rd SW Vienna,VA22180	54-1882048	501(c)(3)	50,000	General Operating Support
(48) St Agnes Hospital Foundation Inc 900 S Caton Ave Baltimore,MD21229	52-1415083	501(c)(3)	6,680	Event Support\Dinner
(49) Suburban Hospital Foundation Inc 8600 Old Georgetown Road Bethesda,MD20814	52-2019696	501(c)(3)	8,000	Event Support\Annual Fundraiser
(50) The Bon Secours of Maryland Foundation 26 North Fulton Avenue Baltimore,MD21223	52-1732800	501(c)(3)	50,000	General Operating Support
(51) The HSC Foundation Inc 2013 H St 300 Washington,DC20006	52-1346603	501(c)(3)	5,500	Event Support\Annual Fundraiser
(52) The Skillsource Group Inc 8300 Boone 450 Vienna,VA22182	30-0129320	501(c)(3)	26,460	Event Support
(53) Trinity College 125 Michigan Avenue NE Washington,DC20017	53-0196640	501(c)(3)	85,000	General Operating Support
(54) United Charitable Programs 8201 Greensboro 702 Tysons,VA22102	20-4286082	501(c)(3)	9,900	Conference Support
(55) United Negro College Fund Inc 1805 7th Ave NW Washington,DC20001	13-1624241	501(c)(3)	10,500	Event Support\Annual Fundraiser
(56) United Way of Central Maryland Inc 100 S Charles St 5th Fl Baltimore,MD21201	52-0591543	501(c)(3)	6,673	Event Support\Dinner
(57) Virginia Hospital Center Foundation 1701 N George Mason Dr Arlington,VT22205	20-4129901	501(c)(3)	9,250	Event Support\Annual Fundraiser
(58) Washington Area Women's Foundation Inc 1331 H St NW Washington,DC20005	52-2028612	501(c)(3)	15,000	Event Support\Luncheon
(59) Washington Ctr For Internships And Acad 1333 16th Street NW Washington,DC20036	52-1019820	501(c)(3)	25,000	Conference Support
(60) Washington Dc Metro Hbcu Alumni Alliance PO Box 9833 Washington,DC20016	36-4734475	501(c)(3)	9,550	Event Support\Health Fair
(61) Washington Regional Assn of Grantmakers 12320 Parklawn Dr Rockville,MD20852	52-1756853	501(c)(3)	11,500	Conference Support
(62) Wide Angle Youth Media Inc 2601 N Howard Ste 160 Baltimore,MD21218	52-2276602	501(c)(3)	6,984	Event Support\Annual Fundraiser
(63) Youth Advocate Programs Inc 2007 N Third St Harrisburg,PA17102	23-1977514	501(c)(3)	7,000	Event Support\Annual Fundraiser
(64) Youth ALIVE 3300 Elm Street Oakland,CA94609	94-3143254	501(c)(3)	9,410	Conference Support

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
PROCEDURES FOR MONITORING THE USE OF GRANTS	Grantees are required to sign a memorandum of understanding with Health plan prior to grant funds dispersal. grantees are required to submit a final report which delineates accomplishments, relates to stated objectives, and describes the evaluation method used to assess accomplishments.

Schedule I (Form 990) 2019

Additional Data

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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

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

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Yes

Were any amounts reported on 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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

