TY 2021 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/1099-NEC)
(1) Gregory Adams...................................................................... Chairman & CEO	4.0 ................. 46.0		X			13,283,101	2,279,123
(2) Arthur Southam...................................................................... EVP, Health Plan Ops & CGO	3.5 ................. 46.5		X			4,764,836	459,569
(3) Kathryn Lancaster...................................................................... EVP & Chief Financial Officer	3.5 ................. 46.5	X				4,580,354	447,559
(4) Janet Liang...................................................................... EVP, Group President & COO	3.5 ................. 46.5		X			4,004,413	934,930
(5) Kimberly Horn...................................................................... EVP, Group President, MOC	3.5 ................. 46.5	X				3,251,755	1,473,258
(6) Mark Zemelman...................................................................... SVP, General Counsel & Secy	1.0 ................. 49.0		X			2,838,538	134,757
(7) Susan Mullaney...................................................................... Regional President - WA	44.0 ................. 6.0		X			2,047,569	729,785
(8) Thomas Meier...................................................................... SVP, Corporate Treasurer	1.5 ................. 48.5		X			1,461,837	301,391
(9) Karen Schartman...................................................................... VP, CFO & Strategy - WA	50.0 ................. 0.0		X			1,353,303	142,372
(10) Alfonse Upshaw...................................................................... SVP,Corporate Controller & CAO	0.0 ................. 50.0		X			1,150,839	199,363
(11) Donald Orndoff...................................................................... SVP, NFS	3.5 ................. 46.5		X			1,127,680	99,760
(12) Andrew Bindman...................................................................... EVP, Chief Medical Officer	1.0 ................. 49.0	X				749,189	214,664
(13) Kelly Stanford...................................................................... VP, Clin Ops, Mkt Integration	50.0 ................. 0.0			X		643,578	139,023
(14) Kristanne Greco...................................................................... VP, PR, Commns & Brand Mgmt	50.0 ................. 0.0			X		635,073	139,452
(15) Hong-Sze Yu...................................................................... VP, Brd & Corp Gov & Asst Secy	3.0 ................. 47.0		X			541,112	198,385
(16) Joseph Smith...................................................................... VP, MSBD	50.0 ................. 0.0		X			524,121	214,778
(17) Ryan Jenson...................................................................... Interim Corp Controller & CAO	0.0 ................. 50.0				X	606,694	125,965

(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/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(18) Alicia Eng........................................................................ VP, Clinical Operations	50.0 .......................0.0				X		0	601,781	129,030
(19) Jennifer Graves........................................................................ VP, Quality, Safety & Rgnl CNE	50.0 .......................0.0				X		0	594,143	130,675
(20) Janet O'Hollaren........................................................................ VP, COO	50.0 .......................0.0			X			0	680,611	28,204
(21) Pamela Warren........................................................................ VP, HPSA - WA	50.0 .......................0.0		X				0	519,566	133,299
(22) Elizabeth Fleming........................................................................ VP, Innovation & New Bus Dev't	50.0 .......................0.0				X		0	523,133	121,617
(23) Laurie Guariglia........................................................................ VP, Information Officer-CDTS	50.0 .......................0.0		X				0	453,010	177,084
(24) Shawna Sweeney........................................................................ Assistant Secretary	50.0 .......................0.0		X				0	464,570	121,818
(25) Todd Hesse........................................................................ VP, MSBD	50.0 .......................0.0		X				62,270	305,420	181,993
(26) Ann Allen........................................................................ VP, COO	50.0 .......................0.0			X			0	318,448	49,985
(27) Maryann Bodayle........................................................................ Assistant Secretary	1.0 .......................49.0		X				0	191,010	55,200
(28) Ramon F Baez........................................................................ Director	1.0 .......................3.77	X					14,500	222,759	-12,291
(29) Margaret E Porfido JD........................................................................ Director	0.25 .......................2.75	X					14,500	264,577	-62,832
(30) Judith A Johansen JD........................................................................ Director	1.0 .......................8.5	X					8,500	268,970	-61,490
(31) Sarah Yates........................................................................ Assistant Secretary	0.0 .......................0.0					X	0	183,780	6,327
(32) Alacia Broussard........................................................................ VP, Contracting Strategy	50.0 .......................0.0			X			0	53,371	13,714
(33) Kim J Kaiser........................................................................ Director	0.5 .......................0.0	X					28,504	10,900	0
(34) Constance W Rice........................................................................ Director	4.0 .......................0.0	X					21,055	0	0
(35) Michael D Wilson........................................................................ Director	1.25 .......................0.0	X					21,055	0	0
(36) Ruta E Fanning........................................................................ Director	1.0 .......................0.0	X					14,500	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
WASHINGTON PERMANENTE MEDICAL GROUP, 1300 SW 27TH ST RENTON,WA98057	MEDICAL SERVICES	507,957,908
OVERLAKE HOSPITAL MEDICAL CENTER, 1035 116TH AVE NE BELLEVUE,WA98004	MEDICAL SERVICES	106,263,319
ST JOSEPH MEDICAL CENTER, 1717 S J ST TACOMA,WA98405	MEDICAL SERVICES	94,958,184
PEACEHEALTH MEDICAL GROUP, 2901 SQUALICUM PARKWAY BELLINGHAM,WA98225	MEDICAL SERVICES	79,996,172
MULTICARE HEALTH SYSTEM, PO BOX 5299 TACOMA,WA98415	MEDICAL SERVICES	78,615,920
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 688

- TIN:

SCHEDULE A
(Form 990)

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.
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Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public
Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

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).)

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 33 1/3% 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 33 1/3% 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 on 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(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 5 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 2021 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2020 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2021. 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—2020. 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—2021. 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—2020. 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) 2021

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) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2017	(b) 2018	(c) 2019	(d) 2020	(e) 2021	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First 5 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 2021 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2020 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2021 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2020 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2021. 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—2020. 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) 2021

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, 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 lines 3b and 3c 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 box 12a or 12b in Part I, answer lines 4b and 4c 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 lines 5b and 5c 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) .

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

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 on 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 on 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) 2021

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 on lines 11b and 11c below, the governing body of a supported organization?

11a

A family member of a person described on 11a above?

11b

A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the officers, 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 line 2 above, 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 lines 2a and 2b 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 on line 2a, above 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 lines 3a and 3b 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?If "Yes" or "No", 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) 2021

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 0.015 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 0.035	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) 2021

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	1
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity	2
3 Administrative expenses paid to accomplish exempt purposes of supported organizations	3
4 Amounts paid to acquire exempt-use assets	4
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI)	5
6 Other distributions (describe in Part VI). See instructions	6
7Total annual distributions. Add lines 1 through 6.	7
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions	8
9 Distributable amount for 2021 from Section C, line 6	9
10 Line 8 amount divided by Line 9 amount	10

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2021	(iii) Distributable Amount for 2021
1 Distributable amount for 2021 from Section C, line 6
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2021:
a From 2016.......
b From 2017.......
c From 2018.......
d From 2019.......
e From 2020.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2021 distributable amount
i Carryover from 2016 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
4Distributions for 2021 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2021 distributable amount
c Remainder. Subtract lines 4a and 4b from line 4.
5 Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2017.....
b Excess from 2018.....
c Excess from 2019.....
d Excess from 2020.....
e Excess from 2021.....

Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

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

OMB No. 1545-0047

2021

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990) (2021)

Schedule B (Form 990) (2021) Page 2

Name of organization KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 3

Name of organization KAISER FOUNDATION HEALTH PLAN OF WASHINGTON		Employer identification number 91-0511770

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990) (2021)

Schedule B (Form 990) (2021)

Page 4


Name of organization KAISER FOUNDATION HEALTH PLAN OF WASHINGTON			Employer identification number 91-0511770
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990) (2021)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990)

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

2021

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 WASHINGTON

Employer identification number

91-0511770

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.

Cat. No. 50084S

Schedule C (Form 990) 2021

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) 2018	(b) 2019	(c) 2020	(d) 2021	(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) 2021

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

65,043

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

Yes

138,945

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

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

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

203,988

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, KAISER FOUNDATION HEALTH PLAN OF WASHINGTON (KFHP WA), IS A MEMBER OF THE KAISER PERMANENTE MEDICAL CARE PROGRAM (KP) 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), KFHP WA HAS A POLICY PROHIBITING ANY OF KFHP WA'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. KFHP WA 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. KFHP WA EMPLOYS INDIVIDUALS, INCLUDING ONE OR MORE REGISTERED LOBBYISTS AND/OR MAY RETAIN ONE OR MORE PROFESSIONAL CONSULTANTS TO REPRESENT KFHP WA'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 KFHP WA'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 KP, 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 KFHP WA 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 KFHP WA. INDIVIDUALS APPEARING AT SUCH HEARINGS AND MEETINGS FOR AND ON BEHALF OF KFHP WA OFTEN ARE REPRESENTING THE INTERESTS OF COMMON INTEREST GROUPS AS WELL AS THE INTERESTS OF THE MEMBERS AND PATIENTS OF KFHP WA. 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, KAISER FOUNDATION HEALTH PLAN OF WASHINGTON (KFHP WA), IS A MEMBER OF THE KAISER PERMANENTE MEDICAL CARE PROGRAM (KP) 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), KFHP WA HAS A POLICY PROHIBITING ANY OF KFHP WA'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. KFHP WA 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. KFHP WA EMPLOYS INDIVIDUALS, INCLUDING ONE OR MORE REGISTERED LOBBYISTS AND/OR MAY RETAIN ONE OR MORE PROFESSIONAL CONSULTANTS TO REPRESENT KFHP WA'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 KFHP WA'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 KP, 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 KFHP WA 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 KFHP WA. INDIVIDUALS APPEARING AT SUCH HEARINGS AND MEETINGS FOR AND ON BEHALF OF KFHP WA OFTEN ARE REPRESENTING THE INTERESTS OF COMMON INTEREST GROUPS AS WELL AS THE INTERESTS OF THE MEMBERS AND PATIENTS OF KFHP WA. 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) 2021

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

2021

Open to Public Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

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) 2021

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 .....	252,741,800		252,741,800
b	Buildings ....	703,256,036	138,954,216	564,301,820
c	Leasehold improvements	52,120,234	19,409,725	32,710,509
d	Equipment ....	230,764,972	144,267,523	86,497,449
e	Other .....	70,436,217	47,220,921	23,215,296
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				959,466,874

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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)DUE FROM AFFILIATES				66,621,147
(2)OPERATING LEASE ROU ASSETS				40,450,729
(3)BROKER RECEIVABLE				48,229
(4)EQUITY IN SUBS				123,249,900
(5)OTHER CURRENT ASSETS				5,383,507
(6)OTHER LONG-TERM ASSETS				39,962
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				235,793,474

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
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	935,703,059
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) 2021

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) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE F(Form 990)

Department of the Treasury
Internal Revenue Service

Statement of Activities Outside the United States

Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. Right pointing arrow large image

Attach to Form 990. Right pointing arrow large image

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization
KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

Part I

General Information on Activities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 14b.

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and

other assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used

to award the grants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other assistance outside the United States.

Activites per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

(a) Region		(b) Number of offices in the region	(c) Number of employees, agents, and independent contractors in the region	(d) Activities conducted in region (by type) (such as, fundraising, program services, investments, grants to recipients located in the region)	(e) If activity listed in (d) is a program service, describe specific type of service(s) in the region	(f) Total expenditures for and investments in the region

















3a	Sub-total ....
b	Total from continuation sheets to Part I ...
c	Totals (add lines 3a and 3b)

For Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2021

Schedule F (Form 990) 2021

Page 2

Part II

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 15, for any recipient who received more than $5,000. Part II can be duplicated if additional space is needed.

(c) Region	(d) Purpose of grant	(e) Amount of cash grant
Europe (Including Iceland and Greenland)	Research	100,506
North America	Research	54,598
Europe (Including Iceland and Greenland)	Research	33,388

2	Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .......	3
3	Enter total number of other organizations or entities .......................

Schedule F (Form 990) 2021

Schedule F (Form 990) 2021Page 3

Part III

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 16.

Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance		(b) Region	(c) Number of recipients	(d) Amount of cash grant	(e) Manner of cash disbursement	(f) Amount of noncash assistance	(g) Description of noncash assistance	(h) Method of valuation (book, FMV, appraisal, other)

Schedule F (Form 990) 2021

Page 4

Part IV

Foreign Forms

Schedule F (Form 990) 2021

Page 5

Part V

Supplemental Information
Provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information. See instructions.

ReturnReference	Explanation

Schedule F (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 300 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	23,002,615	0	23,002,615	0.560 %
b	Medicaid (from Worksheet 3, column a) . . . . .	71,753,922	36,715,953	35,037,969	0.850 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	94,756,537	36,715,953	58,040,584	1.410 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	4,354,197	1,394,049	2,960,148	0.070 %
f	Health professions education (from Worksheet 5) . . .	9,906,029	449,113	9,456,916	0.230 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .	54,579,539	47,605,162	6,974,377	0.170 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	4,246,726	0	4,246,726	0.100 %
j	Total. Other Benefits . .	73,086,491	49,448,324	23,638,167	0.570 %
k	Total. Add lines 7d and 7j .	167,843,028	86,164,277	81,678,751	1.980 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021

Schedule H (Form 990) 2021

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

393,108

Enter Medicare allowable costs of care relating to payments on line 5.....

