Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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.) | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 | ||||
| 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 2023 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-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| SCHEDULE E, LINE 3 | KAISER PERMANENTE BERNARD J. TYSON SCHOOL OF MEDICINE (KPSOM) HAS A POLICY OF NON-DISCRIMINATION AGAINST PROSPECTIVE AND CURRENT STUDENTS, WHICH HAS BEEN APPROVED BY THE BOARD OF DIRECTORS OF KPSOM. |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART V, LINE 2A | ALL COMPENSATED OFFICERS, DIRECTORS AND EMPLOYEES PERFORMING SERVICES FOR KAISER PERMANENTE BERNARD J. TYSON SCHOOL OF MEDICINE, INC.(KPSOM) ARE EMPLOYEES OF OTHER KAISER ORGANIZATIONS. KPSOM IS RECHARGED BY OTHER KAISER ORGANIZATIONS FOR EMPLOYEES' TIME. |
| FORM 990, PART VI, LINE 1A | THE EXECUTIVE COMMITTEE, CONSISTING OF EIGHT DIRECTORS INCLUDING THE BOARD CHAIR, CHAIRS OF OTHER STANDING COMMITTEES, ONE KFHP/H DIRECTOR AND ONE PMG DIRECTOR, HAS AUTHORITY TO ACT FOR THE BOARD BETWEEN MEETINGS EXCEPT IT HAS NO AUTHORITY TO: 1. APPROVE ANY ACTION FOR WHICH CA NONPROFIT PUBLIC BENEFIT CORPORATION LAW OR THIS CORPORATION'S BYLAWS ALSO REQUIRE APPROVAL OF THE MEMBER; 2. FILL VACANCIES ON THE BOARD OR ON ANY COMMITTEE WHICH HAS THE AUTHORITY OF THE BOARD; 3. APPOINT OR REMOVE THE DEAN; 4. ADOPT, AMEND OR REPEAL BYLAWS; 5. AMEND OR REPEAL ANY RESOLUTION OF THE BOARD WHICH BY ITS EXPRESS TERMS IS NOT SO AMENDABLE OR REPEALABLE; 6. APPOINT COMMITTEES OF THE BOARD OR APPOINT THE MEMBERS THEREOF; 7. DETERMINE OR ADJUST IN ANY WAY THE COMPENSATION OF THE DEAN OR OTHERS WHOSE COMPENSATION IS UNDER THE PURVIEW OF THE COMPENSATION COMMITTEE OR THE BOARD; OR 8. APPROVE ANY ASPECT OF A TRANSACTION INVOLVING THE CORPORATION WHEN A MEMBER OF THE BOARD OF DIRECTORS HAS A MATERIAL FINANCIAL INTEREST IN THAT TRANSACTION. |
| FORM 990, PART VI, LINE 4 | ARTICLE IV, SECTION 3 OF THE BYLAWS WAS AMENDED IN SEPTEMBER 2023 TO CHANGE THE DESIGNATION OF THE EX-OFFICIO KFH/P-AFFILIATED DIRECTOR FROM THE SOCAL REGION PRESIDENT TO THE CHAIR OF KFH/P'S COMMUNITY HEALTH COMMITTEE. IN ADDITION, IN SECTION 4, THE COMMENCEMENT OF DIRECTOR TERM HAS BEEN CHANGED TO JULY 1 TO ALIGN IT WITH THE ACADEMIC CALENDAR. |
| FORM 990, PART VI, LINE 6 | THE SOLE CORPORATE MEMBER OF THE CORPORATION IS KAISER FOUNDATION HOSPITALS, A CALIFORNIA NONPROFIT CORPORATION. |
| FORM 990, PART VI, LINE 7A | THE BOARD NOMINATES AND KAISER FOUNDATION HOSPITALS APPOINTS ALL DIRECTORS OTHER THAN EX-OFFICIO DIRECTORS. REMOVAL OF DIRECTORS REQUIRES MEMBER APPROVAL. |