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 on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Gregory Adams EVP, Group President	(i) (ii)	0 ------------- 895,570	0 ------------- 1,220,621	0 ------------- 341,459	0 ------------- 661,797	0 ------------- 26,228	0 ------------- 3,145,675	0 ------------- 0
2Ramon F Baez Director	(i) (ii)	0 ------------- 141,676	0 ------------- 0	0 ------------- 10,915	0 ------------- 0	0 ------------- 0	0 ------------- 152,591	0 ------------- 0
3Regina M Benjamin Director	(i) (ii)	0 ------------- 189,500	0 ------------- 0	0 ------------- 7,678	0 ------------- 0	0 ------------- 0	0 ------------- 197,178	0 ------------- 0
4Karen Elizabeth Blair VP, PR, Comm & Brand Mgmt	(i) (ii)	0 ------------- 202,473	0 ------------- 116,596	0 ------------- 35,690	0 ------------- 82,370	0 ------------- 19,113	0 ------------- 456,242	0 ------------- 0
5Maryann Bodayle Assistant Secretary	(i) (ii)	0 ------------- 149,101	0 ------------- 14,912	0 ------------- 2,238	0 ------------- 24,809	0 ------------- 8,720	0 ------------- 199,780	0 ------------- 0
6Ruben Burnett VP, Natl Consultant Relations	(i) (ii)	0 ------------- 239,746	0 ------------- 140,889	0 ------------- 25,927	0 ------------- 77,711	0 ------------- 13,794	0 ------------- 498,067	0 ------------- 0
7Joseph Butz VP & COO - MAS	(i) (ii)	0 ------------- 333,394	0 ------------- 419,984	0 ------------- 147,347	0 ------------- 121,280	0 ------------- 17,493	0 ------------- 1,039,498	0 ------------- 0
8Thomas W Chapman Director	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 513,713	0 ------------- 0	0 ------------- 0	0 ------------- 513,713	0 ------------- 448,199
9Jeffrey E Epstein Director	(i) (ii)	0 ------------- 199,500	0 ------------- 0	0 ------------- 7,371	0 ------------- 0	0 ------------- 0	0 ------------- 206,871	0 ------------- 0
10Daniel Garcia SVP, CHief Compliance Officer	(i) (ii)	0 ------------- 274,311	0 ------------- 828,960	0 ------------- 34,324	0 ------------- -13,502	0 ------------- 15,672	0 ------------- 1,139,765	0 ------------- 0
11Joan L Gelrud VP, Quality - MAS	(i) (ii)	0 ------------- 248,581	0 ------------- 80,200	0 ------------- 51,148	0 ------------- 69,213	0 ------------- 65,982	0 ------------- 515,124	0 ------------- 0
12J Eugene Grisby III Director	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 27,039	0 ------------- 0	0 ------------- 0	0 ------------- 27,039	0 ------------- 27,039
13George Halvorson Director	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 37,258	0 ------------- 4,120	0 ------------- 0	0 ------------- 41,378	0 ------------- 17,548
14Leslie S Heisz Director	(i) (ii)	0 ------------- 199,500	0 ------------- 0	0 ------------- 15,618	0 ------------- 0	0 ------------- 0	0 ------------- 215,118	0 ------------- 0
15David Hoffmeister Director	(i) (ii)	0 ------------- 214,500	0 ------------- 0	0 ------------- 11,309	0 ------------- 0	0 ------------- 0	0 ------------- 225,809	0 ------------- 0
16Kimberly Horn Regional President - MAS	(i) (ii)	0 ------------- 543,275	0 ------------- 719,347	0 ------------- 25,420	0 ------------- 588,494	0 ------------- 28,803	0 ------------- 1,905,339	0 ------------- 0
17Judith A Johansen JD Director	(i) (ii)	0 ------------- 227,000	0 ------------- 0	0 ------------- 13,707	0 ------------- 0	0 ------------- 0	0 ------------- 240,707	0 ------------- 0
18Kim J Kaiser Director	(i) (ii)	0 ------------- 204,500	0 ------------- 0	0 ------------- 12,047	0 ------------- 0	0 ------------- 0	0 ------------- 216,547	0 ------------- 0
19Marilyn Kawamura Region President - MAS	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 190,164	0 ------------- 0	0 ------------- 0	0 ------------- 190,164	0 ------------- 183,696
20Jon Kunkle VP, CFO - Mid-Atlantic States	(i) (ii)	0 ------------- 303,249	0 ------------- 250,000	0 ------------- 14,895	0 ------------- 125,076	0 ------------- 21,756	0 ------------- 714,976	0 ------------- 0
21Kathryn Lancaster EVP & CFO	(i) (ii)	0 ------------- 823,192	0 ------------- 1,486,990	0 ------------- 371,044	0 ------------- 570,456	0 ------------- 18,145	0 ------------- 3,269,827	0 ------------- 15,594
22Linda S Larch Reg Compliance Officer - MAS	(i) (ii)	0 ------------- 180,662	0 ------------- 25,176	0 ------------- 108,372	0 ------------- 68,589	0 ------------- 11,684	0 ------------- 394,483	0 ------------- 0
23Philip A Marineau Director	(i) (ii)	0 ------------- 222,000	0 ------------- 0	0 ------------- 7,371	0 ------------- 0	0 ------------- 0	0 ------------- 229,371	0 ------------- 0
24Thomas Meier SVP, Corporate Treasurer	(i) (ii)	0 ------------- 382,345	0 ------------- 523,823	0 ------------- 144,650	0 ------------- 111,392	0 ------------- 27,372	0 ------------- 1,189,582	0 ------------- 42,160
25Donald Orndoff SVP, NFS	(i) (ii)	0 ------------- 418,115	0 ------------- 491,764	0 ------------- 25,961	0 ------------- 185,822	0 ------------- 30,493	0 ------------- 1,152,155	0 ------------- 0
26Edward Pei Director	(i) (ii)	0 ------------- 214,000	0 ------------- 0	0 ------------- 12,739	0 ------------- 18,000	0 ------------- 0	0 ------------- 244,739	0 ------------- 0
27Margaret E Porfido JD Director	(i) (ii)	0 ------------- 229,500	0 ------------- 0	0 ------------- 17,858	0 ------------- 0	0 ------------- 0	0 ------------- 247,358	0 ------------- 0