662,949

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-269,841

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2021

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	KAISER PERMANENTE CENTRAL HOSPITAL 201 16TH AVE E SEATTLE,WA981125260 https://wa.kaiserpermanente.org/ HAC.FS.00000020	X	X

Schedule H (Form 990) 2021

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	KAISER PERMANENTE CENTRAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url):

Other website (list url): HTTP://WWW.KP.ORG/CHNA

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): HTTP://WWW.KP.ORG/CHNA

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2021

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	KAISER PERMANENTE CENTRAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of %
and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE SECTION C

The FAP application form was widely available on a website (list url):

SEE SECTION C

A plain language summary of the FAP was widely available on a website (list url):
SEE SECTION C

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 6

Part VFacility Information (continued)

Billing and Collections

	KAISER PERMANENTE CENTRAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2021

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	KAISER PERMANENTE CENTRAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2021

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Part V, Line 5	COMMUNITY INPUT WAS PROVIDED BY A BROAD RANGE OF COMMUNITY MEMBERS USING KEY INFORMANT INTERVIEWS, GROUP INTERVIEWS, FOCUS GROUPS, COMMUNITY EVENTS AND LISTENING SESSIONS. INDIVIDUALS WITH THE KNOWLEDGE,INFORMATION, AND EXPERTISE RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY WERE CONSULTED. THESE INDIVIDUALS INCLUDED REPRESENTATIVES FROM COUNTY PUBLIC HEALTH DEPARTMENTS, SCHOOL DISTRICTS, LOCAL NON-PROFITS, REGIONAL PUBLIC AND PRIVATE ORGANIZATIONS AS WELL AS LEADERS, REPRESENTATIVES, OR MEMBERS WHO RESIDE AND/OR PROVIDE SERVICES IN AN UNDER-RESOURCED OR MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY COMMUNITIES. ADDITIONALLY, WHERE APPLICABLE, OTHER INDIVIDUALS WITH EXPERTISE OF LOCAL HEALTH NEEDS WERE CONSULTED.
Part V, Line 11	Significant needs identified in Kaiser Foundation Health Plan of Washington's hospital facilities' most recently conducted CHNAs. Health need: Access to Care - Charitable health coverage: Provide access and comprehensive health care to low-income individuals and families who do not have access to public or private health coverage. - Medical financial assistance: Provide financial assistance to low-income individuals who receive care at KP facilities and cannot afford medical expenses. - Medicaid: Provide high-quality medical care to Medicaid participants who would otherwise struggle to access care. - Support screening for social and non-medical service needs and connect low-income individuals and families to community and government resources. - Increase access to health care coverage and care for underserved communities through targeted outreach, enrollment, and retention strategies. HEALTH NEED: MENTAL AND BEHAVIORAL HEALTH - SUPPORT THE INFRASTRUCTURE AND CAPACITY BUILDING OF COMMUNITY ORGANIZATIONS AND CLINICS TO IMPROVE ACCESS TO QUALITY MENTAL HEALTH CARE. - PROVIDE WORKFORCE PIPELINE AND TRAINING PROGRAMS TO ENSURE A CULTURALLY COMPETENT MENTAL HEALTH WORKFORCE WITH THE SKILLS TO MEET THE NEEDS OF DIVERSE COMMUNITIES. - SUPPORT AND PARTICIPATE IN SCHOOL-BASED PROGRAMS TO BUILD STUDENT AND STAFF CAPACITY TO ADDRESS TRAUMA AND ADVERSE CHILDHOOD EXPERIENCES. - IMPLEMENT A MULTI-MEDIA CAMPAIGN TO REDUCE STIGMA TOWARDS MENTAL HEALTH CONDITIONS. HEALTH NEED: OBESITY / HEAL / DIABETES - SUPPORT COMMUNITY-DRIVEN EFFORTS TO INCREASE ACCESS TO HEALTHY FOOD AND PHYSICAL ACTIVITY, INCLUDING COMMUNITY GARDENS, FARMERS MARKETS, PARKS, AND SAFE PLAY AREAS FOR CHILDREN. - SUPPORT HIGH-NEED SCHOOLS WITH THE ADOPTION AND IMPLEMENTATION OF HEALTHY EATING ACTIVE LIVING POLICIES AND PRACTICES. - PROVIDE OPPORTUNITIES FOR INCREASING AWARENESS OF PREVENTION AND MANAGEMENT OF CHRONIC DISEASE, INCLUDING CARDIOVASCULAR HEALTH, DIABETES, AND OBESITY. - SUPPORT ACTION-ORIENTED RESEARCH INTO HEALTHY EATING AND ACTIVE LIVING, INCLUDING THE CONNECTIONS BETWEEN FOOD INSECURITY AND HEALTH AND ACTIVE TRANSPORTATION GAPS.
Part V, Line 11	Needs identified but not currently addressed in Kaiser Foundation Health Plan of Washington facilities' most currently conducted CHNAs. Health need: Climate and health / environment - Less feasibility to make an impact on this need. - Less ability for KP to leverage expertise or assets to address this need. - Lack of feasible evidence-based or promising practices to address this need. - Less ability to leverage community assets to address this need. HEALTH NEED: SUBSTANCE USE/ TOBACCO - THIS NEED IS INCORPORATED INTO OTHER NEEDS SELECTED.
Part V, Line 13a	THE HOSPITAL PROVIDES FREE CARE (100% DISCOUNT) ON THE PATIENT COST FOR ELIGIBLE SERVICES TO ALL CHARITY ELIGIBLE PATIENTS REGARDLESS OF WHETHER THEY ARE UNINSURED OR UNDERINSURED. THE DISCOUNT AMOUNT IS NOT ADJUSTED BASED ON INCOME LEVEL.
Part V, Line 13h	A PATIENT OF ANY HOUSEHOLD INCOME LEVEL WITH INCURRED OUT-OF-POCKET MEDICAL AND PHARMACY EXPENSES FOR ELIGIBLE SERVICES OVER A 12 MONTH PERIOD GREATER THAN OR EQUAL TO 10% OF THEIR ANNUAL HOUSEHOLD INCOME IS ELIGIBLE FOR FREE CARE.
Part V, Line 16j	THE FAP PROGRAM MATERIALS ARE AVAILABLE ON THE KP WEBSITES AT www.kp.org/mfa/wa

Schedule H (Form 990) 2021

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?46
Name and address		Type of Facility (describe)
1	Seattle-Capitol Hill Medical Center 201 16th Ave E Seattle,WA98112	Medical Center
2	Olympia Medical Center 700 Lilly Rd NE Olympia,WA98506	Medical Center
3	Bellevue Medical Center 11511 NE 10th Street Bellevue,WA98004	Medical Center
4	Tacoma Medical Center 209 Martin Luther King Jr Way Tacoma,WA98405	Medical Center
5	Everett Medical Center 2930 Maple St Everett,WA98201	Medical Center
6	Spokane - Riverfront Medical Center 322 W North River Drive Spokane,WA99201	Medical Center
7	Seattle - Northgate Medical Center 9800 4th Ave NE Seattle,WA98115	Medical Center
8	Silverdale Medical Center 10452 Silverdale Way NW Silverdale,WA98383	Medical Center
9	Federal Way Medical Center 301 S 320th St Federal Way,WA98003	Medical Center
10	Puyallup Medical Center 1007 39th Ave SE Puyallup,WA38374	Medical Center
11	Tacoma South Medical Center 9505 Steele St S Tacoma,WA98444	Medical Center
12	Bellevue - Factoria Medical Center 13451 SE 36th St Bellevue,WA98006	Medical Center
13	Lynnwood Medical Center 20200 54th Ave W Lynnwood,WA98036	Medical Center
14	Port Orchard Medical Center 1400 Pottery Ave Port Orchard,WA98366	Medical Center
15	Burien Medical Center 140 SW 146th St Seattle,WA98166	Medical Center
16	Renton Medical Center 275 Bronson Way NE Renton,WA98056	Medical Center
17	Bothell - Northshore Medical Center 11913 NE 195th St Bothell,WA98011	Medical Center
18	Redmond Medical Center 15809 Bear Creek Pkwy Ste 100 Redmond,WA98052	Medical Center
19	Spokane - Lidgerwood Medical Center 6002 N Lidgerwood Spokane,WA99207	Medical Center
20	Spokane - Veradale Medical Center 14402 E Sprague Ave Spokane,WA99216	Medical Center
21	Smokey Point 2335 172nd St NE Marysville,WA98271	Medical Clinic
22	Kent Medical Center 26004 104th Ave SE Kent,WA98031	Medical Center
23	Seattle - Rainier Medical Center 5316 Rainier Ave S Seattle,WA98118	Medical Center
24	Kendall Yards Medical Office 546 N Jefferson St Spokane,WA99260	Medical Clinic
25	Poulsbo Medical Center 19379 7th Ave NE Poulsbo,WA98370	Medical Center
26	Ballard Medical Center 1401 NW 46th St 5th Fl Seattle,WA98107	Clinical
27	West Olympia 1200 Cooper Point Rd SW Ste 100 Olympia,WA98502	Medical Clinic
28	Seattle - Northgate South Building 9720 4th Ave NE Seattle,WA98115	Vision Center
29	Spokane - South Hill Medical Center 4102 S Regal St Ste 101 Spokane,WA99223	Medical Center
30	Renton Campus Rainier Building 2715 Naches Avenue SW Renton,WA98057	Vaccination Clinic
31	Tacoma Hear Center & Eye Care 5821 S Sprague Court Tacoma,WA98409	Audiology & Vision Center
32	Gig Harbor Clinic 5216 Point Fosdick Dr Gig Harbor,WA98335	Medical Clinic
33	South Lake Union Medical Office 210 9th Ave N Seattle,WA98109	Medical Clinic
34	Bremerton Behavioral Health Services 555 Pacific Ave Ste 202 Bremerton,WA98337	Behavioral Health Clinic
35	Seattle - Downtown Medical Center 1420 5th Ave Suite 375 Seattle,WA98101	Medical Center
36	Renton Campus Glacier Building 1200 SW 27th Street Renton,WA98057	Vaccination Clinic
37	Renton Campus Adams Building 2921 Naches Avenue SW Renton,WA98057	Telehealth
38	Aki Kurose School 3928 S Graham Street Seattle,WA98122	Teen Medical Clinic
39	Nathan Hale High School 10750 30th Avenue NE Seattle,WA98125	Teen Medical Clinic
40	Northpointe Medical Offices 9631 N Nevada St Ste 100/200 Spokane,WA99218	Clinical
41	Tacoma Behavioral Health Services 4301 S Pine St Tacoma,WA98409	Behavioral Health Clinic
42	Lincoln Heights Medical Office 3010 S Southeast Blvd Ste A Spokane,WA99223	Medical Clinic
43	Seattle - Metropolitan Park East 1730 Minor Avenue Seattle,WA98101	Research Facility
44	Interagency Academy at Columbia School 3528 S Ferdinand Street Seattle,WA98118	Teen Medical Clinic
45	Washington Middle School 2101 S Jackson Street Seattle,WA98144	Teen Medical Clinic
46	Franklin High School 3013 S Mount Baker Boulevard Seattle,WA98144	Teen Medical Clinic

