Kaiser Foundation Health Plan of the Northwest

“The Bylaws of the Corporation were amended in 2016 as follows: On March 3, 2016: - The Independent Director definition was removed and noted as being defined in the Corporate Governance Guidelines. - Article D, Directors, Section D-2 was amended to change the number and description of inside Directors. - Article D, Directors, Section D-4 was amended to modify the term and retirement age for Directors. - Article F, Committees, Section F-4, Executive Committee, was amended to change the Committee composition and remove tax exemption and executive selection, performance appraisal, and succession duties.”

“Kaiser foundation health plan, inc. is the sole member. Upon dissolution, remaining assets shall be distributed to a 501(c)(3) organization.”

“KFHP, INC. appoints the directors (and fills vacancies and has authority to remove directors). The same individuals who comprise the board of directors of KFHP also serve as THE directors of KFHP COLORADO, NORTHWEST, MID-ATLANTIC STATES, AND KFHP WASHINGTON.”

“The following actions of the corporation require approval of the sole member: a) removal of the chairman of the board or the president, the group president or regional president; b) amendment of article d, section d-4 of the bylaws - election and term of office.”

“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.”

“Compliance enforcement a. Regularly and consistently monitors compliance with the conflicts of interest policy - kaiser permanente regularly monitors compliance with the conflicts of interest policy in 3 key ways: a1. The kaiser permanente compliance hotline is available to all employees and vendors to report actual or potential conflicts of interest. All calls are answered by a third party and provided to kaiser permanente's national compliance office for review and appropriate action. Employees can report anonymously. Retaliation is prohibited. Reports of actual or potential conflicts of interest are generated and investigations are conducted as required and information is tracked and trended to determine if additional guidance is required to avoid or manage conflicts of interest. Compliance hotline reports are provided for review and action to the kaiser foundation health plan/hospitals boards of directors annually. A2. The national compliance office and internal audit services annually review the directors', officers', key employees', and executives' annual conflicts of interest questionnaire disclosures and provide direction on any investigations required. Investigations are documented, tracked and trended to determine if additional controls or education is required. In addition, conflicts of interest questionnaire reports are provided for review and action to the kaiser foundation health plan/hospitals boards of directors annually; and a3. Annually, as a component of the external audit, an outside certified public accounting firm reviews the annual conflicts of interest questionnaires process completed by directors, officers, key employees, and executives, and actions taken as a result of the disclosures. The results of the annual audit, including any findings in this area are presented to the kaiser foundation health plan/hospitals audit and compliance committee. B. Regularly and consistently enforces compliance with the conflicts of interest policy - to ensure consistency in the enforcement of the policy kaiser permanente uses the following steps as a general guideline: b1. Represented employees are subject to any corrective/disciplinary action provisions described in specific regional/national collective bargaining agreements and/or organizational policies and practices. B2. Kaiser permanente notifies employees of the national human resources policy no. 14. Corrective/disciplinary action policy during new employee orientation and in annual compliance training. B3. In the event that it is necessary to discipline any employee because of, but not limited to, failure to comply with applicable legal/regulatory requirements, kaiser permanente policies and procedures, or the principles of responsibility, or for unsatisfactory performance or misconduct, coaching/counseling and/or corrective/disciplinary action may include, but is not limited to: - oral discussion and/or warning by the employee's immediate supervisor or higher level manager to correct the problem; - written notice, with or without final warning; - paid or unpaid suspension, with or without final warning; - termination of employment.”

“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, benefit & human resource 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.”

“Forms 990 are available on www.guidestar.org.”

“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: Vice President, Government Relations Kaiser Foundation Health Plan and Hospitals One Kaiser Plaza, 18th Floor Oakland, CA 94612”

“Hours for Related Organization: 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.”

“CHANGE IN pension and other retirement liabilities $(25,348,077) BOOK-TO-TAX DIFFERENCE ON SALE OF INVESTMENTS 1,712,596 OTHER THAN TEMPORARY IMPAIRMENT LOSS (4,753,813) ---------------- TOTAL (28,389,294)”

