efile Public Visual Render
ObjectId: 202403209349303245 - Submission: 2024-11-15
TIN: 52-0954463
Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
23
Open to Public Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number
52-0954463
Part I
Questions Regarding Compensation
Yes
No
1a
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)
b
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
.....
1b
2
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?
....
2
3
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
4
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:
a
Receive a severance payment or change-of-control payment?
.............
4a
Yes
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan?
.........
4b
Yes
c
Participate in, or receive payment from, an equity-based compensation arrangement?
.........
4c
No
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.
5
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:
a
The organization?
....................
5a
No
b
Any related organization?
.......................
5b
No
If "Yes," on line 5a or 5b, describe in Part III.
6
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:
a
The organization?
..................
6a
No
b
Any related organization?
......................
6b
No
If "Yes," on line 6a or 6b, describe in Part III.
7
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
............
7
Yes
8
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
..........................
8
Yes
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)?
.........................
9
Yes
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2023
Page 2
Schedule J (Form 990) 2023
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
(i)
Base
compensation
(ii)
Bonus & incentive
compensation
(iii)
Other
reportable compensation
1
Gregory Adams
Chairman & CEO
(i)
(ii)
0
-------------
2,123,581
0
-------------
9,103,058
0
-------------
1,340,747
0
-------------
122,468
0
-------------
31,592
0
-------------
12,721,446
0
-------------
0
2
Kathryn Lancaster
EVP & Chief Financial Officer
(i)
(ii)
0
-------------
1,269,207
0
-------------
3,069,715
0
-------------
584,481
0
-------------
118,595
0
-------------
19,304
0
-------------
5,061,302
0
-------------
0
3
Kimberly Horn
EVP, Group President, MOC
(i)
(ii)
0
-------------
1,118,899
0
-------------
1,571,247
0
-------------
1,927,210
0
-------------
100,993
0
-------------
33,202
0
-------------
4,751,551
0
-------------
1,391,673
4
Janet Liang
EVP, Group President & COO
(i)
(ii)
0
-------------
1,262,682
0
-------------
2,460,748
0
-------------
693,948
0
-------------
51,770
0
-------------
38,065
0
-------------
4,507,213
0
-------------
0
5
Arthur Southam
EVP, Health Plan Ops & CGO
(i)
(ii)
0
-------------
194,706
0
-------------
3,022,498
0
-------------
559,033
0
-------------
10,910
0
-------------
7,665
0
-------------
3,794,812
0
-------------
0
6
Ruth Williams-Brinkley
Regional President - MAS
(i)
(ii)
0
-------------
804,931
0
-------------
1,256,152
0
-------------
1,357,533
0
-------------
-201,208
0
-------------
24,271
0
-------------
3,241,679
0
-------------
968,436
7
Mark Zemelman
SVP, General Counsel & Secy
(i)
(ii)
0
-------------
0
0
-------------
0
0
-------------
1,833,838
0
-------------
660,356
0
-------------
0
0
-------------
2,494,194
0
-------------
0
8
Vanessa Benavides
SVP,Chief Legal Officer & Secy
(i)
(ii)
0
-------------
708,622
0
-------------
1,028,988
0
-------------
54,845
0
-------------
288,586
0
-------------
19,529
0
-------------
2,100,570
0
-------------
0
9
Thomas Meier
SVP, Corporate Treasurer
(i)
(ii)
0
-------------
593,270
0
-------------
977,784
0
-------------
150,054
0
-------------
94,964
0
-------------
26,384
0
-------------
1,842,456
0
-------------
227,652
10
Donald Orndoff
SVP, NFS
(i)
(ii)
0
-------------
185,407
0
-------------
452,361
0
-------------
663,392
0
-------------
307,153
0
-------------
13,534
0
-------------
1,621,847
0
-------------
36,947
11
Alfonse Upshaw
SVP,Corporate Controller & CAO
(i)
(ii)
0
-------------
535,015
0
-------------
558,993
0
-------------
178,047
0
-------------
176,289
0
-------------
32,080
0
-------------
