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ObjectId: 202343199349301219 - Submission: 2023-11-15
TIN: 84-0591617
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.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
22
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF COLORADO
Employer identification number
84-0591617
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 Hospitals
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
94-1105628
Health Care
CA
501(c)(3)
3
NA
No
(2)
Kaiser Foundation Health Plan Inc
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
94-1340523
Health Care
CA
501(c)(3)
10
NA
No
(3)
Kaiser Foundation Health Plan of GA Inc
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
58-1592076
Health Care
GA
501(c)(3)
10
KFHP Inc
Yes
(4)
Kaiser Foundation Health Plan of the MAS
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
52-0954463
Health Care
MD
501(c)(3)
10
KFHP Inc
Yes
(5)
Kaiser Foundation Health Plan of the NW
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
93-0798039
Health Care
OR
501(c)(3)
10
KFHP Inc
Yes
(6)
Kaiser Fdn Health Plan of Washington
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
91-0511770
Health Care
WA
501(c)(3)
3
KFHPW Hldng
Yes
(7)
Kaiser Hospital Asset Management Inc
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
94-3299125
Asset Mgmt
CA
501(c)(3)
12-I
KFH
Yes
(8)
Kaiser Health Plan Asset Management Inc
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
94-3299124
Asset Mgmt
CA
501(c)(3)
12-I
KFHP Inc
Yes
(9)
Camp Bowie Service Center
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
94-3299123
Admin
CA
501(c)(3)
12-I
KFHP Inc
Yes
(10)
Lokahi Assurance LTD
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
91-2171891
WC Placement
HI
501(c)(3)
12-I
KFHP Inc
Yes
(11)
1800 Harrison Foundation
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
94-3317484
Financing
CA
501(c)(3)
12-I
KFHP Inc
Yes
(12)
Kaiser Hospital Assistance Corporation
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
31-1779500
Financing
CA
501(c)(3)
12-I
KFH
Yes
(13)
Kaiser Health Alternatives
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
93-0954562
Health Care
OR
501(c)(3)
10
KFHP Inc
Yes
(14)
KP Bernard J Tyson School of Medicine
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
81-4053028
Medical Edu.
CA
501(c)(3)
2
KFH
Yes
(15)
KFHPW Holdings
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
93-0480268
Health Care
WA
501(c)(3)
12-I
KFHP Inc
Yes
(16)
Group Health Northwest
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
91-1216856
Inactive
WA
501(c)(3)
12-I
KFHP of WA
Yes
(17)
Group Health of Washington
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
91-1314907
Inactive
WA
501(c)(3)
12-I
KFHP of WA
Yes
(18)
Kaiser Fdn For The Adv of Integrated HC
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
82-3819611
Advocacy
CA
501(c)(4)
N/A
KFHP Inc
Yes
(19)
Kaiser Foundation Health Plan of NV Inc
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
37-2097870
Health Care
DE
501(c)(4)
N/A
KFHP Inc
Yes
(20)
KP Medical Foundation
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
92-0685740
Health Care
DE
501(c)(3)
12-I
KFHP Inc
Yes
(21)
KFH Holdings Inc
One Kaiser Plaza - 26th Floor
Oakland
,
CA
94612
88-4172095
Holding Co
DE
501(c)(3)
12-I
KFH
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2022
Page 2
Schedule R (Form 990) 2022
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)
NXT CAP SR FD I LLC
191 N Wacker Dr 1200
Chicago
,
IL
60606
37-1651297
Investment
DE
NA
N/A
0
0
0
0 %
(2)
Garfield Health Sol E Pvt Ltd
1 Kaiser Pl - 26th Fl
Oakland
,
CA
94612
Admin
IN
NA
N/A
0
0
0
0 %
(3)
Maui Nui ASC Holdco LLC
1 Kaiser Pl - 26th Fl
Oakland
,
CA
94612
Holding Co
HI
NA
N/A
0
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?