Schedule H (Form 990) 2021

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
PART I, LINE 3c	THERE ARE THREE DISTINCT ELIGIBILITY CRITERIA FOR FREE AND DISCOUNTD CARE UNDER KP'S MEDICAL FINANCIAL ASSISTANCE POLICY; (1) MEANS TESTED (INCOME-BASED), (2) HIGH MEDICAL EXPENSES AND (3) SITUATIONS WHERE THE PATIENT HAS BEEN PREQUALIFIED. MEANS-TESTED: A PATIENT OF A HOUSEHOLD INCOME LESS THAN OR EQUAL TO KFHP WA'S MEANS TESTING CRITERIA AS A PERCENTAGE OF THE FEDERAL POVERTY GUIDELINES (FPG) IS ELIGIBLE FOR FREE CARE. NOTE: ASSETS ARE NOT USED IN ELIGIBILITY DETERMINATION. HIGH MEDICAL EXPENSES: A PATIENT OF ANY HOUSEHOLD INCOME LEVEL WITH INCURRED OUT-OF-POCKET MEDICAL AND PHARMACY EXPENSES FOR ELIGIBLE SERVICES OVER A 12 MONTH PERIOD GREATER THAN OR EQUAL 10% OF ANNUAL HOUSEHOLD INCOME IS ELIGIBLE FOR FINANCIAL ASSISTANCE. PREQUALIFICATION: A PATIENT IS PRESUMED TO MEET THE PROGRAM ELIGIBILITY CRITERIA AND IS NOT REQUIRED TO PROVIDE PERSONAL, FINANCIAL AND OTHER INFORMATION TO VERIFY FINANCIAL STATUS WHEN THE PATIENT: 1. IS ENROLLED IN A COMMUNITY PROGRAM TO WHICH PATIENTS HAVE BEEN REFERRED AND PREQUALIFIED THROUGH (1) FEDERAL, STATE OR LOCAL GOVERNMENT, (2) A PARTNERING COMMUNITY-BASED ORGANIZATION, OR (3) AT A KFHP WA SPONSORED COMMUNITY HEALTH EVENT, OR 2. IS ENROLLED IN A KFHP WA COMMUNITY BENEFIT PROGRAM DESIGNED TO SUPPORT ACCESS TO CARE FOR LOW-INCOME PATIENTS AND PREQUALIFIED BY DESIGNATED KFH/HP PERSONNEL, OR 3. IS ENROLLED IN A CREDIBLE MEANS-TESTED HEALTH COVERAGE PROGRAM (E.G., MEDICARE LOW INCOME SUBSIDY PROGRAM), OR 4. WAS GRANTED A PRIOR MEDICAL FINANCIAL ASSISTANCE AWARD WITHIN THE LAST 30 DAYS.
PART I, LINE 7, PERCENT OF TOTAL EXPENSE	THE LOSSES ATTRIBUTED TO PROVIDING CHARITY CARE (MEDICAL FINANCIAL ASSISTANCE AND CHARITABLE HEALTH COVERAGE) AND PARTICIPATION IN SELECT GOVERNMENT OR COMMUNITY SPONSORED HEALTH COVERAGE PROGRAMS ARE CALCULATED USING A COST-BASED METHODOLOGY FOR PATIENTS IN THOSE PROGRAMS. THE COST-BASED LOSS IS GENERATED THROUGH THE STANDARD SYSTEMS USED TO REPORT ON MARKET SEGMENTS FOR KFHP-WA'S COMMERCIAL BUSINESS LINES. PART III, LINE 8 None of the amounts reported on Part III, line 7 has been treated as community benefit. The Medicare hospital cost reports are the source document to capture the Medicare revenue and Medicare allowable costs. To determine the direct costs, the cost report takes inputs from the general ledger by hospital location and applies a step-down methodology to allocate overhead costs. The costs are then passed through additional cost report computations to determine allowable Medicare costs. The total allowable Medicare cost is subtracted from the total revenue by region to determine the Medicare surplus or shortfall.
PART III, LINE 9B, COLLECTION POLICY	When a patient/guarantor indicates an inability to pay (Charity Care), the patient/guarantor will be evaluated for charity care in accordance with established criteria outlined in the medical financial assistance (MFA) program. In addition, outside collection agencies will cancel and return on a retrospective basis any accounts that either would have qualified or now qualify for charity care according to the criteria outlined in the MFA program.
PART VI, LINE 2, NEEDS ASSESSMENT	THE NEEDS ASSESSMENT PROVIDES A SUMMARY OF THE NEEDS ASSESSMENT PROCESS UNDERTAKEN INCLUDING THE METHODOLOGIES AND DATA SOURCES UTILIZED, INDIVIDUALS AND ORGANIZATIONS CONSULTED, A COMPLETE LISTING OF THE NEEDS IDENTIFIED AND DESCRIPTION OF THE METHOD USED TO PRIORITIZE NEEDS FOR INCLUSION IN THE INDIVIDUAL COMMUNITY BENEFIT PLANS. THE MOST RECENT NEEDS ASSESSMENTS WERE COMPLETED IN 2019.
PART VI, LINE 3, PATIENT EDUCATION FOR ELIGIBILITY FOR ASSISTANCE	IN WASHINGTON, INFORMATION REGARDING ASSISTANCE IS WIDELY AVAILABLE THROUGHOUT THE FACILITIES TO ALL PATIENTS. INFORMATION REGARDING THE AVAILABILITY OF KAISER FOUNDATION HEALTH PLAN OF WASHINGTON'S MEDICAL FINANCIAL ASSISTANCE PROGRAM (MFAP) IS POSTED IN THE EMERGENCY DEPARTMENTS AND ADMITTING AREAS OF ALL KAISER FOUNDATION HEALTH PLAN OF WASHINGTON HOSPITALS. THE POSTED INFORMATION CONTAINS CONTACT INFORMATION FOR FURTHER ASSISTANCE. KFHP WA ADMISSION AND DISCHARGE STAFF ARE ALSO A SOURCE OF INFORMATION FOR PATIENTS THAT EXPRESS FINANCIAL HARDSHIP OR REQUEST MEDICAL FINANCIAL ASSISTANCE. THIS STAFF CAN PROVIDE A COPY OF THE FINANCIAL ASSISTANCE POLICY SUMMARY, PROGRAM APPLICATION, OR CONNECT A PATIENT WITH A FINANCIAL COUNSELOR WHO CAN ASSIST PATIENTS IN DETERMINING ELIGIBILITY FOR GOVERNMENT PROGRAMS OR THE MFAP. PATIENT DISCHARGE PACKETS ALSO INCLUDE A COPY OF THE MFAP POLICY SUMMARY. IN ADDITION, MFAP INFORMATION, INCLUDING THE POLICY, POLICY PLAIN LANGUAGE SUMMARY AND APPLICATION, CAN ALSO BE FOUND ON THE PUBLICLY ACCESSIBLE KFHP WA MEDICAL FINANCIAL ASSISTANCE WEBSITE. ALL PATIENT BILLING STATEMENTS INCLUDE INFORMATION THAT FINANCIAL ASSISTANCE IS AVAILABLE AS WELL AS WHERE TO GET ADDITIONAL INFORMATION OR ASSISTANCE. THE MFAP POLICY PLAIN LANGUAGE SUMMARY IS ALSO INCLUDED WITH THE FIRST HOSPITAL BILLING STATEMENT TO ALL PATIENTS. ADDITIONALLY, IF PATIENTS ARE REFERRED TO BAD DEBT COLLECTIONS, PRIOR TO PERFORMING EXTRAORDINARY COLLECTIONS ACTIONS, THE PATIENT RECEIVES NOTIFICATION THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE PROGRAM POLICY, POLICY PLAIN LANGUAGE SUMMARY, AND APPLICATION ARE AVAILABLE WITHOUT CHARGE IN ENGLISH AS WELL AS ALL THE LANGUAGES THAT MEET THE LIMITED ENGLISH PROFICIENCY POPULATION CRITERIA (LESSER OF 1,000 INDIVIDUALS OR 5% OF THE COMMUNITY). LANGUAGES SUPPORTED INCLUDE, BUT ARE NOT LIMITED TO SPANISH, CHINESE, JAPANESE, KOREAN, LAOTIAN, TAGALOG, RUSSIAN, FARSI AND VIETNAMESE.
PART VI, LINE 4, COMMUNITY INFORMATION	THE COMMUNITIES WE SERVE ARE DIVERSE AND INCLUDE BOTH LESS POPULOUS AND DENSELY POPULATED CITIES AND COUNTIES. OUR COMMUNITIES ARE DIVERSE IN MANY WAYS INCLUDING INCOME, RATE OF UNINSURED, HIGH SCHOOL GRADUATION AND LIMITED ENGLISH PROFICIENCY. OUR FACILITIES AND THE PEOPLE WHO WORK WITHIN THEM ARE LOCATED WITHIN AND ARE PART OF OUR COMMUNITIES. IN WASHINGTON, CENTRAL HOSPITAL IS LOCATED IN THE CITY OF SEATTLE. Total population in area (mil)*; 5.6 Median Household Income; $86,023 % below 100% fpl; 9.4% w/o public or private health ins; 5.6% Limited English Proficiency; 3.9% High school graduation rate; 84.4% Unemployment Rate (%); 15.5% US CENSUS BUREAU, AMERICAN COMMUNITY SURVEY: 2015-19 US DEPARTMENT OF EDUCATION * ESRI VIA KAISER PERMANENTE UTILITY FOR CARE DATA ANALYSIS, 2020 AS THE NATION'S LARGEST NONPROFIT INTEGRATED HEALTH CARE ORGANIZATION, KAISER PERMANENTE IS MISSION DRIVEN TO IMPROVE HEALTH AND WELL-BEING IN THE COMMUNITIES WE SERVE AND COMMITTED TO SHAPING THE FUTURE OF HEALTH CARE. KAISER PERMANENTE IS DEDICATED TO CARE INNOVATIONS, CLINICAL RESEARCH, HEALTH EDUCATION AND THE SUPPORT OF COMMUNITY HEALTH. KFHP WA IS COMMITTED TO THE BELIEF THAT GOOD HEALTH IS A FUNDAMENTAL RIGHT SHARED BY ALL, AND WE RECOGNIZE THAT GOOD HEALTH EXTENDS BEYOND THE DOCTOR'S OFFICE AND THE HOSPITAL. LIKE OUR APPROACH TO MEDICINE, OUR WORK IN THE COMMUNITY TAKES A PREVENTION-FOCUSED, EVIDENCE-BASED APPROACH. WE GO BEYOND TRADITIONAL CORPORATE PHILANTHROPY OR GRANT-MAKING TO LEVERAGE FINANCIAL RESOURCES WITH MEDICAL RESEARCH, PHYSICIAN EXPERTISE, AND CLINICAL PRACTICES. HISTORICALLY, WE HAVE FOCUSED OUR INVESTMENTS IN THREE AREAS-HEALTH ACCESS, HEALTHY COMMUNITIES, AND HEALTH EQUITY TO ADDRESS CRITICAL HEALTH ISSUES IN OUR COMMUNITIES. FOR MANY YEARS, WE HAVE WORKED COLLABORATIVELY WITH OTHER ORGANIZATIONS TO ADDRESS SERIOUS PUBLIC HEALTH ISSUES, IMPROVE CONDITIONS FOR HEALTH IN OUR COMMUNITIES, ADVANCE HEALTH AND DRIVE AFFORDABILITY ACROSS THE NATION. WE HAVE CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) TO BETTER UNDERSTAND EACH COMMUNITY'S UNIQUE NEEDS AND RESOURCES. THE CHNA PROCESS INFORMS OUR COMMUNITY INVESTMENTS AND HELPS US DEVELOP STRATEGIES AIMED AT MAKING LONG-TERM, SUSTAINABLE CHANGE-AND IT ALLOWS US TO DEEPEN THE STRONG RELATIONSHIPS WE HAVE WITH OTHER ORGANIZATIONS THAT ARE WORKING TO IMPROVE COMMUNITY HEALTH. THE KFHP/KFH BOARD HAS A STANDING COMMUNITY BENEFIT COMMITTEE OF THE BOARD OF DIRECTORS TO OVERSEE THE PROGRAM-WIDE COMMUNITY BENEFIT PROGRAM. KAISER PERMANENTE ALSO HAS A NATIONAL EXECUTIVE OF KFHP AND KFH TO LEAD KAISER PERMANENTE'S COMMUNITY BENEFIT PROGRAM AS A FULL-TIME ASSIGNMENT.
PART VI, LINE 5, PROMOTION OF COMMUNITY HEALTH	KAISER FOUNDATION HEALTH PLAN OF WASHINGTON'S (KFHP WA) PRINCIPAL PURPOSE IS TO PROVIDE HOSPITAL, MEDICAL, AND SURGICAL CARE, INCLUDING EMERGENCY SERVICES, EXTENDED CARE AND HOME HEALTH CARE TO MEMBERS OF THE PUBLIC WITHOUT REGARD TO AGE, SEX, RACE, RELIGION OR NATIONAL ORIGIN, OR TO THE INDIVIDUAL'S ABILITY TO PAY. KFHP WA SHARES THE KAISER PERMANENTE MISSION, OF PROVIDING AFFORDABLE HIGH-QUALITY HEALTH CARE TO OUR MEMBERS, AND IMPROVING THE HEALTH OF THE COMMUNITIES WE SERVE. KFHP WA'S GENERAL COMMUNITY BENEFITS INCLUDE: i. EMERGENCY DEPARTMENT - KFHP WA OPERATES A FULL-TIME EMERGENCY DEPARTMENT IN ITS LICENSED HOSPITAL, EMERGENCY MEDICAL SERVICES ARE AVAILABLE TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. ii. CARE PROVIDED TO ALL PATIENTS - HOSPITAL CARE IS PROVIDED TO INDIVIDUALS WITH HEALTH CARE COVERAGE FROM ANY PRIVATE OR GOVERNMENT-SPONSORED HEALTH PLAN, INSURED AND UNINSURED REFERRALS FROM SAFETY NET AND OTHER PUBLIC HEALTH PARTNERSHIPS, AND UNINSURED PATIENTS ADMITTED THROUGH THE EMERGENCY DEPARTMENT. iii. OPEN MEDICAL STAFF PRIVILEGES - STAFF PRIVILEGES IN THE HOSPITALS ARE AVAILABLE TO COMMUNITY PRACTITIONERS WHO ARE NOT AFFILIATED WITH A PERMANENTE MEDICAL GROUP. IN ADDITION, KFHP WA IS COMMITTED TO OPERATING TO INTENTIONALLY PROTECT AND PRESERVE THE ENVIRONMENT AND SCARCE RESOURCES. POOR ENVIRONMENTAL QUALITY CONTRIBUTES TO DISEASE AND ECONOMIC INSECURITY. KFHP WA HAS THEREFORE COMMITTED ITSELF TO PROTECTING AND IMPROVING THE NATURAL ENVIRONMENT AS A KEY COMPONENT OF OUR MISSION TO IMPROVE HEALTHCARE QUALITY AND AFFORDABILITY. TO FULFILL THIS COMMITMENT, KFHP WA MAINTAINS A STRUCTURE FOR ENVIRONMENTAL STEWARDSHIP THAT ENABLES THE ORGANIZATION TO CONTINUOUSLY IMPROVE ITS ENVIRONMENTAL PERFORMANCE. THIS STRUCTURE INCLUDES CLEARLY DEFINED ROLES, RESPONSIBILITIES, PLANS AND ROUTINES, AND HAS RESULTED IN FIVE ORGANIZATION-WIDE 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: 1. FINDING SAFE ALTERNATIVES TO HARMFUL INDUSTRIAL CHEMICALS 2. RESPONDING TO CLIMATE CHANGE 3. PROMOTING SUSTAINABLE FARMING AND FOOD CHOICES 4. REDUCING, REUSING, AND RECYCLING TO ELIMINATE WASTE 5. CONSERVING WATER IN EACH OF THESE FOCUS AREAS, KFHP WA HAS ESTABLISHED AMBITIOUS GOALS, IMPLEMENTED INITIATIVES, ACHIEVED MEASURABLE IMPROVEMENTS, AND REGULARLY REPORTED PROGRESS TO OUR BOARD OF DIRECTORS, OUR STAFF, AND THE COMMUNITIES WE SERVE.
PART VI, LINE 6, AFFILIATED HEALTH CARE SYSTEM	Kaiser Foundation Health Plan of Washington (KFHP-WA) is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. KFHP-WA is dedicated to care innovations, clinical research, health education and the support of community health. KFHP-WA has an exclusive contract with Washington Permanente Medical Group (WPMG) a group practice with more than 1,400 physicians, physician assistants, optometrists, midwives and psychologists in Washington state. WPMG is not under common governance or control with KFHP-WA, but the two organizations collaborate to serve the community. Both KFHP-WA and WPMG staff participate as faculty and preceptors for residency and health professionals training programs. In addition to the operation of a family practice residency program (for which WPMG clinicians serve as faculty) and an optometry residency in 2 medical center locations, KFHP-WA and WPMG participate in the training of over a dozen medical specialties and an additional 20+ mid-level and non-physician training programs, including those for critical shortage professions such as nursing, physical therapy and pharmacy. The residency program includes clinical training and the provision of medical care for homeless youth as well as for some of the free clinics in King County. In addition to the above-mentioned programs in Washington state, in 2020, KFHP-WA and WPMG clinicians and staff volunteered medical services to homeless shelters, community clinics and other relief efforts in the U.S. and around the world. Physician and non-physician leaders at WPMG also contribute to the dissemination and community-wide practice of evidence-based medicine and outcomes improvement by sharing clinical guidelines, quality improvement efforts and protocols related to shared decision-making and other patient engagement tools, lean process improvements in clinical care, the medical home team-based care model, the chronic care model, and other care innovations.
PART VI, LINE 7, STATE FILING OF COMMUNITY BENEFIT REPORT	THIS QUESTION IS NOT APPLICABLE.

Schedule H (Form 990) 2021

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

2021

Open to Public
Inspection

Name of the organization
KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number
91-0511770