28J Neal Purcell Director	(i) (ii)	0 ------------- 11,000	0 ------------- 0	0 ------------- 35,000	0 ------------- 0	0 ------------- 0	0 ------------- 46,000	0 ------------- 18,192
29Rochelle Roth Assistant Secretary	(i) (ii)	0 ------------- 178,161	0 ------------- 71,788	0 ------------- 24,645	0 ------------- 99,908	0 ------------- 17,958	0 ------------- 392,460	0 ------------- 0
30Mark Ruszczyk VP, MSBD - MAS	(i) (ii)	0 ------------- 268,600	0 ------------- 218,967	0 ------------- 16,190	0 ------------- 86,716	0 ------------- 61,216	0 ------------- 651,689	0 ------------- 0
31Jacqueline Sellers Assistant Secretary	(i) (ii)	0 ------------- 195,357	0 ------------- 60,644	0 ------------- 9,121	0 ------------- 75,309	0 ------------- 12,779	0 ------------- 353,210	0 ------------- 0
32Richard Shannon MD Director	(i) (ii)	0 ------------- 212,000	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 212,000	0 ------------- 0
33Arthur Southam EVP, Health Plan Operations	(i) (ii)	0 ------------- 851,992	0 ------------- 1,521,837	0 ------------- 401,806	0 ------------- 438,204	0 ------------- 26,212	0 ------------- 3,240,051	0 ------------- 7,159
34Susan Spurlark Assistant Secretary	(i) (ii)	0 ------------- 248,808	0 ------------- 152,829	0 ------------- 237,722	0 ------------- 95,773	0 ------------- 15,253	0 ------------- 750,385	0 ------------- 172,401
35Deborah Stokes SVP,Corporate Controller & CAO	(i) (ii)	0 ------------- 42,705	0 ------------- 395,366	0 ------------- 65,873	0 ------------- 2,147	0 ------------- 1,773	0 ------------- 507,864	0 ------------- 0
36Cynthia A Telles PHD Director	(i) (ii)	0 ------------- 212,500	0 ------------- 0	0 ------------- 11,309	0 ------------- 0	0 ------------- 0	0 ------------- 223,809	0 ------------- 0
37Frank Titus VP, HPSA - MAS	(i) (ii)	0 ------------- 253,243	0 ------------- 214,828	0 ------------- 33,878	0 ------------- 108,080	0 ------------- 23,434	0 ------------- 633,463	0 ------------- 0
38Bernard Tyson Chairman & CEO	(i) (ii)	0 ------------- 1,274,847	0 ------------- 6,056,494	0 ------------- 1,198,157	0 ------------- 686,080	0 ------------- 34,105	0 ------------- 9,249,683	0 ------------- 0
39Alfonse Upshaw SVP,Corporate Controller & CAO	(i) (ii)	0 ------------- 330,597	0 ------------- 250,737	0 ------------- 35,278	0 ------------- 83,390	0 ------------- 24,924	0 ------------- 724,926	0 ------------- 0
40Heidi S Veltman VP, Delivery System Opns-NOVA	(i) (ii)	0 ------------- 235,086	0 ------------- 48,704	0 ------------- 16,262	0 ------------- 151,670	0 ------------- 22,823	0 ------------- 474,545	0 ------------- 0
41Eugene Washington Director	(i) (ii)	0 ------------- 186,176	0 ------------- 0	0 ------------- 450	0 ------------- 0	0 ------------- 0	0 ------------- 186,626	0 ------------- 0
42Delinda Hastie Washington VP, HR - MAS	(i) (ii)	0 ------------- 216,942	0 ------------- 106,159	0 ------------- 33,202	0 ------------- 71,238	0 ------------- 22,093	0 ------------- 449,634	0 ------------- 0
43Hong-Sze Yu Assistant Secretary	(i) (ii)	0 ------------- 219,652	0 ------------- 68,784	0 ------------- 15,909	0 ------------- 104,663	0 ------------- 22,269	0 ------------- 431,277	0 ------------- 0
44Victoria Zatkin VP, Off of Brd & Corp Gov Svcs	(i) (ii)	0 ------------- 25,068	0 ------------- 99,763	0 ------------- 91,952	0 ------------- 1,394	0 ------------- 334	0 ------------- 218,511	0 ------------- 85,158
45Mark Zemelman SVP, General Counsel & Secy	(i) (ii)	0 ------------- 547,086	0 ------------- 839,524	0 ------------- 243,563	0 ------------- 339,949	0 ------------- 30,025	0 ------------- 2,000,147	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE J, PART I, LINE 3	- METHODS USED TO ESTABLISH COMPENSATION OF CEO/EXECUTIVE DIRECTOR - THE FILING ORGANIZATION RELIED ON A RELATED ORGANIZATION 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 OF A RELATED ORGANIZATION.
SCHEDULE J, PART I, LINE 4b	- SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENT - Gregory Adams $ 292,234 Marilyn Kawamura 183,696 Kathryn Lancaster 322,425 Thomas Meier 105,522 Arthur Southam 352,920 Susan Spurlark 211,428 Deborah Stokes 59,716 Bernard Tyson 815,201 Victoria Zatkin 85,158 Mark Zemelman 197,189 SOME OF THE PARTICIPANTS LISTED IN SCHEDULE J, PART II PARTICIPATED IN NONQUALIFIED SUPPLEMENTAL RETIREMENT PLANS. UNDER THESE PLANS, THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS TO A NOTIONAL ACCOUNT ON BEHALF OF EACH PARTICIPANT. CONTRIBUTIONS VARY BY POSITION, LEVEL AND PAY, AND VEST OVER TIME BASED ON AGE AND/OR SERVICE. PARTICIPANT ACCOUNTS ARE CREDITED WITH A FIXED RATE OF INTEREST, INVESTED IN AVAILABLE MUTUAL FUNDS OR A COMBINATION OF BOTH. CERTAIN OFFICERS ACCRUE A BENEFIT THAT VESTS BASED ON AGE AND SERVICE AND TARGETS A PERCENTAGE OF FINAL AVERAGE PAY LESS PRIOR PLAN OFFSETS. UNVESTED AMOUNTS ARE SUBJECT TO RISK OF FORFEITURE. PAY LESS PRIOR PLAN OFFSETS.
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, COLUMN C	THE ACTUARIAL VALUE FOR SOME INDIVIDUALS' DEFINED BENEFIT PLAN DECLINED IN 2016, RESULTING IN NEGATIVE VALUES IN COLUMN (C) IN SOME INSTANCES.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC

Employer identification number

52-0954463

Return Reference	Explanation
Form 990, Heading, Item B, Amended Return	Revision of deferred compensation in Part VII and Schedule J for one officer/director. Form 990, Part VI, Line 4 - Significant Changes to Governing Documents - The Bylaws of the Corporation were amended in 2016 with the following significant changes: On March 3, 2016: The Independent Director definition was removed and noted as being defined in the Corporate Governance Guidelines. Article D, Directors, Section D-2 was amended to change the number and description of inside Directors. Article D, Directors, Section D-4 was amended to modify the term and retirement age for Directors. Article F, Committees, Section F-4, Executive Committee, was amended to change the Committee composition and remove tax exemption and executive selection, performance appraisal, and succession duties.
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. PRIOR TO FINALIZATION, THE RETURN IS REVIEWED BY AN EXTERNAL TAX ADVISOR. 3. 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. 4. 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 $(42,241,291) OTHER THAN TEMPORARY IMPAIRMENTS (1,225,347) GAIN ON SALE OF INVESTMENTS - TAX (291,960) GAIN ON SALE OF INVESTMENTS - BOOK 724,572 ------------ TOTAL $ (43,034,026)
FORM 990, PART III, LINE 4A-4D	2016 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 2016, Mid-Atlantic Health Plan served over 665,000 members and expended approximately $110 million (at cost, net of $246 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 2016, Mid-Atlantic Health Plan expended approximately $97 million (at cost, net of $246 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 2016, Mid-Atlantic Health Plan spent approximately $65.5 million (at cost, net of $52 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 2016, KFHP-MAS provided $44.5 million (at cost, net of $0 of related revenues) 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 KPs high medical expense criteria. In Maryland, Virginia, and Washington D.C., the MFA programs eligibility criteria allows patients falling at or below 300% of the Federal Poverty Guidelines (FPG) to receive full (100%) write off of patient out-of-pocket costs. In 2016, the MFA program assisted over 30,000 qualifying applicants in Maryland, Virginia, and the District of Columbia. This population received full or partial forgiveness for nearly 546,000 outpatient visits and approximately 290,000 prescriptions. A.1.1.1. Community Medical Financial Assistance (CMFA) The MFA program also includes support for community based initiatives, known as Community Medical Financial Assistance (CMFA) programs. CMFA programs are designed to broaden access to health care within the community and help KFHP-MAS fulfill its objectives to reduce the financial barriers that limit access to care for qualified low income populations. The CMFA Program sponsored by Kaiser Foundation Health Plan of Mid-Atlantic States, Inc. is called Healthy Outcomes. It is designed to reduce the financial barriers for specific conditions with expensive treatment costs that will exact a higher than normal financial burden on individuals. Eligibility is based on prescribed levels of income and expenses.
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 medical home. During 2016, KFHP-MAS invested approximately $21 million (at cost, net of $52 thousand of related revenues) to support the CHC program. The CHC program include 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 4,900 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 2016. 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 2016. 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 4,400 children were receiving medical care under this program at the end of 2016. A.2. Participation in Medicaid and Other Government-Sponsored Programs Mid-Atlantic Health Plan has a long history of providing access to low- and moderate-income individuals 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, Maryland and the District of Columbia. In 2016, Mid-Atlantic Health Plan provided coverage and services valued at $31.7 million (at cost, net of $246 million of related revenues) for members and nonmembers in programs sponsored by the federal and state governments. As of December 2016, KFHP-MASs membership in Medicaid programs reached close to 67,000. This represents an increase of approximately 27,000 or 67% from year-end 2015. The Affordable Care Act has had a far-reaching impact on the landscape of government-sponsored programs, as these options have become a 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 Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. is a participating fully capitated Managed Care Organization (MCO) in the states of Maryland and Virginia bringing nationally recognized quality, preventive care, and convenience to the states individuals and families enrolled in Medicaid. 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 $581 thousand (at cost, net of $300 thousand of related revenues) to subsidize patient care under this program. Over 1,200 Priority Partners members received care under fee-for-service arrangements. A.3. Care and Coverage Investments in the Community A.3.1. Shepherd Center In 2016, Shepherd Center of Vienna-Oakton received a charitable contribution of $50,000 intended to provide rides to medical/health-related appointments for seniors on fixed incomes who do not have access to economical, reliable transportation. This grant allowed Shepard Center of Vienna-Oakton the opportunity to provide rides for 1,900 low-income seniors in the Vienna-Oakton area to a broad range of medical and health providers. It improves health outcomes and continuity of care for these patients by reducing the risk of having to miss or cancel appointments. A.4. Prior Year Contributions for Care and Coverage In prior years, KFHP-MAS made contributions to donor advised funds under the direction of a foundation operating in the local community. These funds were intended to identify and support nonprofit organizations that meet community needs in the area of care and coverage. In 2016, the following initiatives were funded through disbursements issued by the community foundation based upon recommendations informed by KFHP-MAS's expertise. A.4.1. Holy Cross Health Foundation The Kevin J. Sexton Fund at the Holy Cross Health Foundation, Inc. received $1 million to address the need for additional resources to provide health care to a growing population of vulnerable individuals in Montgomery County, who live in poverty and tend to suffer poor health when lacking healthcare equity. An objective of this this grant is to provide direct financial support to Holy Cross Health's four Health Centers for primary care and behavioral health services, and two centers for obstetrics and gynecology care, for the purpose of serving low income, vulnerable persons. This contribution helped to support the provision of 37,128 patient visits and 10,000 individuals served. In addition, this contribution helped to support the provision of 24 community-based sites hosting 69 ongoing classes, serving an average of 1,213 participants weekly, totaling 122,495 encounters for the year.
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. Research supports the central premise that excellent medical care alone is insufficient to create healthy people in 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. Two of the primary programs supported within the CHI Stream of Work include: Healthy Eating, Active Living (HEAL) and Obesity Prevention Healthy eating, active living has been and continues to be a compelling focus for Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.s work, as obesity continues to be a significant and pervasive public health problem. Despite encouraging signs of obesity rates leveling off in recent years, substantial racial and ethnic disparities continue to exist. Also, through a focus on healthy eating and active living, Mid-Atlantic Health Plan can have a marked impact on a wide range of health conditions including pre-diabetes, diabetes, cardiovascular disease and several cancers that are affected by these behaviors. Finally, a focus on nutrition, physical activity and weight management are highly aligned with Mid-Atlantic Health Plans clinical expertise in this area, including a prevention orientation and a number of existing programs and partnerships. Wherever possible, KFHP-MAS supports a concentration of multiple strategies that enable sustainable change towards healthy eating and active living lifestyles. These include policies and practices to reduce the availability and consumption of sugar-sweetened beverages, encourage the establishment of safe spaces, promote active transportation policies that support equitable public transit, and create connections between health clinics and community resources. Thriving Schools Thriving Schools is an initiative to improve healthy eating, physical activity, and social and emotional wellness in K-12 schools within Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc.s geographic service areas. Thriving Schools efforts focus