1,480,424
0
-------------
109,173
12
Frank Titus
VP, HPSA - MAS
(i)
(ii)
0
-------------
515,294
0
-------------
447,954
0
-------------
136,189
0
-------------
193,349
0
-------------
18,312
0
-------------
1,311,098
0
-------------
94,692
13
Emily Holliman
VP, COO - MAS
(i)
(ii)
0
-------------
301,406
0
-------------
0
0
-------------
591,656
0
-------------
183,848
0
-------------
17,009
0
-------------
1,093,919
0
-------------
0
14
David Thomason
SVP,Corporate Controller & CAO
(i)
(ii)
0
-------------
412,855
0
-------------
0
0
-------------
485,043
0
-------------
42,288
0
-------------
10,595
0
-------------
950,781
0
-------------
0
15
Ryan Jenson
Interim Corp Controller & CAO
(i)
(ii)
0
-------------
346,441
0
-------------
349,170
0
-------------
47,610
0
-------------
100,508
0
-------------
29,248
0
-------------
872,977
0
-------------
0
16
Brandon Cuevas
EVP, Health Plan
(i)
(ii)
0
-------------
282,154
0
-------------
0
0
-------------
229,498
0
-------------
286,674
0
-------------
6,597
0
-------------
804,923
0
-------------
0
17
William Wiechmann
Assistant Secretary
(i)
(ii)
0
-------------
328,762
0
-------------
205,699
0
-------------
65,385
0
-------------
118,517
0
-------------
31,076
0
-------------
749,439
0
-------------
0
18
Gracelyn McDermott
VP, MSBD - MAS
(i)
(ii)
0
-------------
335,672
0
-------------
224,166
0
-------------
17,666
0
-------------
118,219
0
-------------
30,900
0
-------------
726,623
0
-------------
0
19
Dana Forster
VP, Delivery System Operations
(i)
(ii)
0
-------------
279,195
0
-------------
190,895
0
-------------
40,875
0
-------------
167,002
0
-------------
30,082
0
-------------
708,049
0
-------------
0
20
Cynthia Cifuentes-Finkel
VP, Mktg Comm & Cmty Relations
(i)
(ii)
0
-------------
305,406
0
-------------
196,675
0
-------------
34,566
0
-------------
115,595
0
-------------
29,974
0
-------------
682,216
0
-------------
0
21
Hong-Sze Yu
VP, Brd & Corp Gov & Asst Secy
(i)
(ii)
0
-------------
300,090
0
-------------
188,569
0
-------------
19,933
0
-------------
137,523
0
-------------
30,033
0
-------------
676,148
0
-------------
0
22
Kristin Bear
Assistant Secretary
(i)
(ii)
0
-------------
313,172
0
-------------
131,402
0
-------------
30,063
0
-------------
149,166
0
-------------
21,623
0
-------------
645,426
0
-------------
0
23
Jeanine Maier
VP, Consumer Experience & CCC
(i)
(ii)
0
-------------
323,709
0
-------------
121,240
0
-------------
15,851
0
-------------
113,969
0
-------------
28,434
0
-------------
603,203
0
-------------
0
24
Jared Gross
VP, CFO - MAS
(i)
(ii)
0
-------------
391,762
0
-------------
44,800
0
-------------
49,503
0
-------------
0
0
-------------
67,618
0
-------------
553,683
0
-------------
0
25
Angela Beaudry
VP, HR - MAS
(i)
(ii)
0
-------------
256,625
0
-------------
118,580
0
-------------
82,079
0
-------------
41,122
0
-------------
39,977
0
-------------
538,383
0
-------------
0
26
Jennifer Valentine
ED, FP&A
(i)
(ii)
0
-------------
240,374
0
-------------
173,929
0
-------------
16,453
0
-------------
45,592
0
-------------
10,702
0
-------------
487,050
0
-------------
0
27
Kimberley Ragnartz
VP, Delivery System Operations
(i)
(ii)
0
-------------
71,958
0
-------------
146,941
0
-------------
246,965
0
-------------
-14,436
0
-------------
10,023
0
-------------
461,451
0
-------------
0
28
Lawrence Hamilton
Regional Administrative Leader
(i)
(ii)
0
-------------
0
0
-------------
0
0
-------------
372,697
0
-------------
14,762
0
-------------
0
0
-------------
387,459
0
-------------
55,014
29
Margaret E Porfido JD
Director
(i)
(ii)
14,000
-------------
283,000
0
-------------
0
0
-------------
22,083
0
-------------
16,717
0
-------------
0
14,000
-------------
321,800
0
-------------
0
30
David F Hoffmeister
Director
(i)
(ii)
0
-------------
266,500
0
-------------
0
0
-------------
14,451
0
-------------
17,907
0
-------------
0
0
-------------
298,858
0
-------------
0
31
Judith A Johansen JD
Director
(i)
(ii)
0
-------------
290,800
0
-------------
0
0
-------------
0
0
-------------
6,534
0
-------------
0
0
-------------
297,334
0
-------------
0
32
Leslie S Heisz