“2016 Community Benefit Report Kaiser Foundation Health Plan of the Northwests Commitment to the Community Kaiser Foundation Health Plan of the Northwest (Northwest Health Plan or KFHP-NW) provides and arranges comprehensive health care services for members on a predominantly prepaid basis. Its contractual obligations to group and individual members are fulfilled by contracting with Kaiser Foundation Hospitals (KFH) and Permanente Medical Group physicians to provide health care services for its members. KFHP-NW strives for excellence in serving its members through market-leading performance in quality and service. As a subsidiary of Kaiser Foundation Health Plan, Inc. (KFHP, Inc.), membership is available without regard to age, sex, race, religion, or national origin, or to the individuals ability to pay. Northwest Health Plan members are broadly representative of the communities served. Once enrolled, a member may maintain membership regardless of health or employment status. As related nonprofit organizations, Kaiser Foundation Health Plan, Inc. and Kaiser Foundation Health Plan of the Northwest are committed to improving the health of communities beyond enrolled membership. Annual investments in a range of Community Benefit programs are a fundamental embodiment of the organizations ongoing commitment to improve the general wellbeing within the broader community. These investments result in intentional, planned, measurable, and accountable benefits intended to address many of the health challenges faced at the individual, local, state, and national levels. In 2007, Kaiser Foundation Health Plan, Inc.s board of directors refined the focus of the organizations Community Benefit programs and established the following four priority areas which have come to be known as "Streams of Work": A. Care and Coverage for Low-Income People Creates and supports programs that lower the financial barriers for the under- and uninsured. B. Community Health Initiatives (CHI) Seeks to measurably improve the health of the communities we serve. Designs, delivers, and sustains long-term programs that engage communities in work to improve conditions in their neighborhoods. C. Safety Net Partnerships Builds partnerships with community clinics, local health departments, and public hospitals. Provides funding, technical assistance, dissemination of care management, and quality improvements technology to help improve care and expand treatment capacity for vulnerable populations. D. Developing and Disseminating Knowledge Improves health care by sharing our knowledge educating practitioners, advancing research, empowering consumers, and informing policymakers about evidence-based care and health. In addition to the streams of work above, KFHP-NW also made contributions to benefit the communities served in the following areas: E. Other Community Benefit Investments Support Community Benefit activities and programs beyond the national streams of work, including the administrative expenses of regional Community Benefit departments dedicated to supporting the organizations Community Benefit programs and services and coordinating related initiatives. F. Environmental Stewardship Protecting and improving the natural environment is a key component of KFHP-NWs mission to improve the health of the community it serves. Although costs associated with this initiative are not included in the dollars reported as Community Benefit investments, efforts in this area contribute to advancing a broader vision emphasizing healthy people and healthy environments while also improving health care quality and affordability. The following are details of the Community Benefit activities provided by Kaiser Foundation Health Plan of the Northwest: In 2016, Northwest Health Plan served nearly 553,000 members and expended approximately $70.5 million (at cost, net of $121.3 million of related revenues) to support Community Benefit activities. The following summarizes many of the signature”

“Northwest Health Plans Medical Financial Assistance program provides financial assistance for emergency and medically necessary services, medications, and supplies to patients with a demonstrated financial need. Patients must receive health care services at a Kaiser Permanente facility and/or from a Kaiser Permanente provider. Eligibility is based upon prescribed levels of income to patients who have exhausted other private and public sources of support. In 2016, KFHP-NW provided approximately $12.8 million (at cost, net of related revenues of $0) of services under this program. At KFHP-NW, uninsured patients receive a discount on hospital and professional charges for emergency or other medically necessary care without an application and regardless of income level. The discount is provided to ensure that an uninsured individual is not charged more for emergency or other medically necessary services than the amounts generally billed to insured individuals receiving equivalent care. Contracted collection agency practices are aligned with the organizations social values and IRC section 501(r). Additionally, any patient experiencing financial hardship due to high medical expenses relative to their income level may qualify for the program under the high medical expense criteria. Northwest Health Plans MFA eligibility criteria allows all insured patients falling at or below 300% of the Federal Poverty Guidelines (FPG) to receive full (100%) write off of medical charges. Any patient who does not meet income-based eligibility criteria, but is experiencing financial hardship due to high medical expenses relative to their income may qualify for MFA under high medical expense criteria. Eligibility for high medical expenses exists when the patients incurred out-of-pocket medical and pharmacy expenses over the previous 12-month period is equal to or exceeds 10% of annual income. High medical expenses can apply to any income level. In Oregon and Washington, the MFA program also covers full or partial expenses for dental services if applicants meet qualifying guidelines. Promoting this medical-dental integration within the community is a priority for Kaiser Foundation Health Plan of the Northwest. The Health Plan supports the Oregon Primary Care Association in its efforts to bring dental directors together from Federally Qualified Health Centers to share best practices. Health Plan also employs a Community Benefit dentist for several hours each week to work with safety net partners to increase dental access and medical-dental integration in our community. In 2016, the MFA program assisted more than 13,000 qualified applicants, including nearly 2,000 patients who were not otherwise covered by a health care plan offered by Kaiser Foundation Health Plan of the Northwest. This population received full or partial forgiveness for nearly 116,000 outpatient visits and over 17,000 prescriptions. Approximately 400 people received dental financial assistance in 2016. A.1.1.1. Community Medical Financial Assistance (CMFA) The MFA program also includes support for community based initiatives, known as Community Medical Financial Assistance (CMFA) programs. CMFA programs are designed to broaden access to health care within the community and help KFHP-NW fulfill its objectives to reduce the financial barriers that limit access to care for qualified low income populations. Northwest Health Plan is partnering with Project Access NOW (PAN) in Multnomah, Clackamas and Washington Counties, the Medical Foundation of Marion and Polk Counties in Oregon, and The Free Clinics of Clark County and Cowlitz County in Washington in a broad based community initiative that builds access to health care for low income and uninsured people through the provision of donated medical services. Patients referred to Kaiser Permanente facilities from the partnering organizations are set up with a Health Record Number, Primary Care Provider and Home Clinic for a period of one year. T”