on policy, systems, and environmental changes that make the healthy choice the easy choice. Interventions aim to create a culture of health on school campuses to spur individual behavior change targeting students, teachers, and staff. The focus of KFHP-MASs initiatives target policy and systems reform to achieve equity in access to various social and environmental determinants of health including quality education, jobs and job readiness, affordable healthy food, safe and attractive outdoor spaces, and social/emotional supports and services across its service areas, with emphasis on the most vulnerable populations. KFHP-MAS made a financial investment of $766 thousand in Community Health Initiatives in 2016. Its deep commitment continued through sharing of technical expertise for capacity building. B.1. CHI Investments in the Community B.1.1. The Bon Secours of Maryland Foundation A grant of $50,000 to The Bon Secours of Maryland foundation in 2016 supported initial planning to develop an implementation plan to serve young adults in five highly-distressed neighborhoods in West Baltimore. This grant funded the drafting of a preliminary implementation plan in collaboration with other community partners, residents, and funders. B.1.2. Playworks DC Playworks DC was able to meet or exceed three program goals as a result of a $25,000 grant received in 2016. Ten 4th and 5th grade Bancroft students were accepted and enrolled in Playworks Junior Coach Leadership Program, equipping them with leadership skills training and mentorship that supports their role as leaders in their community and prepares them for their upcoming middle school transition. Additionally, over 40 teachers were trained on how to incorporate physical activity into their classrooms, and 12 girls had the opportunity to participate in their first ever organized sports team. B.1.3. Schools and Corner Stores DC Central Kitchen received $75,000 in 2016 to partner with schools and corner stores to improve healthy food access at a neighborhood level in Wards 7 and 8 in the District of Columbia. Support from this grant allowed DC Central Kitchen to combat childhood obesity and increase access to healthy food, nutrition education, and physical activity for 5,500 schoolchildren. B.2. Prior Year Contributions for CHI Investments In prior years, KFHP-MAS made contributions to donor advised funds under the direction of a foundation operating in the local community. These funds were intended to identify and support nonprofit organizations that meet community needs in the area of community health initiatives. In 2016, the following initiatives were funded through disbursements issued by the community foundation based upon recommendations informed by KFHP-MAS's expertise. B.2.1. Ready for Work (RfW)/Youth CONNECT Venture Philanthropy Partners (VPP) received one third of a cumulative $1 million grant in 2016 for the Ready to Work initiative to build upon and expand the existing Youth Connect initiative in Prince Georges County. Youth Connect is a VPP project that seeks to increase the number of students graduating from high school with relevant technical and academic skills. The targeted population for RfW are students of three Title I schools in Prince Georges County, Maryland, all of which are characterized by Free and Reduced-Price Meals (FARM) participation rates exceeding 50%. Following the programs fall 2016 launch, 1,100 students participated in at least one service component of the Youth Connect program.
C. Safety Net Partnerships	Kaiser Foundation Health Plan of the 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. KFHP-MAS is dedicated to investing in communities and promoting good health for the communities served. As such, Safety Net Partnership (SNP) initiatives aim to strengthen the system of community clinics, public hospitals, and health departments to promote access to high quality care for the uninsured and underserved vulnerable populations. Mid-Atlantic Health Plan also focuses on improving access to health services and the transformation of care delivery to meet the challenges of the ever evolving performance expectations and revenue design. Efforts to improve access and transform care include work on: increasing access to specialty care services; increasing the utility of health information technology in safety net settings; addressing mental health and wellness, improving population outcomes and eliminating health disparities. KFHP-MAS also supports innovative efforts to bring both health care and support services closer to underserved populations through partnerships with school based health centers and community clinics. Investments in Safety Net Partnerships target the following strategic focus areas: I. Care Delivery Transformation II. Capacity Building III. Clinic-Community Integration IV. Policy, Systems, and Environmental Change V. Create and Spread Knowledge VI. Total Health In 2016, KFHP-MAS spent approximately $296 thousand to support Safety Net Partnerships as access to affordable quality care and health disparities amongst vulnerable populations were identified as significant and pervasive barriers to health in the 2016 Community Health Needs Assessments. The following are examples of initiatives funded in accordance with the objectives of the Safety Net Partnerships Stream of Work during the year: C.1. Safety Net Partnerships (SNP) Investments in the Community C.1.1. Educate Before You Medicate In 2016 NOVA Scripts Central, Inc. received $87,159 for its health literacy program, Educate before You Medicate. This programs goal is to provide 750 patients with ALL PHASE (Aspirin, Lisinopril, and Lipid-lowering medication Preventing Heart Attacks and Strokes Everyday) medications to improve health outcomes, increase medication adherence, and reduce the risk of heart attacks and strokes. Between July and December 2016, the program reached 82 participants at 14 health literacy workshops focusing in large part on chronic health concerns. C.1.2. Catholic Charities Esperanza Center Catholic Charities Esperanza Center received $178,890 to hire a bilingual Nurse Practitioner and a part-time Front Desk Coordinator to help provide diagnostics and laboratory services to uninsured immigrants. Both of these positions are expected to be filled in 2017. C.2. Prior Year Contributions for Safety Net Partnerships In prior years, KFHP-MAS made contributions to donor advised funds under the direction of a foundation operating in our local community. These funds were intended to identify and support nonprofit organizations that meet community needs in the area of safety net partnerships. In 2016, the following initiatives were funded through disbursements issued by the community foundation based upon recommendations informed by KFHP-MAS's expertise. C.2.1. Baltimore A-L-L-PHASE Implementation Mid-Atlantic Association of Community Health Centers Inc. received a contribution of $125,000 to implement the evidence-based A-L-L regimen in 6 Baltimore City Federally Qualified Health Centers (FQHC) and 42 clinic locations. The FQHCs and clinics were selected where there is a significant prevalence of cardiovascular disease. Through this funding, the program was able to enroll 10,448 patients in 2016. 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 $3.1 million in 2016 to support programs and services associated with the development and dissemination of knowledge. D.1. Medical Research Programs As the largest nonprofit integrated health system in the United States, Kaiser Permanente has a long history of conducting health research related to both prevention and treatment of disease that benefits both Kaiser Foundation Health Plan, Inc. members and the communities that are served. Mid-Atlantic States Health Plans research efforts are core to the collective organizations mission to improve population health, and promote continued learning. Researchers study critical health issues including: cancer, cardiovascular conditions, diabetes, behavioral and mental health, and health care delivery improvement while remaining broadly centered upon the following three themes: - Understanding health risks; - Addressing patients needs and improving health outcomes; and - Informing policy and practice to facilitate the use of evidence-based care. Kaiser Permanente is uniquely positioned to do research due to its rich, longitudinal, electronic clinical databases that capture virtually complete health care delivery, payment, decision-making and behavioral data in detail to support primary, secondary and tertiary clinical care across inpatient, outpatient and emergency department settings for more than 10 million geographically and demographically diverse members. D.1.1. National Research Program The Mid-Atlantic Permanente Research Institute (MAPRI) is one of seven regional centers overseen and administered by the Kaiser Foundation Research Institute (KFRI) and three national research infrastructure support centers. Research projects conducted by this collaborative team have yielded findings that affect not only the practice of medicine within the area served by KFHP-MAS, but also for society-at-large. The following are descriptions