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) Alliance For A Healthier Generation Inc 1028 Se Water Ave 215 Portland,OR97214	27-2028308	501(c)(3)	133,352	Healthier Generation: Heal 2.0, Po - Grants Splits
(2) Alliance For Education 509 Olive Way Ste 500 Seattle,WA98101	91-1508191	501(c)(3)	10,000	Project Support
(3) Altarum Institute 3520 Green Ct 300 Ann Arbor,MI48105	38-1983442	501(c)(3)	579,166	Research Subrecipient
(4) American Indian Health Commission 808 N 5th Ave Sequim,WA98382	47-0922046	501(c)(3)	60,000	Enhancing Capacity And Development To Address Ai/A
(5) Association Of Washington Cities 1076 Franklin St Se Olympia,WA98501	91-6000045	501(c)(4)	7,000	Project Support
(6) Baylor Research Institute 1950 N Stemmons Fwy Dallas,TX75207	75-1921898	501(c)(3)	43,307	Research Subrecipient
(7) Behavioral Health Resources 3857 Martin Way E B Olympia,WA98506	91-0666889	501(c)(3)	24,500	Unite Washington Platform For Integrated Health
(8) Blaine School District No 503 765 H St Blaine,WA98230	91-1174254	Government	7,299	Summer Meals For Kids
(9) Boston Medical Center Corporation 660 Harrison Ave Fl 2 Boston,MA02118	04-3314093	501(c)(3)	252,247	Research Subrecipient
(10) Brigham And Women's Hospital Inc Po Box 3149 Boston,MA02241	04-2312909	501(c)(3)	71,912	Research Subrecipient
(11) Carl Maxey Center 1312 N Monroe St 148 Spokane,WA99201	82-4396555	501(c)(3)	40,000	Black Business Support Team
(12) Central Valley School District 356 19307 E Cataldo Ave Spokane Valley,WA99016	91-6008402	Government	13,000	Central Valley School District Student And Family
(13) Cheney School District 360 12414 S Andrus Rd Cheney,WA99004	91-0833847	Government	24,000	Cheney Sd Safe Food Transportation Refrigerated Tr
(14) Chief Leschi Schools 5625 52nd St E Puyallup,WA98371	91-1597976	Government	24,000	Summer Meals For Kids
(15) City Year Inc 2203 23rd Ave S Ste 101 Seattle,WA98144	22-2882549	501(c)(3)	10,000	Project Support
(16) Clover Park School District 10903 Gravelly Lake Dr Sw Lakewood,WA98499	91-6001838	Government	13,407	Purchase Oven
(17) College Success Foundation - Tacoma 6501 S 19th St Tacoma,WA98466	91-2036088	501(c)(3)	10,000	Project Support
(18) Columbia Hospitality Inc 2200 Alaskan Way Ste 200 Seattle,WA98121	52-2207354	For Profit	10,000	Project Support
(19) Community Health Association Of Spokane 203 N Washington St 300 Spokane,WA99202	91-1641797	501(c)(3)	100,000	John R Rogers Sbhc
(20) Community Health Care 1148 Broadway 100 Tacoma,WA98402	91-1349657	501(c)(3)	105,000	Chc Shining Mtn Sbhc Phase 2
(21) Country Doctor Community Health Centers 500 19th Ave E Seattle,WA98112	23-7100868	501(c)(3)	215,000	Lowell Elementary School Based Health Clinic
(22) Dare2be Project 6714 S 122nd St Seattle,WA98178	83-3590168	501(c)(3)	99,500	Skyway Fresh Produce Access Program
(23) Duke University Po Box 90847 Durham,NC27708	56-0532129	501(c)(3)	22,302	Research Subrecipient
(24) Education Northwest 1417 Nw Everett St 310 Portland,OR97209	93-0553346	501(c)(3)	99,500	Community Partnerships For Reengagement (Cpr) Init
(25) El Centro De La Raza 2524 16th Ave S Seattle,WA98144	91-0899927	501(c)(3)	30,000	Financial Empowerment
(26) Essentia Institute Of Rural Health 502 E Second Street Duluth,MN55805	27-1291124	501(c)(3)	227,511	Research Subrecipient
(27) Everett Station District Alliance 3331 Broadway Everett,WA98201	82-4569568	501(c)(3)	95,000	Everett Station Equitable Neighborhood Development
(28) Farestart 700 Virginia St Seattle,WA98101	91-1546757	501(c)(3)	47,500	Food Security For South King County Families
(29) Financial Empowerment Network 12819 Se 38th St 304 Bellevue,WA98006	82-2691437	501(c)(3)	25,000	Financial Empowerment Integration For Financial He
(30) Forterra Nw 901 5th Ave 2200 Seattle,WA98164	94-3112461	501(c)(3)	7,724	Project Support
(31) Fred Hutchinson Cancer Research Ctr 1100 Fairview Ave N Seattle,WA98109	23-7156071	501(c)(3)	116,948	Research Subrecipient
(32) Gather Church 408 W Main St Centralia,WA98531	27-3731709	501(c)(3)	24,500	Food Box Delivery Logistics
(33) Geisinger Clinic 100 N Academy Ave Danville,PA17822	23-6291113	501(c)(3)	159,020	Research Subrecipient
(34) Georgia State University Po Box 3999 Atlanta,GA30302	58-1845423	Government	61,498	Research Subrecipient
(35) Global To Local Health Initiative 2800 S 192nd St 104 Seatac,WA98188	27-3133200	501(c)(3)	26,500	Culturally Relevant Meals For Summer Food Service
(36) Harvard Pilgrim Health Care Inc 401 Park Drive Ste 401 Boston,MA02215	04-2452600	501(c)(3)	570,710	Research Subrecipient
(37) Healthpartners Institute Po Box 1524 Ms 21109a Minneapolis,MN55440	41-1670163	501(c)(3)	335,332	Research Subrecipient
(38) Healthpoint 955 Powell Ave Sw Renton,WA98057	91-0884412	501(c)(3)	180,000	Federal Way School District School-based Health Ce
(39) Henry Ford Health System Fund Accounting 1414 E Maple Rd Unit 2n Troy,MI48083	38-1357020	501(c)(3)	610,381	Research Subrecipient
(40) Indiana University 509 E 3rd St Bloomington,IN47401	35-6001673	Government	840,009	Research Subrecipient
(41) Innovia Foundation 421 W Riverside Ave 606 Spokane,WA99201	91-0941053	501(c)(3)	25,000	Cstep Staffing 2022
(42) Institute For Family Health 2006 Madison Ave New York,NY10035	13-3273402	501(c)(3)	198,294	Research Subrecipient
(43) International Community Health Services Po Box 3007 Seattle,WA98114	91-0947084	501(c)(3)	65,000	Wa Safety Net Vaccine Equity Initiative ? Ichs Com
(44) Kitsap Community Foundation Po Box 3670 Silverdale,WA98383	94-3205217	501(c)(3)	213,676	Trauma-informed Community Approach
(45) March Of Dimes 2102 N Pearl St Tacoma,WA98046	13-1846366	501(c)(3)	11,000	Project Support
(46) Marshfield Clinic Inc 1000 N Oak Ave Marshfield,WI54449	39-0452970	501(c)(3)	300,826	Research Subrecipient
(47) Mary Mahoney Professional Nurses Po Box 22003 Seattle,WA98122	91-1653833	501(c)(3)	10,000	Project Support
(48) Md Anderson Cancer Center Po Box 4266 Houston,TX77210	74-6001118	Government	223,333	Research Subrecipient
(49) Medical University Of South Carolina 1 S Park Cir Ste 402 Charleston,SC29407	57-6028985	Government	6,610	Research Subrecipient
(50) Montefiore Medical Center 111 E 210th St Bronx,NY10467	13-1740114	501(c)(3)	151,998	Research Subrecipient
(51) Multicare Health System Po Box 5299 Tacoma,WA98415	91-1352172	501(c)(3)	126,044	Research Subrecipient
(52) Nami Washington 1107 Ne 45th St 230 Seattle,WA98105	91-1689067	501(c)(3)	30,000	Nami Washington Alliance 2021 Sponsorships
(53) Neighborcare Health 1200 12th Ave S 901 Seattle,WA98144	91-0893287	501(c)(3)	90,000	Wa Safety Net Vaccine Equity Initiative
(54) Northeastern University 360 Huntington Ave Boston,MA02115	04-1679980	501(c)(3)	19,844	Research Subrecipient
(55) Northwest Educational Service District 189 1601 R Ave Anacortes,WA98221	91-0868056	Government	500,000	Mtss: Project Share
(56) Northwestern University 680 N Lake Shore Dr Chicago,IL60611	36-2167817	501(c)(3)	52,168	Research Subrecipient
(57) Nw Children's Foundation 2100 24th Ave S 320 Seattle,WA98144	91-1314318	501(c)(3)	10,000	Project Support
(58) Ochin Inc 1881 Sw Naito Parkway Portland,OR97201	20-0195556	501(c)(3)	127,492	Research Subrecipient
(59) Olympia Free Clinic Po Box 6310 Olympia,WA98507	27-1606329	501(c)(3)	24,500	Tofc?S Unite Wa Initiative In Support Of Social De
(60) Palo Alto Medical Foundation Po Box 255448 Sacramento,CA95865	94-1156581	501(c)(3)	54,834	Research Subrecipient
(61) Pierce County Project Access 223 Tacoma Ave S Tacoma,WA98402	27-1185895	501(c)(3)	75,000	Project Support
(62) Pyramid Communications Inc 1932 First Ave Ste 507 Seattle,WA98101	91-1622387	For Profit	26,419	Research Subrecipient
(63) Raimi & Associates Inc 1900 Addison St Ste 200 Berkeley,CA94704	20-4994828	For Profit	89,958	Research Subrecipient
(64) Rand Corp Po Box 2138 Santa Monica,CA90407	95-1958142	501(c)(3)	156,150	Research Subrecipient
(65) Regents Of The University Of California 1855 Folsom St San Francisco,CA94143	95-2226406	Government	449,869	Research Subrecipient
(66) Regents Of The University Of Michigan 2800 Plymouth Rd Bldg35 Ann Arbor,MI48109	38-6006309	501(c)(3)	73,854	Research Subrecipient
(67) Research Institute At Nationwide Po Box 781653 Detroit,MI48278	31-6056230	501(c)(3)	147,795	Research Subrecipient
(68) Schools Out Washington 801 23rd Ave S A Seattle,WA98144	46-0809713	501(c)(3)	64,800	Youth Organizers Of Mental Health Education (Yohme
(69) Seattle Childrens Hospital 4800 Sand Point Way Ne Seattle,WA98105	91-0564748	501(c)(3)	681,631	Research Subrecipient
(70) Seattle Good Business Network 1143 Martin Luther King Jr Way77 Seattle,WA98122	27-2172486	501(c)(3)	10,000	Fall 2021 Good Food Kitchens Buy One, Give One
(71) South Kitsap School District 2689 Hoover Ave Se Port Orchard,WA98366	91-6001633	Government	13,000	Planning For The Next Normal At School
(72) Sutter West Bay Hospitals 3569 Round Barn St 200 Santa Rosa,CA95403	94-6187756	501(c)(3)	63,151	Research Subrecipient
(73) Swedish Health Services Po Box 84392 Seattle,WA98124	91-0433740	501(c)(3)	33,241	Research Subrecipient
(74) Tabor 100 7100 Fort Dent Way 100 Tukwila,WA98188	91-2013635	501(c)(3)	25,000	Tabor 100 Cares: Community Development
(75) Tacoma School District No 10 Po Box 1357 Tacoma,WA98401	91-6001553	Government	20,000	Wellness Minigrants For Tps Staff
(76) Tacoma Urban League 2550 Yakima Ave A Tacoma,WA98405	91-0826302	501(c)(3)	50,000	Black Empowerment Center - Small Business Support
(77) Teamchild 1225 S Weller St 420 Seattle,WA98144	91-1930194	501(c)(3)	104,705	Roadmap Region Listening Session Series
(78) The Trust For Public Land 101 Montgomery St900 San Francisco,CA94104	23-7222333	501(c)(3)	500,000	Tacoma Green Schoolyards
(79) Thurston County Food Bank 220 Thurston Ave Ne Olympia,WA98501	23-7297837	501(c)(3)	24,500	Client Services Support Program
(80) Uc Regents 695 Charles Young Dr La Jolla,CA92093	95-6006143	Government	27,419	Research Subrecipient
(81) United Negro College Fund Inc 1805 7th St Nw Washington,DC20001	13-1624241	501(c)(3)	35,000	Kp Health Equity Sc
(82) United Way Of King County 720 2nd Ave Seattle,WA98104	91-0565555	501(c)(3)	150,000	Fuel Your Future Campaign
(83) United Way Of Pierce County Po Box 2215 Tacoma,WA98401	91-0650669	501(c)(3)	342,882	Center For Strong Families
(84) Unity Care Nw 1616 Cornwall Ave 205 Bellingham,WA98225	91-2168190	501(c)(3)	65,000	Wa Safety Net Vaccine Equity Initiative
(85) University Of Ca Riverside 900 University Ave Riverside,CA92521	95-6006142	Government	226,701	Research Subrecipient
(86) University Of Ca San Diego 200 W Arbor Dr Mc8821 Los Angeles,CA90074	33-0599494	Government	31,898	Research Subrecipient
(87) University Of Colorado Health Sciences Po Box 910220 Denver,CO80291	84-6000555	Government	41,364	Research Subrecipient
(88) University Of Iowa 431 Newton Rd 116 Emrb Iowa City,IA52242	42-0931777	Government	29,828	Research Subrecipient
(89) University Of Massachusetts Worcester 181 Presidents Dr Amherst,MA01003	04-3167352	Government	138,076	Research Subrecipient
(90) University Of Miami 1320 S Dixie Hwy Coral Gables,FL33146	59-0624458	501(c)(3)	103,586	Research Subrecipient
(91) University Of New Mexico 1 Univ Of N Mexico Albuquerque,NM87131	85-0275408	Government	133,449	Research Subrecipient
(92) University Of Pittsburgh 200 Gardner Steel Ctr Pittsburgh,PA15260	25-0965591	Government	138,580	Research Subrecipient
(93) University Of Texas Southwestern Po Box 841864 Dallas,TX75284	75-6002868	Government	64,619	Research Subrecipient
(94) University Of Washington 4333 Brooklyn Ave Ne Seattle,WA98195	91-6001537	Government	2,696,668	Research Subrecipient
(95) University Of Washington Foundation 4101 15th Ave Ne 354900 Seattle,WA98105	94-3079432	501(c)(3)	96,158	Scaling Youth Suicide Prevention In Washington Sta
(96) Urban League Of Metropolitan Seattle 105 14th Ave 200 Seattle,WA98122	91-0575954	501(c)(3)	50,000	Ulms Entrepreneurship Community Collaboration
(97) Vanderbilt University 407810 2309 W End Ave Nashville,TN37240	35-2528741	501(c)(3)	10,155	Research Subrecipient
(98) Ventures 2100 24th Ave S 380 Seattle,WA98144	91-1704028	501(c)(3)	30,000	Enhancing Ventures? Financial Health Education And
(99) Washington Alliance For Better Schools 18560 1st Ave Ne Shoreline,WA98155	91-1698851	501(c)(3)	35,000	Access Stem Program And Natural Leaders Program
(100) Washington Poison Center 155 Ne 100th St 100 Seattle,WA98125	94-3214597	501(c)(3)	20,000	Washington Poison Center Emergency Helpline
(101) Washington School Administrators Po Box 14459 Tumwater,WA98511	82-3291509	501(c)(6)	9,000	Project Support
(102) Washington School-based Health Alliance Po Box 9565 Seattle,WA98109	45-0937382	501(c)(3)	160,000	Expanding And Improving School-based Health Care I
(103) Washington Stem Center 210 S Hudson St Seattle,WA98134	27-2133169	501(c)(3)	805,000	Project Support
(104) Weill Medical College Of Cornell Po Box 22371 New York,NY10087	13-1623978	501(c)(3)	330,183	Research Subrecipient
(105) Workforce Development Council Of Snohomi 808 134th St Sw 105 Everett,WA98204	91-2071882	501(c)(3)	50,000	Wellness And Security Through Financial Empowermen
(106) Your Money Matters Po Box 52 Auburn,WA98071	82-3618832	501(c)(3)	25,000	Financial Education For Bipoc Youth & Young Adults

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

101

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) 2021

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
SCHEDULE I, PART I, LINE 2	PROCEDURES FOR MONITORING THE USE OF GRANTS AT THE END OF THEIR FUNDING CYCLE, GRANTEES ARE REQUIRED TO SUBMIT A FINAL REPORT WHICH DELINEATES ACCOMPLISHMENTS RELATED TO STATED OBJECTIVES. LARGER GRANTS (TYPICALLY OVER $100,000) MAY REQUIRE QUARTERLY PROGRESS REPORTS.

