SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBulletInformation about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number

52-0954463
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity

















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


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)KAISER FOUNDATION HEALTH PLAN INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-1340523 		HEALTH CARE CA 501(c)(3) 9 NA
 
 
No
(2)KAISER FOUNDATION HOSPITALS

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-1105628 		HEALTH CARE CA 501(c)(3) 3 KFHP INC
 
Yes
 
(3)KAISER FDN HEALTH PLAN OF COLORADO

ONE KAISER PLAZA 15L

OAKLAND,CA94612
84-0591617 		HEALTH CARE CO 501(c)(3) 9 KFHP INC
 
Yes
 
(4)KAISER FDN HEALTH PLAN OF GEORGIA INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
58-1592076 		HEALTH CARE GA 501(c)(3) 9 KFHP INC
 
Yes
 
(5)KAISER FDN HEALTH PLAN OF THE NORTHWEST

ONE KAISER PLAZA 15L

OAKLAND,CA94612
93-0798039 		HEALTH CARE OR 501(c)(3) 9 KFHP INC
 
Yes
 
(6)KAISER FDN HEALTH PLAN OF OHIO

ONE KAISER PLAZA 15L

OAKLAND,CA94612
34-0922268 		HEALTH CARE OH 501(c)(3) 9 KFHP INC
 
Yes
 
(7)KAISER HEALTH PLAN ASSET MANAGEMENT INC

ONE KAISER PLAZA 15L

OAKLAND,CA94612
94-3299124 		ASSET MGMT CA 501(c)(3) 11 - I KFHP INC
 
Yes
 
(8)LOKAHI ASSURANCE LTD

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

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

ONE KAISER PLAZA 15L

OAKLAND,CA94612
31-1779500 		FINANCING CA 501(c)(3) 11 - III-NF KFH
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Page 2
Schedule R (Form 990) 2013
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
Yes No Yes No
(1) HEALTH CARE MANAGEMENT SOLUTIONS LLC

ONE KAISER PLAZA SUITE 15L
OAKLAND,CA94612
20-3924985 		CASE MGMT CA NA
  		N/A                












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) OAK TREE ASSURANCE LTD

ONE KAISER PLAZA 15L
OAKLAND,CA94612
03-0329760 		INSURANCE VT NA
  		C CORP 0 0 0 % Yes  
(2) KAISER PERMANENTE INSURANCE COMPANY

ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3203402 		INSURANCE CA NA
  		C CORP 0 0 0 % Yes  
(3) KAISER PROPERTY SERVICES INC

ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3259432 		REAL ESTATE CA NA
  		C CORP 0 0 0 % Yes  
(4) ARCHIMEDES INC

ONE KAISER PLAZA 15L
OAKLAND,CA94612
20-3774729 		CONSULTING CA NA
  		C CORP 0 0 0 % Yes  
(5) KAISER PERMANENTE INTERNATIONAL

ONE KAISER PLAZA 15L
OAKLAND,CA94612
94-3245176 		CONSULTING CA NA
  		C CORP 0 0 0 % Yes  




Schedule R (Form 990) 2013
Page 3
Schedule R (Form 990) 2013
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
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
 
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) KAISER FOUNDATION HEALTH PLAN INC