of the entities providing support at the national level. D.1.1.1. Kaiser Foundation Research Institute (KFRI) The Kaiser Foundation Research Institute (KFRI) is a national program established in 1958 to administer and support research at Kaiser Permanente. KFRIs responsibilities include: overseeing and maintaining Kaiser Permanente's relationship with federal granting agencies, providing contract negotiation services for all regional centers, promoting responsible research conduct; and partnering with clinical trials stakeholders across Kaiser Permanente to ensure quality and compliance through the clinical trials program. D.1.1.2. The Center for Effectiveness and Safety Research (CESR) The Center for Effectiveness & Safety Research enhances opportunities to answer questions about which interventions work best for whom across all of KPs regional centers by investing in the ongoing development of a common data model, convening researchers and organizational leaders at an annual meeting and via webinars, and by conducting research. The center routinely partners with investigators in KPs regional research centers and with selected operational analytical groups. D.1.1.3. The Utility for Care Data Analysis (UCDA) The Utility for Care Data Analysis (UCDA) was created to ensure that analysts and researchers throughout Kaiser Permanente are able to fully realize the analytical potential of Kaiser Permanentes enterprise-wide information systems. This allows experts to compile and compare clinical and utilization data from across Kaiser Permanente in order to assess patterns in health, health care delivery, and clinical quality. UCDA has developed tools for using geographic information systems and providing analytic support for Community Benefit, including the Community Health Needs Assessments.
D.1.1.4. The Kaiser Permanente Research Bank	The Kaiser Permanente Research Bank is a research resource designed to help the organization better understand how peoples health is affected by their genes, behaviors and the environment. It allows researchers to use DNA and other health information voluntarily provided by a diverse cross-section of KP members to study how genetic and environmental factors affect health, and look for new ways to diagnose, treat and prevent certain diseases. KP has set a goal to collect data from a total of 500,000 participants from all seven regional centers, which would make it one of the worlds largest and most diverse repositories of genetic, environmental and health data. To date, more than 250,000 members from four geographic regions have participated in bio-banking efforts. 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 Mid-Atlantic Permanente Research Institute (MAPRI) was established in 2000 and is the research core for Mid-Atlantic Permanente Medical Group, PC, in collaboration with Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. The institutes 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. The institutes primary research continues to be patient-focused, with major areas of study in infectious diseases, cardiovascular and metabolic research, oncology, and health informatics, as well as clinical trials. Mid-Atlantic Health Plan provided approximately $2.3 million for medical research projects in 2016. Key Statistics: - Number of investigators: 5 - Number of support staff: 26 - Number of research papers published in journals in 2016: 23 - Number of clinical trials in 2016: 15 - Number of active studies (clinical and non-clinical trials) in 2016: 96 Top Research Areas: - Economic Impact of Health Care - Epidemiology - Health Services and Disparities - Health Information Technology - Infectious Diseases with special emphasis on HIV, Hepatitis, and Sexually Transmitted diseases - Oncology - Metabolic and Cardiovascular Diseases 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 2016: D.1.2.2.1. HIV Quality Improvement and Performance Program Research Area: Health Care Delivery and Comparative Health Systems Collaborating Kaiser Permanente sites: Kaiser Permanente Mid-Atlantic in collaboration with all Kaiser Permanente regions. This study is focused on determining quantitative measures of HIV care and outcomes in Kaiser Permanente. Researchers are initiating 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 Plans D.2. Educational Theatre Programs (ETP) Confronted with an urgent need for preventive health information in the communities we serve, the Educational Theatre Program (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 2016, Mid-Atlantic Health Plan spent over $768 thousand on this program. In 2016, ETP performed approximately 125 times for over 25,000 children and adults at schools and other locations. In 2016, guided by our recent Community Health Needs Assessments, ETP was reshaped to respond to identified priority needs, specifically economic insecurity, and mental and behavioral health. Building on years of experience working in schools and community settings, the program has evolved to offer longer-form programming that engages fewer schools and students, with more depth. The integration of arts has long been recognized by educators as a powerful way to connect individuals, heal communities, and raise awareness of public health issues. Arts Integrated Resources (AIR) integrates the arts with multi-media technology and public health knowledge to improve community health. All programs and services provided by AIR are rooted in the philosophy and best practices of Positive Youth Development (PYD), a strength-based approach that sees all people as bearers of solutions rather than problems to be fixed. D.3. Health Professional Training Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. invested $90 thousand to provide community-based programs and services to low-income residents and students through learning centers and youth employment programs. In 2016, KFHP-MAS supported three community-based programs to advance education and economic opportunity for the next generation. Programs included Light City Teen Scholars Program, Marion S. Barry Summer Youth Employment Program and YearUP. E. Other Community Benefit Investments During 2016, Mid-Atlantic Health Plan spent approximately $7.7 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 2016 was the eighth year of the Community Ambassador program, which grew from two nurse practitioners (NPs) and one physician assistant to a total of 24 NPs and physician assistants placed in 10 safety net clinics in Washington DC, suburban Maryland, Northern Virginia and Baltimore. 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. In 2016, 43,339 people were able to have access to this program through an investment of $4.2 million. E.2. West Baltimore Community Park KFHP-MAS partnered with the people of West Baltimore to transform and reopen their community park. In partnership with local nonprofit Park Heights Renaissance and community members, Kaiser Permanente provided funding and support to clear overgrown plants, repair playground equipment, resurface a half-court for basketball and equip the court with a half-height hoop to emphasize that this is a place for children to be active. E.3. New Beginnings Barbershop Preventative Screenings KFHP-MAS, Mid-Atlantic Permanente Medical Group, P.C. (MAPMG) and New Beginnings Barbershop teamed up to offer free flu immunizations and preventive screenings in a Southwest Baltimore neighborhood. Kaiser Permanente experts - including physicians and nurses - are on site at the barbershop every Friday and Saturday to engage visitors in conversations about health and wellness and offer flu vaccinations and preventive screenings at no cost to participants. The program launched in late 2016.
F. Environmental Stewardship	Poor environmental quality contributes to disease, illness and economic insecurity Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. has therefore committed itself to protecting and improving the natural environment as a key component of our social mission to improve the health of the communities we serve. To fulfill this commitment. To fulfill this commitment, 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 that have been selected based on their ability to have the most impact on the environmental forces that shape environmental and human health: - Addressing causes of climate change - Promoting sustainable farming and food choices - Reducing, reusing, and recycling to eliminate waste - Buying products and materials that do not contain chemicals of concern - 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 communities we serve. F.1. Performance Metrics During 2016, key performance indicators for Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. included: F.1.1. Improved our water use intensity (gallons/rentable square foot) by 5% since our 2013 baseline year. F.1.2. Contracted to purchase approximately 52 million kilowatt-hours of Green-e Certified Renewable Energy Certificates. F.1.3. Responsibly reused or recycled over 2,000 tons of materials. F.1.4. Improved our energy use intensity (kBtu/rentable square foot) by 4% compared to our 2010 baseline year.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC

Employer identification number

52-0954463

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(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	Yes	No
(1)KAISER FOUNDATION HEALTH PLAN INC ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-1340523	HEALTH CARE	CA	501(c)(3)	10	NA		No
(2)KAISER FOUNDATION HOSPITALS ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-1105628	HEALTH CARE	CA	501(c)(3)	3	na		No
(3)KAISER FDN HEALTH PLAN OF COLORADO ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 84-0591617	HEALTH CARE	CO	501(c)(3)	10	KFHP INC	Yes
(4)KAISER FDN HEALTH PLAN OF GEORGIA INC ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 58-1592076	HEALTH CARE	GA	501(c)(3)	10	KFHP INC	Yes
(5)KAISER FDN HEALTH PLAN OF THE NORTHWEST ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 93-0798039	HEALTH CARE	OR	501(c)(3)	10	KFHP INC	Yes
(6)KAISER HEALTH PLAN ASSET MANAGEMENT INC ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-3299124	ASSET MGMT	CA	501(c)(3)	12 - I	KFHP INC	Yes
(7)LOKAHI ASSURANCE LTD ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 91-2171891	WC PLACEMENT	HI	501(c)(3)	12 - I	KFHP INC	Yes
(8)KAISER HOSPITAL ASSET MANAGEMENT INC ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-3299125	ASSET MGMT	CA	501(c)(3)	12 - I	KFH	Yes
(9)CAMP BOWIE SERVICE CENTER ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-3299123	ADMIN	CA	501(c)(3)	12 - I	KFHP INC	Yes
(10)KAISER FDN HEALTH PLAN OF WASHINGTON ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 93-0480268	HEALTH CARE	WA	501(c)(3)	12 - I	KFHP INC	Yes
(11)KAISER HEALTH ALTERNATIVES ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 93-0954562	HEALTH CARE	OR	501(c)(3)	10	KFHP INC	Yes
(12)1800 HARRISON FOUNDATION ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-3317484	FINANCING	CA	501(c)(3)	12 - II	KFHP INC	Yes
(13)KAISER HOSPITAL ASSISTANCE CORPORATION ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 31-1779500	FINANCING	CA	501(c)(3)	12 - I	KFH	Yes
(14)KAISER PERMANENTE SCHOOL OF MEDICINE INC ONE KAISER PLAZA 15L OAKLAND,CA94612 81-4053028	MEDICAL EDUC	CA	501(C)(3)	2	KFH	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) NXT CAP SR FD ILLC 191 N WACKER DR STE 1200 CHICAGO,IL60606 37-1651297	INVESTMENT	DE	NA	N/A

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(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	Yes	No
(1) OAK TREE ASSURANCE LTD ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 03-0329760	INSURANCE	VT	NA	C CORP	0	0	Yes
(2) KAISER PERMANENTE INSURANCE COMPANY ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-3203402	INSURANCE	CA	NA	C CORP	0	0	Yes
(3) KAISER PROPERTIES SERVICES INC ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-3259432	REAL ESTATE	CA	NA	C CORP	0	0	Yes
(4) KAISER PERMANENTE INTERNATIONAL ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 94-3245176	CONSULTING	CA	NA	C CORP	0	0	Yes
(5) KAISER COLORADO HOLDINGS ONE KAISER PLAZA SUITE 15L OAKLAND,CA94612 81-4691154	HEALTH CARE	CO	NA	C CORP	0	0	Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

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 .....................

Yes

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

Yes

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) Kaiser Foundation Health Plan Inc	l	13,550,896	Per Agreement
(2) Kaiser Foundation Health Plan Inc	m	111,980,454	Per Agreement
(3) Kaiser Foundation Health Plan Inc	p	63,316,648	Per Agreement
(4) Kaiser Foundation Health Plan Inc	q	19,433,399	Per Agreement
(5) Kaiser Foundation Health Plan Inc	r	957,141,347	Per Agreement
(6) Kaiser Foundation Health Plan Inc	s	1,189,005,937	Per Agreement
(7) Kaiser Foundation Hospitals	a	9,013,356	Per Agreement
(8) Kaiser Foundation Hospitals	e	30,000,000	Per Agreement
(9) Kaiser Foundation Hospitals	l	690,889	Per Agreement
(10) Kaiser Foundation Hospitals	m	569,658,506	Per Agreement
(11) Kaiser Foundation Hospitals	p	163,377,047	Per Agreement
(12) Kaiser Foundation Hospitals	q	355,306,275	Per Agreement
(13) Camp Bowie Service Center	m	18,413,087	Per Agreement
(14) Camp Bowie Service Center	q	45,605,754	Per Agreement
(15) Kaiser Permanente Insurance Company	m	14,789,185	Per Agreement
(16) Kaiser Permanente Insurance Company	p	694,493	Per Agreement
(17) Lokahi Assurance LTD	l	1,383,791	Per Agreement
(18) Lokahi Assurance LTD	m	22,299,996	Per Agreement
(19) Lokahi Assurance LTD	q	13,387,194	Per Agreement
(20) Lokahi Assurance LTD	r	4,449,000	Per Agreement
(21) Kaiser FDN Health Plan of the Northwest	l	406,436	Per Agreement
(22) Kaiser FDN Health Plan of the Northwest	m	232,142	Per Agreement
(23) Kaiser FDN Health Plan of the Northwest	p	320,501	Per Agreement
(24) Kaiser FDN Health Plan of Colorado	l	569,201	Per Agreement
(25) Kaiser FDN Health Plan of Colorado	m	537,276	Per Agreement
(26) Kaiser FDN Health Plan of Colorado	p	573,408	Per Agreement
(27) Kaiser FDN Health Plan of Georgia Inc	l	1,296,186	Per Agreement
(28) Kaiser FDN Health Plan of Georgia Inc	m	2,688,468	Per Agreement
(29) Kaiser FDN Health Plan of Georgia Inc	p	1,749,903	Per Agreement
(30) Kaiser FDN Health Plan of Georgia Inc	q	1,661,651	Per Agreement
(31) Oak Tree Assurance Ltd	l	78,955	Per Agreement
(32) Oak Tree Assurance Ltd	p	60,866	Per Agreement
(33) Oak Tree Assurance Ltd	q	61,523	Per Agreement

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE HIGH-QUALITY, AFFORDABLE HEALTH CARE SERVICES TO IMPROVE CARE SERVICES TO IMPROVE THE HEALTH OF OUR MEMBERS AND THE COMMUNITIES WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	14
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	13
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	9,087
6	Total number of volunteers (estimate if necessary) .............	6	1,002
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	998,264
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	28,275	0
9	Program service revenue (Part VIII, line 2g) .........	3,076,460,197	3,409,654,462
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,919,874	4,306,127
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	477,400	452,715
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	3,080,885,746	3,414,413,304
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	150,000	1,925,414
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)	678,597,644	738,695,432
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	2,408,979,289	2,666,100,739
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	3,087,726,933	3,406,721,585
19	Revenue less expenses. Subtract line 18 from line 12.......	-6,841,187	7,691,719
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	1,354,374,378	1,382,676,878
21	Total liabilities (Part X, line 26).............	1,485,089,595	1,548,393,010
22	Net assets or fund balances. Subtract line 21 from line 20.....	-130,715,217	-165,716,132

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 2,763,774,239 including grants of $ 0 ) (Revenue $ 3,163,911,477 )
	member health care services and medical training for care improvement Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) provides medical and surgical care, including urgent care services, extended care and home health care, for its members without regards to age, sex, race, religion or national origin or the ability to pay. KFHP of MAS educates and trains medical students and other health care professionals and promotes scientific and nursing education in order to improve care.