Director
(i)
(ii)
0
-------------
249,000
0
-------------
0
0
-------------
19,956
0
-------------
24,274
0
-------------
0
0
-------------
293,230
0
-------------
0
33
Ramon F Baez
Director
(i)
(ii)
0
-------------
252,500
0
-------------
0
0
-------------
14,451
0
-------------
21,121
0
-------------
0
0
-------------
288,072
0
-------------
0
34
Jeffrey E Epstein
Director
(i)
(ii)
0
-------------
256,500
0
-------------
0
0
-------------
9,415
0
-------------
13,187
0
-------------
0
0
-------------
279,102
0
-------------
0
35
Richard P Shannon MD
Director
(i)
(ii)
0
-------------
236,500
0
-------------
0
0
-------------
0
0
-------------
27,421
0
-------------
0
0
-------------
263,921
0
-------------
0
36
Vivek Sharma
Director
(i)
(ii)
0
-------------
241,500
0
-------------
0
0
-------------
19,956
0
-------------
0
0
-------------
0
0
-------------
261,456
0
-------------
0
37
Jenny J Ming
Director
(i)
(ii)
0
-------------
229,000
0
-------------
0
0
-------------
19,772
0
-------------
12,004
0
-------------
0
0
-------------
260,776
0
-------------
0
38
Maryann Bodayle
Assistant Secretary
(i)
(ii)
0
-------------
180,482
0
-------------
13,962
0
-------------
2,310
0
-------------
44,374
0
-------------
10,815
0
-------------
251,943
0
-------------
0
39
Matthew T Ryan
Director
(i)
(ii)
0
-------------
236,500
0
-------------
0
0
-------------
14,451
0
-------------
0
0
-------------
0
0
-------------
250,951
0
-------------
0
40
A Eugene Washington MD
Director
(i)
(ii)
0
-------------
244,000
0
-------------
0
0
-------------
0
0
-------------
4,278
0
-------------
0
0
-------------
248,278
0
-------------
0
41
David J Barger
Director
(i)
(ii)
0
-------------
234,000
0
-------------
0
0
-------------
0
0
-------------
13,569
0
-------------
0
0
-------------
247,569
0
-------------
0
42
Regina M Benjamin MD MBA
Director
(i)
(ii)
0
-------------
210,000
0
-------------
0
0
-------------
9,620
0
-------------
27,404
0
-------------
0
0
-------------
247,024
0
-------------
0
43
Edward Y W Pei
Director
(i)
(ii)
0
-------------
0
0
-------------
0
0
-------------
53,623
0
-------------
0
0
-------------
0
0
-------------
53,623
0
-------------
43,217
44
Kim J Kaiser
Director
(i)
(ii)
0
-------------
24,300
0
-------------
0
0
-------------
14,704
0
-------------
0
0
-------------
0
0
-------------
39,004
0
-------------
0
Schedule J (Form 990) 2023
Page 3
Schedule J (Form 990) 2023
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
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 4a
Mark Zemelman $1,823,105 Donald Orndoff $ 501,026 Kimberley Ragnartz $ 218,842 Lawrence Hamilton $ 317,533 LISTED PERSONS PARTICIPATED IN SEPARATION ARRANGEMENTS. DEPENDING ON POSITION LEVEL, TENURE, AND SEPARATION REASON, BENEFITS PAYABLE UNDER THESE ARRANGEMENTS PROVIDE FOR PAY AND HEALTH BENEFITS CONTINUATION PLUS PAYMENT OF ACCRUED OBLIGATIONS. IN ADDITION, FOR SOME OF THE LISTED PERSONS, BENEFITS PAYABLE INCLUDE PRORATED INCENTIVE AWARDS FOR PERFORMANCE PERIODS NOT YET ENDED. NONE OF THE LISTED PERSONS PARTICIPATED IN ARRANGEMENTS ENTITLING THEM TO CHANGE-OF-CONTROL PAYMENTS.
SCHEDULE J, PART I, LINE 4B
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN PAYMENT Gregory Adams $1,177,969 Kathryn Lancaster 521,405 Kimberly Horn 1,872,534 Janet Liang 640,943 Arthur Southam 521,405 Ruth Williams-Brinkley 1,288,433 Thomas Meier 95,030 Donald Orndoff 147,967 Alfonse Upshaw 135,880 Frank Titus 117,033 William Wiechmann 43,391 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 I, LINE 8
CERTAIN AMOUNTS REPORTED IN FORM 990, PART VII, WERE PAID OR ACCRUED PURSUANT TO A CONTRACT THAT WAS SUBJECT TO THE INITIAL CONTRACT EXCEPTION DESCRIBED IN REGULATIONS SECTION 53.4958-4(A)(3). FIXED PAYMENTS WERE PAID TO OR ACCRUED FOR 3 OFFICERS IN 2023.
SCHEDULE J, PART II, SECTION A, COLUMN F
AMOUNTS INCLUDED IN SCHEDULE J, PART II, COLUMN F INCLUDE AMOUNTS PREVIOUSLY REPORTED AS DEFERRED COMPENSATION, AS WELL AS DISTRIBUTIONS FROM A 457(B) PLAN THAT WERE PREVIOUSLY REPORTED AS REPORTABLE COMPENSATION IN ACCORDANCE WITH FORM 990 INSTRUCTIONS.
Schedule J (Form 990) 2023
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