Schedule I (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

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

2021

Open to Public Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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 Chairman & CEO	(i) (ii)	0 ------------- 1,949,013	0 ------------- 10,590,330	0 ------------- 743,758	0 ------------- 2,248,687	0 ------------- 30,436	0 ------------- 15,562,224	0 ------------- 3,067,941
2Arthur Southam EVP, Health Plan Ops & CGO	(i) (ii)	0 ------------- 1,196,028	0 ------------- 3,042,244	0 ------------- 526,564	0 ------------- 427,557	0 ------------- 32,012	0 ------------- 5,224,405	0 ------------- 0
3Kathryn Lancaster EVP & Chief Financial Officer	(i) (ii)	0 ------------- 1,197,032	0 ------------- 2,859,194	0 ------------- 524,128	0 ------------- 430,575	0 ------------- 16,984	0 ------------- 5,027,913	0 ------------- 0
4Janet Liang EVP, Group President & COO	(i) (ii)	0 ------------- 1,187,802	0 ------------- 2,273,257	0 ------------- 543,354	0 ------------- 900,276	0 ------------- 34,654	0 ------------- 4,939,343	0 ------------- 373,405
5Kimberly Horn EVP, Group President, MOC	(i) (ii)	0 ------------- 1,048,109	0 ------------- 1,460,250	0 ------------- 743,396	0 ------------- 1,442,280	0 ------------- 30,978	0 ------------- 4,725,013	0 ------------- 502,935
6Mark Zemelman SVP, General Counsel & Secy	(i) (ii)	0 ------------- 767,516	0 ------------- 1,741,934	0 ------------- 329,088	0 ------------- 96,689	0 ------------- 38,068	0 ------------- 2,973,295	0 ------------- 0
7Susan Mullaney Regional President - WA	(i) (ii)	0 ------------- 744,016	0 ------------- 1,056,586	0 ------------- 246,967	0 ------------- 702,762	0 ------------- 27,023	0 ------------- 2,777,354	0 ------------- 142,079
8Thomas Meier SVP, Corporate Treasurer	(i) (ii)	0 ------------- 545,140	0 ------------- 785,594	0 ------------- 131,103	0 ------------- 271,040	0 ------------- 30,351	0 ------------- 1,763,228	0 ------------- 0
9Karen Schartman VP, CFO & Strategy - WA	(i) (ii)	0 ------------- 536,601	0 ------------- 369,074	0 ------------- 447,628	0 ------------- 123,728	0 ------------- 18,644	0 ------------- 1,495,675	0 ------------- 341,259
10Alfonse Upshaw SVP,Corporate Controller & CAO	(i) (ii)	0 ------------- 510,316	0 ------------- 601,573	0 ------------- 38,950	0 ------------- 177,877	0 ------------- 21,486	0 ------------- 1,350,202	0 ------------- 0
11Donald Orndoff SVP, NFS	(i) (ii)	0 ------------- 469,482	0 ------------- 517,692	0 ------------- 140,506	0 ------------- 68,245	0 ------------- 31,515	0 ------------- 1,227,440	0 ------------- 0
12Andrew Bindman EVP, Chief Medical Officer	(i) (ii)	0 ------------- 720,179	0 ------------- 0	0 ------------- 29,010	0 ------------- 202,316	0 ------------- 12,348	0 ------------- 963,853	0 ------------- 0
13Kelly Stanford VP, Clin Ops, Mkt Integration	(i) (ii)	0 ------------- 335,147	0 ------------- 232,760	0 ------------- 75,671	0 ------------- 114,489	0 ------------- 24,534	0 ------------- 782,601	0 ------------- 0
14Kristanne Greco VP, PR, Commns & Brand Mgmt	(i) (ii)	0 ------------- 330,411	0 ------------- 227,677	0 ------------- 76,985	0 ------------- 115,456	0 ------------- 23,996	0 ------------- 774,525	0 ------------- 0
15Hong-Sze Yu VP, Brd & Corp Gov & Asst Secy	(i) (ii)	0 ------------- 285,025	0 ------------- 147,406	0 ------------- 108,681	0 ------------- 170,997	0 ------------- 27,388	0 ------------- 739,497	0 ------------- 69,146
16Joseph Smith VP, MSBD	(i) (ii)	0 ------------- 163,114	0 ------------- 259,782	0 ------------- 101,225	0 ------------- 199,203	0 ------------- 15,575	0 ------------- 738,899	0 ------------- 55,722
17Ryan Jenson Interim Corp Controller & CAO	(i) (ii)	0 ------------- 299,001	0 ------------- 197,139	0 ------------- 110,554	0 ------------- 98,471	0 ------------- 27,494	0 ------------- 732,659	0 ------------- 66,215
18Alicia Eng VP, Clinical Operations	(i) (ii)	0 ------------- 325,106	0 ------------- 240,138	0 ------------- 36,537	0 ------------- 112,861	0 ------------- 16,169	0 ------------- 730,811	0 ------------- 0
19Jennifer Graves VP, Quality, Safety & Rgnl CNE	(i) (ii)	0 ------------- 371,406	0 ------------- 203,685	0 ------------- 19,052	0 ------------- 119,899	0 ------------- 10,776	0 ------------- 724,818	0 ------------- 0
20Janet O'Hollaren VP, COO	(i) (ii)	0 ------------- 285,255	0 ------------- 361,522	0 ------------- 33,834	0 ------------- 14,500	0 ------------- 13,704	0 ------------- 708,815	0 ------------- 0
21Pamela Warren VP, HPSA - WA	(i) (ii)	0 ------------- 327,797	0 ------------- 171,608	0 ------------- 20,161	0 ------------- 114,655	0 ------------- 18,644	0 ------------- 652,865	0 ------------- 0
22Elizabeth Fleming VP, Innovation & New Bus Dev't	(i) (ii)	0 ------------- 314,321	0 ------------- 181,996	0 ------------- 26,816	0 ------------- 106,647	0 ------------- 14,970	0 ------------- 644,750	0 ------------- 0
23Laurie Guariglia VP, Information Officer-CDTS	(i) (ii)	0 ------------- 245,917	0 ------------- 151,761	0 ------------- 55,332	0 ------------- 155,295	0 ------------- 21,789	0 ------------- 630,094	0 ------------- 0
24Shawna Sweeney Assistant Secretary	(i) (ii)	0 ------------- 279,999	0 ------------- 167,083	0 ------------- 17,488	0 ------------- 95,766	0 ------------- 26,052	0 ------------- 586,388	0 ------------- 0
25Todd Hesse VP, MSBD	(i) (ii)	23,782 ------------- 266,159	0 ------------- 23,900	38,488 ------------- 15,361	2,458 ------------- 169,310	1,206 ------------- 9,019	65,934 ------------- 483,749	0 ------------- 0
26Ann Allen VP, COO	(i) (ii)	0 ------------- 144,923	0 ------------- 0	0 ------------- 173,525	0 ------------- 39,901	0 ------------- 10,084	0 ------------- 368,433	0 ------------- 0
27Maryann Bodayle Assistant Secretary	(i) (ii)	0 ------------- 170,274	0 ------------- 18,502	0 ------------- 2,234	0 ------------- 44,738	0 ------------- 10,462	0 ------------- 246,210	0 ------------- 0
28Ramon F Baez Director	(i) (ii)	14,500 ------------- 209,052	0 ------------- 0	0 ------------- 13,707	0 ------------- -12,291	0 ------------- 0	14,500 ------------- 210,468	0 ------------- 0
29Margaret E Porfido JD Director	(i) (ii)	14,500 ------------- 243,000	0 ------------- 0	0 ------------- 21,577	0 ------------- -62,832	0 ------------- 0	14,500 ------------- 201,745	0 ------------- 0
30Judith A Johansen JD Director	(i) (ii)	8,500 ------------- 259,100	0 ------------- 0	0 ------------- 9,870	0 ------------- -61,490	0 ------------- 0	8,500 ------------- 207,480	0 ------------- 0
31Sarah Yates Assistant Secretary	(i) (ii)	0 ------------- 0	0 ------------- 178,860	0 ------------- 4,920	0 ------------- 6,327	0 ------------- 0	0 ------------- 190,107	0 ------------- 0
32Alacia Broussard VP, Contracting Strategy	(i) (ii)	0 ------------- 51,415	0 ------------- 0	0 ------------- 1,956	0 ------------- 10,562	0 ------------- 3,152	0 ------------- 67,085	0 ------------- 0

Schedule J (Form 990) 2021

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 $ 637,715 Arthur Southam 467,059 Kathryn Lancaster 464,623 Janet Liang 496,329 Kimberly Horn 313,188 Mark Zemelman 272,737 Susan Mullaney 203,298 Thomas Meier 86,733 Karen Schartman 425,750 Donald Orndoff 106,741 Kristanne Greco 53,554 Hong-Sze Yu 91,157 Joseph Smith 69,988 Ryan Jenson 89,323 SOME OF THE PARTICIPANTS LISTED IN SCHEDULE J, PART II PARTICIPATED IN NONQUALIFIED SUPPLEMENTAL RETIREMENT PLANS. UNDER THESE PLANS, THE ORGANIZATION MAKES ANNUAL CONTRIBUTIONS TO A NOTIONAL ACCOUNT ON BEHALF OF EACH PARTICIPANT. CONTRIBUTIONS VARY BY POSITION, LEVEL AND PAY, AND VEST OVER TIME BASED ON AGE AND/OR SERVICE. PARTICIPANT ACCOUNTS ARE CREDITED WITH A FIXED RATE OF INTEREST, INVESTED IN AVAILABLE MUTUAL FUNDS OR A COMBINATION OF BOTH. CERTAIN OFFICERS ACCRUE A BENEFIT THAT VESTS BASED ON AGE AND SERVICE AND TARGETS A PERCENTAGE OF FINAL AVERAGE PAY LESS PRIOR PLAN OFFSETS. UNVESTED AMOUNTS ARE SUBJECT TO RISK OF FORFEITURE.
SCHEDULE J, PART I, LINE 7	NON-FIXED PAYMENTS THE ORGANIZATION PROVIDED NON-FIXED PAYMENTS TO SOME OF THE PERSONS LISTED. PAYMENTS WERE MADE UNDER DISCRETIONARY BONUS PROGRAMS AND 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. THE PLANS' ORGANIZATIONAL PERFORMANCE GOALS INCLUDED: QUALITY OF CARE AND SERVICE, MEMBERSHIP GROWTH, OPERATING INCOME, PER MEMBER EXPENSE TREND, AND COMMUNITY BENEFIT. PLAN DESIGNS, PERFORMANCE, AND PAYOUT LEVELS, AS WELL AS INDIVIDUAL PAYMENTS TO CERTAIN PERSONS, WERE REVIEWED AND APPROVED BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, COMPRISED OF INDEPENDENT DIRECTORS.
SCHEDULE J, PART II, COLUMN C	CERTAIN BOARD MEMBERS ARE ELIGIBLE FOR A RETIREE MEDICAL BENEFIT FOLLOWING RETIREMENT FROM THE BOARD. THE ACTUARIAL INCREASE OR DECREASE IN VALUE MAY CHANGE FOR VARIOUS REASONS, INCLUDING CONTINUED SERVICE, AGE, AND CHANGES IN ASSUMPTIONS, RESULTING IN NEGATIVE VALUES IN COLUMN (C) IN SOME INSTANCES.

Schedule J (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered "Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ.
MediumBullet

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

OMB No. 1545-0047

2021

Open to Public Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

Part I

Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(c) Description of transaction	(d) Corrected?
1(a) Name of disqualified person	(c) Description of transaction	Yes	No

Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22

(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	(d) Loan to or from the organization?		(e) Original principal amount	(f) Balance due	(g) In default?		(h) Approved by board or committee?		(i) Written agreement?
(a) Name of interested person	(b) Relationship with organization	(c) Purpose of loan	To	From	(e) Original principal amount	(f) Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefiting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of assistance	(d) Type of assistance	(e) Purpose of assistance

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

Cat. No. 50056A

Schedule L (Form 990) 2021

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) THERESA DIEMOND	FAMILY MEMBER OF OFFICER	90,846	COMPENSATION		No

Part V

Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).