| FORM 990, PART VI, LINE 7B | THE FOLLOWING ACTIONS BY THE BOARD ARE SUBJECT TO THE APPROVAL OF THE MEMBER: (I) APPROVAL OF ANNUAL OPERATING, CASH AND CAPITAL BUDGETS; (II) APPROVAL OF THE CORPORATION'S LONG-RANGE STRATEGIC OR BUSINESS PLAN AND BUDGET FORECASTS; (IIV) CORPORATE BORROWINGS, DEBT ISSUANCE, OR GUARANTEES OF PAYMENT OF DEBT SERVICE; (IV) ACQUISITION, SALE, LEASE OR MORTGAGE OF ANY REAL PROPERTY; (V) ACCEPTANCE OF DONATIONS WHICH NECESSITATE MAJOR ADDITIONAL CAPITAL OR OPERATING EXPENDITURES; (VI) FORMATION OF ANY NEW CORPORATION, PARTNERSHIP OR ENTITY IN WHICH THE CORPORATION WILL BE A MAJORITY SHAREHOLDER, THE CONTROLLING MEMBER OR MEMBERS, THE CONTROLLING PARTNER OR PARTNERS, OR WILL EXERCISE CONTROL THROUGH ANY OTHER MECHANISM; (VII) APPROVAL OF THE BOARD'S SELECTION OF ANY CANDIDATE TO SERVE AS A DIRECTOR OF THE CORPORATION; (VIII) MERGER OR CONSOLIDATION OF THE CORPORATION WITH ONE OR MORE OTHER CORPORATION(S), OR AFFILIATION OR JOINT VENTURE OF THE CORPORATION WITH ONE OR MORE OTHER BUSINESS ENTITIES; THE MEMBER HAS SOLE AUTHORITY TO APPROVE THE FOLLOWING ACTIONS: (I) CHANGING THE CHARITABLE MISSION OR PURPOSE OR PURPOSES OF THE CORPORATION; (II) AMENDMENT, REPEAL OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS OF THE CORPORATION; (III) SALE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; (IV) VOLUNTARY DISSOLUTION OF THE CORPORATION; (V) APPROVAL OF ANY OTHER ACTION THAT WOULD BE INCONSISTENT WITH THE OBJECTIVES AND PURPOSES OF THE CORPORATION SET FORTH IN THE CORPORATION'S ARTICLES OF INCORPORATION OR IN ARTICLE I OF THE BYLAWS. |
| FORM 990, PART VI, LINE 11B | FORM 990 REVIEW PROCESS: 1. KEY INFORMATION NECESSARY FOR THE PREPARATION OF THE TAX RETURN IS OBTAINED AND/OR CONFIRMED WITH INTERNAL SOURCES INCLUDING REGIONAL FINANCE, EXECUTIVE COMPENSATION, COMMUNITY BENEFITS, TREASURY, GOVERNMENT RELATIONS, AND LEGAL. 2. PRIOR TO FINALIZATION, THE RETURN IS REVIEWED BY AN EXTERNAL TAX ADVISOR. 3. ONCE SIGNED BY AN EXTERNAL TAX ADVISOR, THE RETURN AND UNDERLYING DATA ARE REVIEWED BY AN OFFICER OR A MEMBER OF MANAGEMENT DESIGNATED BY AN OFFICER FOR SIGNATURE AND FILING. 4. COPIES ARE THEN PROVIDED TO BOARD MEMBERS PRIOR TO FILING. |
| FORM 990, PART VI, LINE 12C | 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. The Hotline is managed by a third party; however, reported conflicts of interest allegations are provided to Ethics and Compliance for investigation, and if required, corrective actions are taken to address the conflict of interest. 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 (e.g., research investigator, managers and supervisors with funds disbursement authority, or sales consultants) are required to complete a Conflicts of Interest Disclosure form. 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 in our system of record 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 on 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 conflicts of interest disclosure 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: - Interactive conflicts of interest scenarios, and the Conflicts of Interest and Corrective or Disciplinary Action policies are provided and reviewed as part of the general annual ethics and compliance training, and compliance training for new employees. - Employees who complete the training are provided learning boosters which occur 2 days, 2 weeks, and 2 months after the course