4b	(Code: ) (Expenses $ 277,410,326 including grants of $ 0 ) (Revenue $ 245,690,771 )
	MEDICAID AND OTHER GOVERNMENT SPONSORED PROGRAMS Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) is committed to improving medical care for beneficiaries of Medicaid and other government sponsored programs, not only for KFHP-MAS members, but also within the communities we serve. At the end of 2016, close to 67,000 individuals were receiving benefits under KFHP-MASs Medicaid managed care programs in Maryland and Virginia. In addition, KFHP-MAS provided health care on a fee-for-service basis for Medicaid beneficiaries who were not enrolled as KFHP-MAS members.

4c	(Code: ) (Expenses $ 65,551,115 including grants of $ 0 ) (Revenue $ 52,214 )
	CHARITABLE CARE (MEDICAL FINANCIAL ASSISTANCE AND CHARITABLE HEALTH COVERAGE) Kaiser Foundation Health Plan of the Mid-Atlantic States (KFHP-MAS) provides charity care to low-income vulnerable patients through the Medical Financial Assistance (MFA) and Charitable Health Coverage (CHC) Programs. KFHP-MAS offers financial assistance through the MFA program to help families and individuals with a demonstrated financial need pay for all or part of the cost of emergency or medically necessary care provided in Kaiser Permanente facilities and/or by Kaiser Permanente providers. In 2016, this program assisted over 30,000 qualifying applicants. The CHC program offers regular Kaiser Foundation Health Plan membership at minimal cost to low income families who are not eligible for other public or privately sponsored coverage. Approximately 9,400 individuals were receiving comprehensive health care through this program at the end of 2016.

	(Code: ) (Expenses $ 12,784,899 including grants of $ 1,925,414 ) (Revenue $ )
	SEE COMMUNITY BENEFIT REPORT IN SCH O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 12,784,899 including grants of $ 1,925,414 ) (Revenue $ )
4e	Total program service expenses3,119,520,579

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	33,654,775	5,660,601

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		0

		Business Code
2a	MBR HLTH CARE PREM	900099	2,792,533,909	2,792,533,909
b	MEDICARE/MEDICAID	900099	402,099,893	402,099,893
c	SUPPL CHARGE/PHARM	900099	167,289,458	167,018,192	271,266
d	NON-PLAN & IND REV	900099	3,901,135	3,174,137	726,998
e	OTHER PRGM SERVICE	900099	43,830,067	43,830,067
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		3,409,654,462

3 Investment income (including dividends, interest, and othersimilar amounts) ......			4,197,997			4,197,997
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		135,475	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	135,475	6c
d	Net rental income or (loss).......			135,475			135,475
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	199,600	174,788,999	7a
b	Less: cost or other basis and sales expenses	383,430	174,497,039	7b
c	Gain or (loss)	-183,830	291,960	7c
d	Net gain or (loss).........			108,130			108,130
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a	0
b	Less: direct expenses ...		8b	0
c	Net income or (loss) from fundraising events..			0
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a	PARKING REVENUE		812930	317,240			317,240
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			317,240
12	Total revenue. See instructions.....			3,414,413,304	3,408,656,198	998,264	4,758,842

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,925,414	1,925,414
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	526,866,560	485,638,723	41,227,837
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	68,384,880	68,384,880
9	Other employee benefits .......	102,987,123	88,100,958	14,886,165
10	Payroll taxes ...........	40,456,869	40,456,869
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	1,065,555		1,065,555
c	Accounting ...........	1,670,034		1,670,034
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	182,200		182,200
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 ....	10,813,090	413,862	10,399,228
13	Office expenses .......	15,660,504	14,105,714	1,554,790
14	Information technology ......	188,921,131	131,848,102	57,073,029
15	Royalties ..	0
16	Occupancy ...........	31,182,691	31,182,691
17	Travel ............	2,120,014	1,655,588	464,426
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	2,008,686		2,008,686
20	Interest ...........	11,779,645	11,779,645
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	69,644,233	69,644,233
23	Insurance ...	24,560,087	24,523,462	36,625
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	1,059,192,849	1,059,192,849
b	PURCHASED MEDICAL SERVICES	309,182,824	309,182,824
c	SUPPLIES	570,336,652	513,072,259	57,264,393
d	INTER-REGIONAL CHARGES	141,321,897	118,460,935	22,860,962
e	All other expenses	226,458,647	149,951,571	76,507,076
25	Total functional expenses. Add lines 1 through 24e	3,406,721,585	3,119,520,579	287,201,006	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			0	1	0
2	Savings and temporary cash investments .........			44,552,214	2	40,834,573
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			132,305,433	4	154,776,528
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7	0
8	Inventories for sale or use ............			38,581,139	8	38,327,415
9	Prepaid expenses and deferred charges ......			6,546,443	9	5,365,358
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,395,612,399
b	Less: accumulated depreciation	10b	634,101,056	747,149,245	10c	761,511,343
11	Investments—publicly traded securities .			251,412,429	11	254,890,242
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 ...........			133,827,475	15	126,971,419
16	Total assets. Add lines 1 through 15 (must equal line 33)...			1,354,374,378	16	1,382,676,878

17	Accounts payable and accrued expenses .....	227,541,220	17	295,003,175
18	Grants payable ...	0	18	0
19	Deferred revenue .........	21,043,004	19	35,554,659
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	1,236,505,371	25	1,217,835,176
26	Total liabilities. Add lines 17 through 25..	1,485,089,595	26	1,548,393,010

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....	8,301,762	29	8,301,762
30	Paid-in or capital surplus, or land, building or equipment fund ...	0	30	0
31	Retained earnings, endowment, accumulated income, or other funds	-139,016,979	31	-174,017,894
32	Total net assets or fund balances ...........	-130,715,217	32	-165,716,132
33	Total liabilities and net assets/fund balances ........	1,354,374,378	33	1,382,676,878