Return Reference	Explanation

Schedule L (Form 990) 2021

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

Return Reference	Explanation
FORM 990, PART VI, LINE 1A	VOTING MEMBER AND GOVERNING BODY THE EXECUTIVE COMMITTEE, CONSISTING OF THREE DIRECTORS, HAS AUTHORITY TO ACT FOR THE BOARD BETWEEN MEETINGS EXCEPT IT HAS NO AUTHORITY TO: 1. ADOPT, AMEND OR REPEAL BYLAWS; 2.AMEND OR REPEAL ANY RESOLUTION OF THE BOARD WHICH BY ITS EXPRESS TERMS IS NOT SO AMENDABLE OR REPEALABLE; 3. ELECT, APPOINT OR REMOVE DIRECTORS, DESIGNATE COMMITTEES OF THE BOARD OR FILL VACANCIES IN THE BOARD OR IN ANY SUCH COMMITTEE; 4. DISSOLVE, MERGE OR CONSOLIDATE THE CORPORATION; 5. ADOPT, AMEND OR REPEAL THE ARTICLES OF INCORPORATION; 6. SELL, LEASE, PLEDGE, TRANSFER OR EXCHANGE ALL OR SUBSTANTIALLY ALL OF THE PROPERTY OF THE CORPORATION; 7. FIX COMPENSATION OF DIRECTORS FOR SERVING ON THE BOARD OR ON ANY COMMITTEE; 8. AUTHORIZE ANY DIRECT OR INDIRECT TRANSFER OF MONEY OR OTHER PROPERTY OR INCUR ANY INDEPTEDNESS TO OR FOR THE BENEFIT OF TRANSFEREES IN LIQUIDATION (OTHER THAN CREDITORS OF THE CORPORATION); 9. TAKE ANY OTHER ACTION WHICH THE BOARD IS NOT AUTHORIZED TO TAKE OR WHICH A COMMITTEE OF THE BOARD IS NOT AUTHORIZED TO TAKE UNDER WA LAW.
Form 990, PART VI, LINE 6	THE SOLE CORPORATE MEMBER OF THE CORPORATION IS KFHPW HOLDINGS, A WASHINGTON NONPROFIT CORPORATION.
Form 990, PART VI, LINE 7A	KFHPW HOLDINGS APPOINTS THE DIRECTORS (AND FILLS VACANCIES AND HAS AUTHORITY TO REMOVE DIRECTORS).
Form 990, PART VI, LINE 7B	THE FOLLOWING ACTIONS OF THE CORPORATION ARE RESERVED TO OR REQUIRE APPROVAL OF THE MEMBER: A) APPOINTMENT OF THE CHAIR OF THE BOARD AND THE PRESIDENT AND CEO, AND REMOVAL OF THE CHAIR OF THE BOARD, THE CEO OR ANY PRESIDENT. THE COMPENSATION OF ANY PRESIDENT AND OTHER EXECUTIVE OFFICERS OF THE CORPORATION REQUIRES APPROVAL BY THE COMPENSATION COMMITTEE OF THE ENTITY THAT SERVES AS THE OFFICIAL EMPLOYER OF RECORD FOR THE EXECUTIVE; B) SALE, LEASE, EXCHANGE, OR OTHER DISPOSITION OF, THE MORTGAGE, PLEDGE OR DEDICATION TO THE REPAYMENT OF INDEBTEDNESS, OR ANY OTHER ENCUMBRANCE OF PROPERTY OF THE CORPORATION, OR THE ACQUISITION OF ASSETS,WHETHER OR NOT IN THE USUAL OR REGULAR COURSE OF THE CORPORATION'S ACTIVITIES, WHERE THE FAIR MARKET VALUE OF SUCH CORPORATE PROPERTY OR ASSETS BEING DISPOSED OF, ACQUIRED OR ENCUMBERED EXCEEDS 10% OF THE VALUE OF THE ASSETS OF THE CORPORATION AS REFLECTED IN THE MOST RECENT ANNUAL OR QUARTERLY FINANCIAL STATEMENTS THAT ARE AVAILABLE ON THE DATE IMMEDIATELY PRECEDING THE DATE OF THE RELEVANT TRANSACTION REQUIRES MEMBER APPROVAL; C) CAPITAL EXPENDITURE EXCEEDING $150 MILLION; D) ISSUANCE OF TAX-EXEMPT BONDS E) AMENDMENT OF ARTICLES C (MEMBER), D (DIRECTORS) OR H (AMENDMENT OF BYLAWS)
Form 990, PART VI, LINE 12C	Ethics and Compliance Ongoing Monitoring and Enforcement Activities Kaiser Permanente regularly and consistently monitors and enforces compliance with the Conflicts of Interest policy in the following ways: Reporting Conflicts of Interest Concerns - The Kaiser Permanente Ethics and Compliance Hotline or Webline is available to all employees, vendors, contractors, and agents to anonymously report actual or perceived conflicts of interest. This process is managed by a third party; however, all reported allegations are provided to Ethics and Compliance for investigation, and if required, corrective action. Employees are prohibited from retaliating against or intimidating anyone who reports concerns in good faith or refuse to participate in wrongdoing. Annual Disclosure Process - Annually, Directors, Officers, Key Employees, Executives, and other employees in roles with elevated risk are required to complete a Conflicts of Interest Disclosure (COID). Responses are reviewed by Ethics and Compliance, Board Services, and / or the Governance, Accountability and Nominating Committee of the Kaiser Foundation Health Plan/Hospital Board of Directors. When actions are required, they are addressed in accordance with policies and written standards. Conflicts of interest responses and actions are maintained for tracking and reporting purposes. Ongoing Disclosure Process - In addition to the annual disclosure process and in accordance with the Conflicts of Interest policy, on an ongoing basis Ethics and Compliance receives, consults, and reports conflicts of interest matters. External Audit Review of Disclosures - Annually, as a part of the Kaiser Permanente external audit, an outside certified public accounting firm reviews the COID process and actions taken for Directors, Officers, Key Employees, and Executives. The results, inclusive of any findings, are presented to the Kaiser Foundation Health Plan/ Hospital Audit and Compliance Committee of the Board of Directors. Awareness and Enforcement - Kaiser Permanente adheres to the following general awareness and enforcement guidelines: - Annually, the Conflicts of Interest and Corrective / Disciplinary Action policies are provided and reviewed as a part of the general ethics and compliance training. - Represented employees are subject to corrective/disciplinary action provisions outlined in the regional or national collective bargaining agreements and applicable policies. - In the event disciplinary action is required due to failure to comply with applicable legal and regulatory requirements, Kaiser Permanente policies and procedures, the Code of Conduct (Principles of Responsibility), unsatisfactory performance, or misconduct disciplinary action includes, but is not limited to: * verbal discussion, coaching, and/or warning by the employee's immediate; supervisor or higher-level manager to correct the problem; * written notice, with or without final warning; * suspension, with or without final warning; or * 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, BENEFITS & HUMAN RESOURCES 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 Copy: 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: National Communications - RM Operations 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 DONATED CAPITAL $ (43,294) CHANGE IN PENSION & RETIREMENT LIABILITIES 161,119,735 OTHER THAN TEMPORARY IMPAIRMENTS (4,245,982) GAIN/LOSS ON SALE OF INVESTMENTS - BOOK 14,455,622 GAIN/LOSS ON SALE OF INVESTMENTS - TAX (8,250,808) ------------------ $ 163,035,273
FORM 990, PART III, LINE 4A-4D	I. Introduction A. About Kaiser Permanente Founded in 1945, Kaiser Permanente is recognized as one of America's leading health care providers and nonprofit health plans. We were created to meet the challenge of providing American workers with medical care during the Great Depression and World War II, when most people could not afford to go to a doctor. Since our beginnings, we have been committed to helping shape the future of healthcare. Kaiser Permanente has influenced U.S. health care through its innovations in these areas: - Prepaid health plans, which spread the cost to make it more affordable - A focus on preventing illness and disease as much as on caring for the sick - An organized, coordinated system that puts as many services as possible under one roof-all connected by an electronic medical record Kaiser Permanente has been committed to shaping the future of health and health care - and helping our members, patients, and communities experience more healthy years. We are recognized as one of America's leading health care providers and not-for-profit health plans. Since 1945, Kaiser Permanente's mission has been to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 12.5 million members in 8 states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists, and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery, and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education, and the support of community health. B. Kaiser Permanente's Approach to Community Health At Kaiser Permanente, we recognize that where we live and how we live has a big impact on our health and well-being. Our work is driven by our mission: to provide high-quality, affordable health care services and to improve the health of our members and our communities. It's also driven by our heritage of prevention and health promotion, and by our conviction that good health is a fundamental right. To be our healthiest we need more than high-quality medical care - we need to improve the conditions for health and equity in the communities we serve. What does that mean? It means addressing all the factors that affect health, such as having a safe place to live, enough money to pay the bills, access to healthy meals, and meaningful social connections. Kaiser Permanente is accelerating efforts to broaden the scope of our work - and ultimately create healthier, more equitable communities for all. Through our continued focus on expanding our community health approach, however, we laid the foundation for an acceleration of work to meet the challenges posed by the public health crises we now face. We dedicated ourselves to improving the social health of our 12.5 million members and the communities we serve. C. Kaiser Permanente's Total Contribution Kaiser Permanente provided $2.6 billion in 2021 to improve the health of our communities. The amounts attributable to Kaiser Foundation Health Plan of Washington is $81.7 million as follows: - Financial Assistance at cost - $23 million - Medicaid - $35 million - Community health improvement services and community benefit operations - $3 million - Health Professions Education - $9.5 million - Research - $7 million - Cash and in-kind contributions from community benefit - $4.2 million In addition to our direct spend, we also leverage assets from across Kaiser Permanente to help us achieve our mission to improve the health of communities. This "Total Health" strategy includes our widely recognized activities around supplier diversity, socially responsible investing and environmental stewardship.
II.Health Access	Ensuring health access means serving those most in need of health care through Medicaid, medical financial assistance, charitable health coverage, and other forms of subsidized care and coverage. It also means connecting people with wrap-around social services, healthy meals, affordable homes, safe playgrounds, and supportive schools. For many low-income people without access to health care coverage, or for those who lose their jobs and can't maintain health care coverage, an emergency room is often the only place they receive care. At Kaiser Permanente, we're working to change that with programs that lower financial barriers by providing deeply subsidized health coverage and medical financial assistance for care. We also provide information about how to access and qualify for public programs such as Medicaid and financial assistance through the marketplace to individuals who may be eligible. Kaiser Foundation Health Plan of Washington supports the health access needs of our communities through a combination of coverage and care programs. We provide coverage to low-income populations through our participation in government programs like Medicaid and the Children's Health Insurance Programs (CHIP). Similarly, we provide care to low-income populations through two key vehicles: first, via our treatment of Medicaid and CHIP enrollees, and second, via the Medical Financial Assistance (MFA) program, which is Kaiser Permanente's traditional charity care or financial assistance program (FAP). For Kaiser Foundation Health Plan, Inc. and all of its subsidiary health plans, the main way to address health access challenges is by absorbing the cost of the coverage and care programs described above. A. Coverage Having health coverage means consistent access to comprehensive and continuous medical and preventative services for people to get and stay healthy, a much better alternative to episodic care at emergency departments. Coverage is good for the patient, good for Kaiser Permanente and good for the US overall because it helps people get and stay healthy and avoid costly hospital services. i. Coverage provided through Medicaid, CHIP and other government programs 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 US population. Kaiser Permanente has responded to this challenge by developing organizational strategies to enable low-income individuals to obtain and/or retain health coverage through Medicaid, CHIP or other government programs, even as their personal or financial circumstances may be changing. At the end of 2021, Kaiser Foundation Health Plan of Washington was providing care to approximately 32,000 people through its Medicaid Managed Care contracts with other health plans. B. Care To get and/or stay healthy, people need access to high quality care by providers they trust. This care must include preventative services and required medications so that people can avoid ending up in the emergency room or requiring more extensive services down the line. Kaiser Permanente helps low income populations gain access to this type of care by leveraging the full scope of its integrated delivery system, including not only critical hospital-based services but also outpatient primary, specialty and pharmacy services. i. Care provided through Medicaid, CHIP and other government programs Kaiser Permanente provides a wide range of health care services to individuals enrolled in Medicaid, CHIP and other government programs, regardless of whether they are assigned to Kaiser Permanente or not. In addition to the individuals who received health coverage in 2021 due to Kaiser Permanente's participation in these government programs, Kaiser Foundation Health Plan of Washington also subsidized care to people who are enrolled in these programs but not formally assigned to Kaiser Foundation Health Plan. ii. Care subsidized by MFA Medical Financial Assistance program (MFA) helps low-income, uninsured, and underinsured patients receive access to care. The program provides temporary financial assistance or free care to patients who receive health care services from our providers, regardless of whether they have health coverage or are uninsured. Eligibility is based on financial need. In general, patients whose household income is at or below 200 percent, and in some regions up to 400 percent, of the federal poverty guidelines are eligible for the MFA program. Patients who are experiencing high medical expenses as compared to their income may be eligible under high medical expenses criteria, regardless of household income. The MFA program covers emergency and medically necessary health care services, pharmacy services and products, and medical supplies provided at Kaiser Permanente facilities (i.e. hospitals, medical centers, and medical office buildings), at Kaiser Permanente outpatient pharmacies, or by Kaiser Permanente providers. Over the course of 2021, Kaiser Foundation Health Plan of Washington subsidized care for a total of 17,000 people through the MFA program. C. Safety-Net Partnerships Safety net providers are a mix of public hospitals, community-based organizations such as federally qualified health centers, and other health care organizations. Safety-net health care providers have a legal mandate or explicit mission to provide care for patients who have low incomes and/or are uninsured regardless of their ability to pay. In Kaiser Permanente service areas, federally qualified health centers serve the uninsured, Medicaid, and other vulnerable populations. In addition to working families, children, the elderly, and the disabled, health centers serve students, homeless people, people living in public housing, agricultural workers, and veterans. Strengthening the safety net advances our mission to improve the health of the communities we serve as well as our equity agenda. Our communities' most vulnerable populations, including a disproportionate number of low-income people of color, rely on the safety net for their health care needs. Our support ensures that communities have access to a strong safety net that can equitably meet patients' needs and improve health outcomes. As we continue to confront COVID-19, ensuring that low-income patients and people experiencing homelessness continue to have access to high-quality health care is more important than ever. As part of Kaiser Permanente's $8.15 million commitment to COVID- 19 vaccine equity, Kaiser Foundation Health Plan of Washington provided funding of $280,000 in 2021 to multiple Federally Qualified Health Centers (FQHC) across Washington state. Efforts focused on serving the safety net population and connecting them to vaccines and aiding equitable vaccine access across disproportionately impacted communities. Kaiser Foundation Health Plan of Washington's support encouraged FQHC capacity to leverage federal support for vaccines. Kaiser Foundation Health Plan of Washington also awarded $275,000 to Project Access Northwest and Project Access Pierce County. This partnership will ensure organizations can collaborate with the health care community to open doors to medical and dental care for low-income individuals with limited access. It will also support the specialty care coordination program to ensure that low-income people have access to necessary and appropriate specialty care. Support staff will provide not only the care coordination, but also ancillary patient support services such as interpreters, transportation, prescriptions, and medical equipment.