 L 12,018,080 PER AGREEMENT
(2) KAISER FOUNDATION HEALTH PLAN INC

 M 93,744,248 PER AGREEMENT
(3) KAISER FOUNDATION HEALTH PLAN INC

 P 52,517,033 per agreement
(4) KAISER FOUNDATION HEALTH PLAN INC

 Q 51,181,597 per agreement
(5) KAISER FOUNDATION HEALTH PLAN INC

 R 17,270,964 PER AGREEMENT
(6) KAISER FOUNDATION HEALTH PLAN INC

 S 31,124,472 PER AGREEMENT
(7) KAISER FOUNDATION HOSPITALS

 a 1,650,184 PER AGREEMENT
(8) KAISER FOUNDATION HOSPITALS

 e 2,353,772 PER AGREEMENT
(9) KAISER FOUNDATION HOSPITALS

 L 171,764,448 PER AGREEMENT
(10) KAISER FOUNDATION HOSPITALS

 M 274,881,905 PER AGREEMENT
(11) KAISER FOUNDATION HOSPITALS

 p 245,500,300 PER AGREEMENT
(12) KAISER FOUNDATION HOSPITALS

 q 597,194,760 PER AGREEMENT
(13) KAISER FOUNDATION HOSPITALS

 r 539,153,177 PER AGREEMENT
(14) KAISER FOUNDATION HOSPITALS

 s 685,720,122 PER AGREEMENT
(15) CAMP BOWIE SERVICE CENTER

 M 8,970,429 PER AGREEMENT
(16) CAMP BOWIE SERVICE CENTER

 P 464,569 per agreement
(17) CAMP BOWIE SERVICE CENTER

 q 16,763,949 PER AGREEMENT
(18) KAISER PERMANENTE INSURANCE COMPANY

 L 3,570,753 PER AGREEMENT
(19) KAISER PERMANENTE INSURANCE COMPANY

 M 18,399,015 PER AGREEMENT
(20) KAISER PERMANENTE INSURANCE COMPANY

 q 4,453,234 PER AGREEMENT
(21) LOKAHI ASSURANCE LTD

 L 13,886,483 PER AGREEMENT
(22) LOKAHI ASSURANCE LTD

 m 20,700,000 PER AGREEMENT
(23) LOKAHI ASSURANCE LTD

 q 17,068,758 PER AGREEMENT
(24) LOKAHI ASSURANCE LTD

 r 42,086,000 per agreement
(25) LOKAHI ASSURANCE LTD

 s 42,416,000 PER AGREEMENT
(26) KAISER FDN HEALTH PLAN OF THE NORTHWEST

 L 415,977 PER AGREEMENT
(27) KAISER FDN HEALTH PLAN OF THE NORTHWEST

 m 140,044 PER AGREEMENT
(28) KAISER FDN HEALTH PLAN OF THE NORTHWEST

 q 76,058 PER AGREEMENT
(29) KAISER FDN HEALTH PLAN OF OHIO

 L 92,848 PER AGREEMENT
(30) KAISER FDN HEALTH PLAN OF OHIO

 m 295,410 PER AGREEMENT
(31) KAISER FDN HEALTH PLAN OF OHIO

 q 155,088 PER AGREEMENT
(32) KAISER FDN HEALTH PLAN OF OHIO

 r 52,682 PER AGREEMENT
(33) KAISER FDN HEALTH PLAN OF COLORADO

 L 416,633 PER AGREEMENT
(34) KAISER FDN HEALTH PLAN OF COLORADO

 m 267,965 PER AGREEMENT
(35) KAISER FDN HEALTH PLAN OF COLORADO

 p 796,417 PER AGREEMENT
(36) KAISER FDN HEALTH PLAN OF COLORADO

 q 82,991 PER AGREEMENT
(37) KAISER FDN HEALTH PLAN OF GEORGIA INC

 L 922,972 PER AGREEMENT
(38) KAISER FDN HEALTH PLAN OF GEORGIA INC

 m 1,805,092 PER AGREEMENT
(39) KAISER FDN HEALTH PLAN OF GEORGIA INC

 p 161,378 PER AGREEMENT
(40) KAISER FDN HEALTH PLAN OF GEORGIA INC

 q 70,225 PER AGREEMENT
(41) OAK TREE ASSURANCE LTD

 m 207,539 PER AGREEMENT
(42) OAK TREE ASSURANCE LTD

 p 55,398 PER AGREEMENT
(43) OAK TREE ASSURANCE LTD

 q 263,037 PER AGREEMENT
Schedule R (Form 990) 2013
Page 4
Schedule R (Form 990) 2013
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2013
Page 5
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R, Part II In 2013, Kaiser Foundation Health Plan, Inc. and HealthSpan Partners, an unrelated not-for-profit Ohio-based health system, entered into a definitive agreement to transfer the sole corporate membership of Kaiser Foundation Health Plan of Ohio to HealthSpan Partners. On October 1, 2013, the member substitution transaction was completed.
Schedule R (Form 990) 2013

Additional Data


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