to help retain and apply learning. - The Conflicts of Interest Policy is reviewed and attested to by those selected to complete the annual disclosure form. - Conflict of interest topics (e.g., how to disclose conflict of interest situations, examples of conflicts of interest, etc.) are included in annual Ethics and Compliance week's activities. - Road shows are conducted throughout the year to educate employees in elevated risk departments, such as Community Health, on conflicts of interest situations. - Represented employees are subject to corrective or 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 FOR THE CEO/TOP MANAGEMENT OFFICIAL AND CERTAIN OFFICERS AS ADMINISTERED BY KAISER PERMANENTE BERNARD J. TYSON SCHOOL OF MEDICINE (KP-SOM) IS DESIGNED TO RECRUIT, RETAIN AND MOTIVATE QUALIFIED SENIOR MANAGEMENT PERSONNEL. THE CEO/TOP MANAGEMENT OFFICIAL AND CERTAIN OFFICERS HAVE A SIGNIFICANT IMPACT ON THE STRATEGIC AND POLICY DIRECTION AND RESULTS OF THE ORGANIZATION. THEREFORE, THE EXECUTIVE COMPENSATION PROGRAM HAS A PERFORMANCE-BASED COMPONENT. THE COMPENSATION PROGRAM FOR THE CEO/TOP MANAGEMENT OFFICIAL AND OTHER DISQUALIFIED PERSON EXECUTIVES WHO PERFORM SUBSTANTIALLY ALL OF THEIR SERVICE FOR THE ORGANIZATION ARE REVIEWED ANNUALLY BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS. THE CEO/TOP MANAGEMENT OFFICIAL WILL BE SUBJECT TO FINAL APPROVAL BY CERTAIN DISINTERESTED DIRECTORS OF THE BOARD. CERTAIN OTHER OFFICERS ARE REVIEWED ANNUALLY BY THE CEO/TOP MANAGEMENT OFFICIAL, THE KP-SOM COMPENSATION COMMITTEE AND/OR MANAGEMENT COMMITTEE ON COMPENSATION. PRIOR TO PAYMENT, ALL PROGRAMS AND PAYMENTS TO THE CEO, EXECUTIVE DIRECTOR, AND OTHER TOP MANAGEMENT OFFICIALS (EXECUTIVES) ARE REVIEWED BY THE BOARD OF DIRECTORS, COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OR THE CEO/TOP MANAGEMENT OFFICIAL, AND FOR CERTAIN OFFICERS THE KP-SOM COMPENSATION COMMITTEE AND/OR THE MANAGEMENT COMMITTEE ON COMPENSATION. BASE PAY FOR EXECUTIVE POSITIONS IS ESTABLISHED AT A LEVEL COMPARABLE TO THE RELEVANT MARKET. IN ADDITION, FOR CERTAIN EXECUTIVES, 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 PERFORMANED BY AN INDEPENDENT COMPENSATION, BENEFITS & HUMAN RESOURCES CONSULTING FIRM. |
| FORM 990, PART VI, LINE 18 | TO REQUEST COPIES CONTACT: NATIONAL COMMUNICATIONS - RM OPERATIONS KAISER FOUNDATION HEALTH PLAN AND HOSPITALS ONE KAISER PLAZA, 22ND FLOOR OAKLAND, CA 94612 |
| FORM 990, PART VI, LINE 19 | These documents are made available when regulatorily required. |
| FORM 990, PART VII, SECTION A, COLUMN B | HOURS FOR RELATED ORGANIZATIONS 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 WERE ESTIMATED. |
| FORM 990, PART XI, Line 9 | OTHER CHANGES IN NET ASSETS OR FUND BALANCES CHANGE IN CAPITAL TRANSFERS $ 96,876,472 CONTRIBUTIONS FROM AFFILIATED ORG (96,876,472) OTHER THAN TEMPORARY IMPAIRMENTS (884,471) GAIN/LOSS ON INVESTMENTS - BOOK (60,638) GAIN/LOSS ON INVESTMENTS - TAX 832,403 --------------- TOTAL $ (112,706) |
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