III.Social Health	Healthy individuals need healthy communities, and healthy communities need healthy people to thrive. At Kaiser Permanente, we are working to improve the conditions for health and equity in communities by addressing the root causes of health, such as healthy food, economic opportunity, affordable housing, and safe and supportive schools. We screen patients for social factors influencing their health and connect them to resources when needed - both community-based programs and Kaiser Permanente-funded initiatives. These improvements grow from our collaboration with each community to co-design and co-create solutions that truly make a positive impact. By engaging members, communities, our sizeable workforce, and all of our organization's considerable assets, we are working to create communities that are among the healthiest in the nation, and inspiring greater health for America and the world. A. Economic Opportunity Inclusive economic growth is critical to both individual and community health. When there is a lack of economic opportunity in communities, the prospects for upward social mobility are diminished, often resulting in poorer health and higher mortality rates for people living in those communities. By contrast, economic growth and opportunity provides individuals with jobs, income, a sense of purpose, and opportunities to improve their economic circumstances overtime. As a large, influential institution in our communities, Kaiser Permanente also recognizes that the way we do business can support economic opportunity in local communities through how we hire, purchase, build our facilities and partner with communities. Some ways that we're helping revitalize and grow our communities by strengthening economic opportunity include: - Providing good jobs to individuals facing barriers to employment through high-impact hiring and workforce pipeline efforts. - Pursuing a social impact investment strategy to support impact investments aimed at addressing key social issues that have a significant impact on health. - Purchasing goods and services from local minority- and women-owned businesses and encouraging good employment practices by our vendor partners. - Building new facilities with an emphasis on positive local community impact, including local construction hiring, local and diverse purchasing, healthy and sustainable design features, neighborhood revitalization, and deep community engagement. - Partnering with community organizations to grow local business capacity, increase access to good jobs, and support stable, quality, affordable housing. Kaiser Permanente is also deepening its efforts to get at the heart of inequities, addressing systemic racism, breaking cycles of trauma, and creating economic opportunities for communities that have endured decades of underinvestment. We are working with communities striving to overcome systemic and structural economic disadvantage and supporting the resiliency of businesses owned by Black and other historically underrepresented individuals. We recognize that it will require sustained efforts to increase access to business capital and build capacity for growth. Success for these communities requires intentional, long-term investment, and ongoing work to dismantle racist systems that create barriers to success. Kaiser Foundation Health Plan of Washington approved $1,000,000 of which, $342,882 was paid in 2021 to United Way of Pierce County to support their Centers for Strong Families. Fund will be used to provide the staffing, training and outreach for nine Center for Strong Family sites to provide financial coaching and workforce supports to financially precarious families in Pierce County. These centers will help families increase income, decrease expenses, build credit and acquire assets. United Way of Pierce County will also deepen its commitment to addressing racial wealth disparities by adopting a new Diversity, Equity and Inclusion approach into every aspect of its program and dismantling barriers to accessing the program. Kaiser Foundation Health Plan of Washington provided funding of $140,000 to support the Tacoma Urban League and the Pierce Center for Arts & Technology. Support will include building pathways for achievement and self-sufficiency that enable economic and social progress, and achievement of social equity for underserved individuals and communities. Funding will also be used to support the Tacoma Urban League's Black Empowerment Center to improve and protect the economic security of African Americans in Tacoma Pierce County by enhancing asset-building services, support with financial coaching and entrepreneurial support for small business development. B. Housing for Health Without a safe place to call home, it's nearly impossible to focus on basic health and medical needs. Kaiser Permanente is leading efforts to end homelessness and preserve affordable housing by making strategic impact investments, shaping policy, and catalyzing innovative partnerships. The COVID-19 pandemic had a significant impact on social health needs in our communities, and people experiencing homelessness or housing insecurity were among the most vulnerable. Even in the absence of COVID-19, people experiencing homelessness face a higher risk of death than housed populations. Increasing affordable housing preserves homes that improve total health and lift residents socially and economically. Nationwide, people of color are disproportionately impacted by homelessness and housing insecurity, further exacerbated by COVID-19. The health crisis and economic fallout from the pandemic have hit low-income and communities of color hardest and threaten to widen the health equity gap in our country even further. Kaiser Permanente cannot solve the affordable housing and homelessness crisis alone. Only through innovative partnerships, strategic investments, and impactful storytelling can we move the needle for our most vulnerable communities. Kaiser Permanente will continue to drive national housing for health initiatives that create more healthy years for all. Kaiser Foundation Health Plan of Washington also partnered with Community Solutions International, Inc. to help accelerate efforts to end chronic homelessness in communities within Kaiser Permanente's national footprint. Our partnership with Community Solutions includes supporting their capacity and ability to successfully conduct Built for Zero work in Kaiser Permanente communities. It also supports building the evidence base for validating the Built for Zero methodology and creating other models to help communities achieve quality data, an essential piece of the Built for Zero process. New proof points and shared learning around Built for Zero's success will help build out a roadmap to help any community reduce and end homelessness.
C.Thriving Schools	At Kaiser Permanente, we're committed to not only delivering great health care but also creating communities where people can be healthy in all the places they live, learn, work, and play. Thriving Schools brings together Kaiser Permanente's extensive health care expertise and our partnerships with nationally recognized and trusted organizations working to support schools in becoming a beacon of health in their community. Thriving Schools takes an integrated approach to school health, curating the best thinking and guidance on how to keep students, staff, teachers, and families healthy across four dimensions of health: physical health, mental health, social health, and equity and access. Taking an integrated approach to health means supporting schools and districts in advancing their wellness and educational goals by incorporating health-related strategies into school and district improvement efforts. Like the communities in which they sit, schools often reflect a diversity of cultures, beliefs, and experiences. As such, the services and opportunities they provide must ensure that all students and staff are given the opportunity to reach their full potential. Thriving Schools' integrated approach explicitly addresses equity and inclusion, both in the assessment tools we use and in the resources we offer for school staff and district leaders. Kaiser Foundation Health Plan of Washington partnered with the Alliance for Healthier Generation to advance the RISE (Resilience in School Environments) initiative, an enterprise-wide effort. RISE is designed to empower schools and districts to create safe and supportive learning environments by cultivating practices that strengthen the social and emotional health of all students and school staff. RISE is the first national initiative of its kind specifically designed for schools and districts to improve safety, connectedness, and relationships among students and staff; increase skills related to social and emotional learning for students and staff; increase mental health supports; and increase job satisfaction, including reducing staff member stress. Kaiser Foundation Health Plan of Washington awarded $500,000 to the Northwest Educational Service District's Project Support Health and Resiliency in Education (SHARE) program. This effort collaborates with stakeholders to expand organizational capacity and build upon existing family, school, provider and community partnerships. Promotion and awareness and mental health issues for both staff and students will be addressed through a variety of trainings and workshops to improve school wellness culture and reduce stigma. Funding will also provide an opportunity to demonstrate our commitment to addressing the unique needs of the rural communities in our service area. D. Thrive Local Social determinants of health -- the conditions in which people live, learn, work, and play - affect a wide range of health risks and outcomes. Access to quality health care is critical, but social factors, such as lack of safe housing and transportation, inadequate education or job opportunities, and poor access to good nutrition and physical activity, inevitably create barriers to health and wellbeing. While many social resources may exist in a community, they are often unknown to those most in need and disconnected from one another even when serving the same client, creating confusion and exacerbating stress for community members. Through the Thrive Local initiative, launched in late 2019, Kaiser Permanente is establishing bi-directional electronic community networks in every Kaiser Permanente service area. The networks enable health care providers, safety net clinics, social service agencies, government programs, and other participants to make, receive, and track patient and client referrals. Health care providers can refer patients to organizations that address social factors affecting their health, and social service providers can coordinate effectively among themselves to improve community-wide care delivery. Data aggregated through the network technology provides a robust source of information on local social needs and service gaps to drive collaborative community planning. Kaiser Permanente's Thrive Local contributions in 2021 facilitated growth of these community networks by funding community-based organizations to invest in change management, technology, or staffing to assist them in joining the network, as well as "anchor" social service organizations that participated in outreach to build the networks, ensuring they reflect the needs of their respective communities. Kaiser Foundation Health Plan of Washington awarded community-based organizations approximately $100,000 to assist community partners to join the community network and to serve as a "champion" to support outreach and on-boarding of local social service providers. Community based organizations address a variety of needs including, housing insecurity and homelessness; health and behavioral health; child, youth, family, and senior services; nutrition and food insecurity; financial support and employment; and domestic and interpersonal violence. Funds will be used to provide much needed services to under-served communities and will include working in partnership with local employers, educators, government and community organizations. This effort will facilitate participation of key social service providers in the community networks. E. Food for Life Food for Life is Kaiser Permanente's comprehensive approach to transforming the economic, social, and policy environments connected to food so that people across the nation have access to, and can afford, healthy food. It includes increasing individual and family purchasing power; providing enhanced nutrition to vulnerable and sick members; improving access to community resources; and advancing local and national food security efforts through research, policy advocacy, thought leadership and community support. Kaiser Permanente recognizes that solving for food security goes beyond just giving people food. People's attitudes toward food, the economic tradeoffs they must make, the stigma around food assistance, and social and culture dimensions all play an important role. Food insecurity is linked to a variety of adverse health outcomes, including poor chronic disease management, developmental and mental health problems, increased hospitalizations, and higher costs of care. Kaiser Foundation Health Plan of Washington awarded $150,000 to United Way of King County in support of their Fuel Your Future campaign which transforms schools and communities by leveraging existing federal nutrition programs to reduce childhood hunger. The Fuel Your Future campaign will work statewide to increase access to school breakfast, afterschool meals, summer meals, and SNAP for low-income youth. The Fuel Your Future campaign leverages federal nutrition programs to increase access to critical food resources. This project will address food insecurity by ensuring that low-income youth are connected to three healthy meals per day, and their families are connected to the Basic Food (SNAP) grocery benefits that they are entitled to receive.
IV.Policy and Systems	A. Thriving Cities The places where we live, learn, work, and play - our cities and towns, our schools, our homes, our neighborhoods - have an enormous impact on our health. And how we shape those places, through public policy and the support for healthy environments, has the potential to make real, lasting impacts on our surroundings and our everyday quality of life. Through Kaiser Foundation Health Plan of Washington's ongoing partnerships with community organizations, municipal leaders, and public health champions, we are working to incorporate health, equity and sustainability considerations into public policy and the built environment in ways that influence how neighborhoods take shape and grow. In 2018, we joined forces with the de Beaumont Foundation, a leader in public health philanthropy, to help U.S. cities thrive through the CityHealth initiative. Created by the de Beaumont Foundation to promote practices that make cities healthier, CityHealth tracks and reports on proven policies, and works with cities to advance policies that achieve community health priorities. Through this relationship, Kaiser Foundation Health Plan of Washington will leverage its deep expertise in health policy, government relations, and community-based prevention to accelerate cities' efforts to improve people's health and quality of life. For Kaiser Foundation Health Plan of Washington, this partnership complements the organization's established approach to community health - bringing together health leaders, clinicians and community partners to help solve the social, economic and environmental health challenges facing the who live in the communities it serves. Policy menu includes: earned sick leave, high-quality accessible pre-Kindergarten, affordable housing/inclusionary zoning, complete streets, safer alcohol sales, Tobacco 21, smoke-free indoor air, food safety and restaurant inspection rating, healthy food procurement. Kaiser Foundation Health Plan of Washington also supported efforts to partner with the Vose River Charitable Fund, which is an organization that develops tools and collaborates with other nonprofit organizations and government health departments to support effective policies and the public health workforce. Our partnership with Vose River Charitable Fund will ensure the CityHealth initiative has sufficient staffing and consultants, policy-specific technical assistance, policy assessment research and communications support. Funding will also support a new policy menu and greater reach among cities in Kaiser Permanente's footprint. B. Environmental Stewardship At Kaiser Permanente, we believe it is our obligation as a health care provider to minimize our environmental impact. We work to be environmentally responsible throughout our organization - in how we power our facilities, purchase food and medical supplies and equipment, manage waste, and invest in our communities. We also prioritize partnerships with others to develop policies and systems that strengthen community health and protect our environment. Our mission to improve the total health of our members and the communities we serve compels us to take bold steps to reduce our impact on the climate and increase understanding of the connection between climate and health. We know one way to improve the health of the communities we serve is by improving their environmental conditions. In 2020, we became the first U.S. health system to become carbon neutral as an organization, completing the "last mile" toward this milestone through investment in carefully chosen carbon offset projects. By eliminating our carbon footprint, we have taken measurable action to improve conditions that lead to poor health, deepening our commitment to create more healthy years for all, and supporting the medical community's pledge to do no harm. In 2021, we also dedicated 26.62% of overall spending on products to items that met our Environmentally Preferable Purchasing standards and 100% of our overall operations were powered by renewable electricity. C. Health Professionals Education Our Graduate Medical Education (GME) program provides training and education for medical residents and interns in the interest of educating the next generation of physicians. The nationally acclaimed program attracts some of the top medical school graduates in the United States and serves as a national model by exposing future health care providers to an integrated health care delivery system. Residents are offered the opportunity to serve a large, culturally diverse patient base in a setting with sophisticated technology and information systems, established clinical guidelines and an emphasis on preventive and primary care. The majority of medical residents are studying within the primary care medicine areas of family practice, internal medicine, ob/gyn, pediatrics, preventive medicine, and psychiatry. In addition to GME, we provide a range of training and education programs for nurse practitioners, nurses, radiology and sonography technicians, physical therapists, post-graduate psychology and social work students, pharmacists, and other non-physician health professionals. D. Research Kaiser Permanente's research efforts are core to the organization's mission to improve population health, and its commitment to continued learning. Kaiser Permanente researchers study critical health issues such as cancer, cardiovascular conditions, diabetes, behavioral and mental health, and health care delivery improvement. Kaiser Permanente's research is broadly focused on 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 conduct research due to its rich, longitudinal, electronic clinical databases that capture virtually complete health care delivery, payment, decision-making and behavioral data across inpatient, outpatient, and emergency department settings for its geographically and demographically diverse members. In 2021, Kaiser Foundation Health Plan of Washington engaged in 338 active studies (including 16 clinical trials) and published 337 journal articles. Kaiser Permanente Washington Health Research Institute (KPWHRI) has been conducting public-interest research on preventing and effectively treating major health problems, optimizing patient care, and addressing social determinants of health since 1983. Its mission is to improve health, well-being, and health equity for Kaiser Permanente members and all communities through collaborative research and evaluation. In 2021, the Kaiser Permanente Washington Health Research Institute published the following research: Firearms are the most common method of suicide, one of the "diseases of despair" driving increased mortality in the US over the past decade. Research scientists sought to determine if patients would respond to a standard question about firearm access on a routine mental health monitoring questionnaire. In a study published in JAMA Health Forum, 83-91% of patients who completed the questionnaire answered the firearm access question. 15-21% of those reported that they had access to a firearm. The authors suggested that this screening practice may improve efforts to identify and engage patients at risk of suicide in discussions about securing firearms.
V.Pandemic Response	After two years, the COVID-19 pandemic continues to be a significant risk in our communities, especially for people who are not yet vaccinated. We rapidly rolled out vaccines, and now boosters, and administered COVID-19 tests while managing new and unpredictable variants like delta and omicron as they surfaced. Kaiser Permanente awarded grants to dozens of community-based organizations, safety net providers, and trusted messengers in every market we serve to expand public education and to create trusted messenger campaigns to increase education and to remove barriers for individuals and communities at highest risk for contracting COVID-19. Kaiser Permanente's COVID-19 Social Health Playbook provides care teams with guidance and tools for screening patients for social needs, connecting them to help, and following up to ensure their needs are met. The guidelines have a strong focus on addressing COVID-19 patients' social needs to improve their health outcomes and to prevent further transmission of the virus. Kaiser Permanente has been part of studies to improve our understanding of COVID-19 and develop tools to prevent and treat the disease, including clinical trials to determine the safety and effectiveness of coronavirus vaccines.