Yes
No
(1)
OAK TREE ASSURANCE LTD
One Kaiser Plaza - 26th Floor
OAKLAND
,
CA
94612
03-0329760
INSURANCE
VT
NA
C CORP
0
0
Yes
(2)
KAISER PERMANENTE INSURANCE COMPANY
One Kaiser Plaza - 26th Floor
OAKLAND
,
CA
94612
94-3203402
INSURANCE
CA
NA
C CORP
0
0
Yes
(3)
KAISER PERMANENTE INTERNATIONAL
One Kaiser Plaza - 26th Floor
OAKLAND
,
CA
94612
94-3245176
CONSULTING
CA
NA
C CORP
0
0
Yes
(4)
KFHP OF WASHINGTON OPTIONS INC
One Kaiser Plaza - 26th Floor
OAKLAND
,
CA
94612
91-1467158
INSURANCE
WA
NA
C CORP
0
0
Yes
Schedule R (Form 990) 2022
Page 3
Schedule R (Form 990) 2022
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
Yes
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
No
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
Yes
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
Yes
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
129,627,482
PER AGREEMENT
(2)
KAISER FOUNDATION HEALTH PLAN INC
M
21,678,436
PER AGREEMENT
(3)
KAISER FOUNDATION HEALTH PLAN INC
P
51,147,473
PER AGREEMENT
(4)
KAISER FOUNDATION HEALTH PLAN INC
Q
231,081,498
PER AGREEMENT
(5)
KAISER FOUNDATION HEALTH PLAN INC
R
16,733,669
PER AGREEMENT
(6)
KAISER FOUNDATION HEALTH PLAN INC
S
2,028,506
PER AGREEMENT
(7)
KAISER FOUNDATION HOSPITALS
J
7,443,456
PER AGREEMENT
(8)
KAISER FOUNDATION HOSPITALS
L
93,270,042
PER AGREEMENT
(9)
KAISER FOUNDATION HOSPITALS
P
1,930,465
PER AGREEMENT
(10)
KAISER FOUNDATION HOSPITALS
Q
89,230,690
PER AGREEMENT
(11)
KAISER FDN HEALTH PLAN OF GEORGIA INC
L
1,673,334
PER AGREEMENT
(12)
KAISER FDN HEALTH PLAN OF GEORGIA INC
M
1,714,011
PER AGREEMENT
(13)
KAISER FDN HEALTH PLAN OF GEORGIA INC
Q
275,643
PER AGREEMENT
(14)
KAISER FDN HEALTH PLAN OF GEORGIA INC
S
698,300
PER AGREEMENT
(15)
KFHP OF THE MID-ATLANTIC STATES INC
L
459,758
PER AGREEMENT
(16)
KFHP OF THE MID-ATLANTIC STATES INC
M
139,679
PER AGREEMENT
(17)
KFHP OF THE MID-ATLANTIC STATES INC
S
678,722
PER AGREEMENT
(18)
KAISER FDN HEALTH PLAN OF THE NORTHWEST
A
512
PER AGREEMENT
(19)
KAISER FDN HEALTH PLAN OF WASHINGTON
L
234,210
PER AGREEMENT
(20)
KAISER FDN HEALTH PLAN OF WASHINGTON
M
681,604
PER AGREEMENT
(21)
KAISER FDN HEALTH PLAN OF WASHINGTON
Q
249,611
PER AGREEMENT
(22)
CAMP BOWIE SERVICE CENTER
L
3,828,745
PER AGREEMENT
(23)
CAMP BOWIE SERVICE CENTER
M
61,290,641
PER AGREEMENT
(24)
CAMP BOWIE SERVICE CENTER
P
64,357,089
PER AGREEMENT
(25)
CAMP BOWIE SERVICE CENTER
Q
492,526
PER AGREEMENT
(26)
KAISER PERMANENTE INSURANCE COMPANY
L
27,304,232
PER AGREEMENT
(27)
KAISER PERMANENTE INSURANCE COMPANY
M
2,387,299
PER AGREEMENT
(28)
KAISER PERMANENTE INSURANCE COMPANY
Q
51,927
PER AGREEMENT
(29)
LOKAHI ASSURANCE LTD
L
6,876,108
PER AGREEMENT
(30)
LOKAHI ASSURANCE LTD
P
103,288
PER AGREEMENT
(31)
LOKAHI ASSURANCE LTD
Q
169,429
PER AGREEMENT
Schedule R (Form 990) 2022
Page 4
Schedule R (Form 990) 2022
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) 2022
Page 5
Schedule R (Form 990) 2022
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) 2022
Additional Data
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