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

Cat. No. 51056K

Schedule O (Form 990) 2021

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

2021

Open to Public Inspection

Name of the organization

KAISER FOUNDATION HEALTH PLAN OF WASHINGTON

Employer identification number

91-0511770

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
(1) COLUMBIA MEDICAL ASSOCIATES LLC ONE KAISER PLAZA 15L OAKLAND,CA94612 20-0986848	COMP MED CARE	WA	0	0	KFHPW
(2) COLUMBIA CLINIC LLC ONE KAISER PLAZA 15L OAKLAND,CA94612	INACTIVE	WA	0	0	CMA LLC

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 HOSPITALS ONE KAISER PLAZA 15L OAKLAND,CA94612 94-1105628	HEALTH CARE	CA	501(C)(3)	3	NA		No
(2)KAISER FOUNDATION HEALTH PLAN INC ONE KAISER PLAZA 15L OAKLAND,CA94612 94-1340523	HEALTH CARE	CA	501(C)(3)	10	NA		No
(3)KAISER FOUNDATION HEALTH PLAN OF CO ONE KAISER PLAZA 15L OAKLAND,CA94612 84-0591617	HEALTH CARE	CO	501(C)(3)	10	KFHP INC	Yes
(4)KAISER FOUNDATION HEALTH PLAN OF GA ONE KAISER PLAZA 15L OAKLAND,CA94612 58-1592076	HEALTH CARE	GA	501(C)(3)	10	KFHP INC	Yes
(5)KAISER FOUNDATION HEALTH PLAN OF THE MAS ONE KAISER PLAZA 15L OAKLAND,CA94612 52-0954463	HEALTH CARE	MD	501(C)(3)	10	KFHP INC	Yes
(6)KAISER FOUNDATION HEALTH PLAN OF NW ONE KAISER PLAZA 15L OAKLAND,CA94612 93-0798039	HEALTH CARE	OR	501(C)(3)	10	KFHP INC	Yes
(7)KAISER HOSPITAL ASSET MANAGEMENT INC ONE KAISER PLAZA 15L OAKLAND,CA94612 94-3299125	ASSET MGMT	CA	501(C)(3)	12-I	KFH	Yes
(8)KAISER HEALTH PLAN ASSET MANAGEMENT INC ONE KAISER PLAZA 15L OAKLAND,CA94612 94-3299124	ASSET MGMT	CA	501(C)(3)	12-I	KFHP INC	Yes
(9)CAMP BOWIE SERVICE CENTER ONE KAISER PLAZA 15L OAKALAND,CA94612 94-3299123	ADMIN	CA	501(C)(3)	12-I	KFHP INC	Yes
(10)LOKAHI ASSURANCE LTD ONE KAISER PLAZA 15L OAKLAND,CA94612 91-2171891	WC PLACEMENT	HI	501(C)(3)	12-I	KFHP INC	Yes
(11)1800 HARRISON FOUNDATION ONE KAISER PLAZA 15L OAKLAND,CA94612 94-3317484	FINANCING	CA	501(C)(3)	12-I	KFHP INC	Yes
(12)KAISER HOSPITAL ASSISTANCE CORPORATION ONE KAISER PLAZA 15L OAKLAND,CA94612 31-1779500	FINANCING	CA	501(C)(3)	12-I	KFH	Yes
(13)KAISER HEALTH ALTERNATIVES ONE KAISER PLAZA 15L OAKLAND,CA94612 93-0954562	HEALTH CARE	OR	501(C)(3)	10	KFHP INC	Yes
(14)KP BERNARD J TYSON SCHOOL OF MEDICINE ONE KAISER PLAZA 15L OAKLAND,CA94612 81-4053028	MEDICAL EDU	CA	501(C)(3)	2	KFH	Yes
(15)KFHPW HOLDINGS ONE KAISER PLAZA 15L OAKLAND,CA94612 93-0480268	HEALTH CARE	WA	501(C)(3)	12-I	KFHP INC	Yes
(16)GROUP HEALTH NORTHWEST ONE KAISER PLAZA 15L OAKLAND,CA94612 91-1216856	INACTIVE	WA	501(C)(3)	12-I	KFHP OF WA	Yes
(17)KAISER FND FOR THE ADV OF INTEGRATED HC ONE KAISER PLAZA 15L OAKLAND,CA94612 82-3819611	ADVOCACY	CA	501(C)(4)	N/A	KFHP INC	Yes
(18)GROUP HEALTH OF WASHINGTON ONE KAISER PLAZA 15L OAKLAND,CA94612 91-1314907	INACTIVE	WA	501(c)(3)	12-I	KFHP OF WA	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) NXT CAP SR FD ILLC 191 N Wacker Dr 1200 chicago,IL60606 37-1651297	investment	DE	NA	NONE	0	0			0

Part IV

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership	Yes	No
(1) OAK TREE ASSURANCE LTD ONE KAISER PLAZA 15L OAKLAND,CA94612 03-0329760	INSURANCE	VT	NA	C CORP	0	0		Yes
(2) KAISER PERMANENTE INSURANCE COMPANY ONE KAISER PLAZA 15L OAKLAND,CA94612 94-3203402	INSURANCE	CA	NA	C CORP	0	0		Yes
(3) KAISER PERMANENTE INTERNATIONAL ONE KAISER PLAZA 15L OAKLAND,CA94612 94-3245176	CONSULTING	CA	NA	C CORP	0	0		Yes
(4) GROUP HEALTH OF SERVICES INC ONE KAISER PLAZA 15L OAKLAND,CA94612 91-1392222	INACTIVE	WA	NA	C CORP	0	0	100.000 %	Yes
(5) KFHP OF WASHINGTON OPTIONS INC ONE KAISER PLAZA 15L OAKLAND,CA94612 91-1467158	INSURANCE	WA	NA	C CORP	976,448,251	363,315,087	100.000 %	Yes

Schedule R (Form 990) 2021

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

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

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

Yes

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) .......................

Yes

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

Yes

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) ...................

Yes

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

Yes

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	B	435,380	PER AGREEMENT
(2) KAISER FOUNDATION HEALTH PLAN INC	L	23,008,059	PER AGREEMENT
(3) KAISER FOUNDATION HEALTH PLAN INC	M	73,619,811	PER AGREEMENT
(4) KAISER FOUNDATION HEALTH PLAN INC	P	380,549,499	PER AGREEMENT
(5) KAISER FOUNDATION HEALTH PLAN INC	Q	50,697,114	PER AGREEMENT
(6) KAISER FOUNDATION HEALTH PLAN INC	R	130,743,092	PER AGREEMENT
(7) KAISER FOUNDATION HEALTH PLAN INC	S	257,230,539	PER AGREEMENT
(8) KAISER FOUNDATION HOSPITALS	E	175,000,000	PER AGREEMENT
(9) KAISER FOUNDATION HOSPITALS	M	17,454,291	PER AGREEMENT
(10) KAISER FOUNDATION HOSPITALS	P	37,173,055	PER AGREEMENT
(11) KAISER FOUNDATION HOSPITALS	Q	10,355,463	PER AGREEMENT
(12) KAISER FOUNDATION HOSPITALS	R	554,603	PER AGREEMENT
(13) KAISER FOUNDATION HOSPITALS	S	1,288,181	PER AGREEMENT
(14) KAISER FDN HEALTH PLAN OF COLORADO	L	788,566	PER AGREEMENT
(15) KAISER FDN HEALTH PLAN OF COLORADO	M	492,199	PER AGREEMENT
(16) KAISER FDN HEALTH PLAN OF COLORADO	P	208,111	PER AGREEMENT
(17) KAISER FDN HEALTH PLAN OF COLORADO	Q	30,769	PER AGREEMENT
(18) KAISER FDN HEALTH PLAN OF COLORADO	S	332,835	PER AGREEMENT
(19) KAISER FDN HEALTH PLAN OF NORTHWEST	L	5,931,190	PER AGREEMENT
(20) KAISER FDN HEALTH PLAN OF NORTHWEST	P	260,905	PER AGREEMENT
(21) KAISER FDN HEALTH PLAN OF NORTHWEST	Q	460,527	PER AGREEMENT
(22) KAISER FDN HEALTH PLAN OF WASHINGTON OPTIONS	L	138,932,612	PER AGREEMENT
(23) KAISER FDN HEALTH PLAN OF WASHINGTON OPTIONS	P	11,693,986	PER AGREEMENT
(24) KAISER FDN HEALTH PLAN OF WASHINGTON OPTIONS	Q	3,380,765	PER AGREEMENT
(25) CAMP BOWIE SERVICE CENTER	M	190,702	PER AGREEMENT
(26) CAMP BOWIE SERVICE CENTER	P	5,813,432	PER AGREEMENT
(27) LOKAHI ASSURANCE LTD	L	19,098,926	PER AGREEMENT
(28) LOKAHI ASSURANCE LTD	M	10,756,643	PER AGREEMENT
(29) LOKAHI ASSURANCE LTD	Q	10,546,721	PER AGREEMENT
(30) LOKAHI ASSURANCE LTD	S	4,874,605	PER AGREEMENT

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

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) 2021

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 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	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	7
5	Total number of individuals employed in calendar year 2021 (Part V, line 2a) ......	5	9,716
6	Total number of volunteers (estimate if necessary) .............	6	535
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	14,612,132
b	Net unrelated business taxable income from Form 990-T, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	53,216,864	53,099,970
9	Program service revenue (Part VIII, line 2g) .........	3,790,234,280	3,897,219,296
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	77,327,184	-26,435,159
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	1,188,287	573,613
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	3,921,966,615	3,924,457,720
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	19,675,183	16,433,447
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)	829,229,782	824,641,979
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)....	3,195,239,375	3,243,844,307
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	4,044,144,340	4,084,919,733
19	Revenue less expenses. Subtract line 18 from line 12.......	-122,177,725	-160,462,013
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	2,591,753,080	2,969,156,636
21	Total liabilities (Part X, line 26).............	1,068,969,316	1,474,865,943
22	Net assets or fund balances. Subtract line 21 from line 20.....	1,522,783,764	1,494,290,693

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 3,698,892,004 including grants of $ 12,186,721 ) (Revenue $ 3,811,055,019 )
	MEMBER HEALTH CARE SERVICES AND MEDICAL TRAINING FOR CARE IMPROVEMENT KAISER FOUNDATION HEALTH PLAN OF WASHINGTON, INC. (KFHP-WA) 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 WASHINGTON EDUCATES AND TRAINS MEDICAL STUDENTS AND OTHER HEALTH CARE PROFESSIONALS AND PROMOTES SCIENTIFIC AND NURSING EDUCATION IN ORDER TO IMPROVE CARE.

4b	(Code: ) (Expenses $ 71,753,922 including grants of $ 0 ) (Revenue $ 36,715,953 )
	MEDICAID AND OTHER GOVERNMENT SPONSORED PROGRAMS KAISER FOUNDATION HEALTH PLAN OF WASHINGTON (KFHP-WA) IS COMMITTED TO IMPROVING MEDICAL CARE FOR BENEFICIARIES OF MEDICAID AND OTHER GOVERNMENT SPONSORED PROGRAMS, NOT ONLY FOR KFHP-WA MEMBERS, BUT ALSO, WITHIN THE COMMUNITIES WE SERVE. AT THE END OF 2021, APPROXIMATELY 32,000 INDIVIDUALS WERE RECEIVING BENEFITS THROUGH KFHP-WA'S MEDICAID MANAGED CARE CONTRACTS.

4c	(Code: ) (Expenses $ 23,002,615 including grants of $ 0 ) (Revenue $ 0 )
	CHARITY CARE (MEDICAL FINANCIAL ASSISTANCE) KAISER FOUNDATION HEALTH PLAN OF WASHINGTON (KFHP-WA) PROVIDES CHARITY CARE TO LOW INCOME VULNERABLE PATIENTS THROUGH THE MEDICAL FINANCIAL ASSISTANCE (MFA) PROGRAM. KFHP-WA 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 2021, THIS PROGRAM ASSISTED A TOTAL OF 17,000 PATIENTS THROUGH FINANCIAL ASSISTANCE.

	(Code: ) (Expenses $ 4,246,726 including grants of $ 73,086,491 ) (Revenue $ 49,448,324 )
	SEE EXEMPT PURPOSE ACHIEVEMENTS IN SCH O

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 73,086,491 including grants of $ 4,246,726 ) (Revenue $ 49,448,324 )
4e	Total program service expenses3,866,735,032

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	62,270	47,706,226	9,257,854

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	49,212,005

f	All other contributions, gifts, grants, and similar amounts not included above		1f	3,887,965

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

h Total. Add lines 1a-1f.......		53,099,970

		Business Code
2a	MEMBERS HEALTH DUES	900099	2,026,708,775	2,026,708,775
b	MEDICARE	900099	1,063,166,718	1,063,166,718
c	COPAYS, DEDUCTIBLES, FEES	900099	368,316,206	368,316,206
d	NON-PLAN & INDUSTRIAL	900099	68,951,818	54,339,686	14,612,132
e	OTHER PROGRAM SERVICE	900099	370,075,779	370,075,779
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		3,897,219,296

3 Investment income (including dividends, interest, and othersimilar amounts) ......			-34,507,603			-34,507,603
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents		468,440	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	468,440	6c
d	Net rental income or (loss).......			468,440			468,440
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory	108,111	456,573,233	7a
b	Less: cost or other basis and sales expenses	286,475	448,322,425	7b
c	Gain or (loss)	-178,364	8,250,808	7c
d	Net gain or (loss).........			8,072,444			8,072,444
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	33,298			33,298
b	GIFT SHOP REVENUE		453220	31,989			31,989
c	CAFETERIA REVENUE		722514	39,886			39,886
d	All other revenue ....
e	Total. Add lines 11a–11d ......			105,173
12	Total revenue. See instructions.....			3,924,457,720	3,882,607,164	14,612,132	-25,861,546

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	16,244,955	16,244,955
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. .............	188,492	188,492
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	188,548		188,548
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	90,846		90,846
7	Other salaries and wages........	690,027,926	620,997,186	69,030,740	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	62,282,820	62,282,820
9	Other employee benefits .......	21,518,761		21,518,761
10	Payroll taxes ...........	50,533,078	50,533,078
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	670,571		670,571
c	Accounting ...........	1,068,765		1,068,765
d	Lobbying ...........	132,000		132,000
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	365,324		365,324
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	0
12	Advertising and promotion ....	11,924,819	6,878,859	5,045,960
13	Office expenses .......	24,504,633	24,203,383	301,250
14	Information technology ......	62,313,705	25,737,635	36,576,070
15	Royalties ..	0
16	Occupancy ...........	31,952,505	31,952,505
17	Travel ............	1,485,396	1,467,122	18,274
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	243,912		243,912
20	Interest ...........	2,822,916	2,822,916
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	93,883,589	93,883,589
23	Insurance ...	16,745,480	16,745,480
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	PURCHASED MEDICAL SVC	1,548,037,146	1,548,037,146
b	SUPPLIES - PHARMACY, OFFICE	707,260,028	672,031,269	35,228,759
c	BASIC CONTRACTUAL PAYMENTS	501,611,425	501,611,425
d	PURCHASED NON-MEDICAL SVC	152,450,364	151,148,126	1,302,238
e	All other expenses	86,371,729	39,969,046	46,402,683
25	Total functional expenses. Add lines 1 through 24e	4,084,919,733	3,866,735,032	218,184,701	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 .........			46,234,810	2	19,780,379
3	Pledges and grants receivable, net ......			0	3	0
4	Accounts receivable, net .............			121,950,993	4	180,282,698
5	Loans and other receivables from 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 ............			21,304,811	8	23,230,367
9	Prepaid expenses and deferred charges ......			18,603,473	9	204,474,833
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	1,309,319,259
b	Less: accumulated depreciation	10b	349,852,385	961,453,634	10c	959,466,874
11	Investments—publicly traded securities .			713,441,819	11	936,877,993
12	Investments—other securities. See Part IV, line 11 .....			23,799,538	12	25,913,039
13	Investments—program-related. See Part IV, line 11 ..			0	13	0
14	Intangible assets ...............			297,298,789	14	383,336,979
15	Other assets. See Part IV, line 11 ...........			387,665,213	15	235,793,474
16	Total assets. Add lines 1 through 15 (must equal line 33)...			2,591,753,080	16	2,969,156,636

17	Accounts payable and accrued expenses .....	495,748,503	17	514,943,442
18	Grants payable ...	0	18	0
19	Deferred revenue .........	30,049,555	19	24,219,442
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	543,171,258	25	935,703,059
26	Total liabilities. Add lines 17 through 25..	1,068,969,316	26	1,474,865,943

	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 .....	0	29	0
30	Paid-in or capital surplus, or land, building or equipment fund ...	1,863,496,806	30	1,863,453,512
31	Retained earnings, endowment, accumulated income, or other funds	-340,713,042	31	-369,162,819
32	Total net assets or fund balances ...........	1,522,783,764	32	1,494,290,693
33	Total liabilities and net assets/fund balances ........	2,591,753,080	33	2,969,156,636

1	Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
2	Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to separately file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A; don't file with Form 990). . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
3	Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with Respect to Certain Foreign Corporations. (see Instructions for Form 5471). . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
4	Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) .	Yes	No
5	Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with Respect to Certain Foreign Partnerships (see Instructions for Form 8865). . . . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No
6	Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to separately file Form 5713, International Boycott Report (see Instructions for Form 5713; don't file with Form 990).. . . . . . . . . . . . . . . . . . . . . . . . . . . .	Yes	No