“Northwest Health Plan participated in three Medicaid managed care programs in Oregon and Washington as well as a fee-for-service provider for patients who have no formal affiliation with KFHP-NW. In 2016, KFHP-NW expended approximately $49.1 million (at cost, net of $119.1 million of related revenues) to subsidize care under Medicaid. In Oregon, Health Plan partners with the Health Share of Oregon as a fully capitated, risk-accepting entity and Trillium Community Health as a fee for service provider. In Washington, Health Plan participates as a fully capitated contractor of Molina Healthcare of Washington. The following describe the programs and target populations. A.2.1.1. Medicaid Managed Care Programs A.2.1.1.1. Health Share of Oregon Northwest Health Plan is a direct contractor with Health Share of Oregon under a Provider Care Organization contract to deliver primary and specialty care paid by the state. All reporting, analysis, auditing, and member administration is performed by KFHP-NW as a Managed Care Organization. As a result, KFHP-NW is engaged in policy development, program structure, and technical capabilities in partnership with the Health Share of Oregon. Currently, Northwest Health Plan, along with other regional health care providers, Tuality Healthcare, Care Oregon, and Providence Health Services, is a risk-accepting entity and a founding partner of Health Share of Oregon for Multnomah, Clackamas, and Washington counties. This is the largest Coordinated Care Organization in the state. A.2.1.1.2. Trillium Community Health With the establishment of Coordinated Care Organizations in the State of Oregon, KFHP-NW joined other health plans as a risk-accepting entity and founding partner in the management of Medicaid managed care contracts. KFHP-NW provides service for individuals with Medicaid or other government sponsored programs in the fee-for-service setting for individuals/populations not enrolled in managed care in Lane County. A.2.1.1.3. Molina Healthcare of Washington Washington Apple Health program is a Medicaid program offered by Molina Healthcare for low-income individuals that meet eligibility requirements for Medicaid. It is a fully-capitated state program managed by the Washington State Health Care Authority (HCA). Northwest Health Plan provides services to eligible participants who reside in either Clark or Cowlitz counties through a subcontract with Molina Healthcare. A.2.1.1.4. Medicaid Dental Program Kaiser Foundation Health Plan of the Northwest has known for 40 years that dental care is a crucial component of total health. Research has shown that dental care combined with medical care improves health outcomes for members and the bottom line for insurers. Northwest Health Plans actuarial team estimated savings of approximately $11 million for diabetic and cardiac patients who utilize dental services compared to those without Health Plan dental. Dental diseases account for between 5 percent and 10 percent of total health care expenditures. This exceeds the cost of treating cardiovascular disease, cancer, and osteoporosis. A.2.1.2. Medicaid Fee-for-Service Northwest Health Plan contributed $4.3 million (at cost, net of $3.7 million of related revenues) in subsidized care to Medicaid Fee-for-Service patients during 2016. These patients have no formal membership affiliation with KFHP-NW. When a Medicaid nonmember receives services from Kaiser Permanente providers at hospitals or outpatient services as a result of hospital visit follow-up, these expenses are captured as professional and non-professional losses under the Medicaid nonmember program. A.2.1.3. Child Health Insurance Program (CHIP) In both Oregon and Washington, KFHP-NW participates as a provider in the states Child Health Insurance Program. The program provides health insurance to children whose family income is between 200 percent and 300 percent of the federal poverty level, and who are not eligible for Medicaid. Subsidies are provided o”

“During 2016, Northwest Health Plan spent $2.0 million to support Community Benefit activities and programs beyond the national streams of work. This included the administrative expenses of a Community Benefit department dedicated to supporting regional Community Benefit programs and services and coordinating related initiatives.”

“Poor environmental quality contributes to disease, illness and economic insecurity. Kaiser Permanente has therefore committed itself to protecting and improving the natural environment as a key component of our social mission to improve the health of the communities we serve. To fulfill this commitment, Kaiser Permanente maintains a governance 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. - Addressing causes of climate change - Promoting sustainable farming and food choices - Reducing, reusing, and recycling to eliminate waste - Buying products and materials that do not contain chemicals or concern - Conserving water In each of these focus areas, KFHP-NW has established ambitious goals (including a target to reduce total greenhouse gas emissions by 30% by 2020, compared to a 2008 baseline), implemented initiatives, achieved measurable improvements, and regularly reported progress to the board of directors, staff, and the general public. F.1. Performance Metrics During 2016, key performance indicators for Kaiser Foundation Health Plan of the Northwest included: F.1.1. Medical product categories for which at least 99% of purchased products were free of harmful polyvinyl chloride (PVC) and bis(2-ethylhexyl) phthalate (DEHP) chemicals included: 1. Breast pumps; 2. Enteral nutrition products; 3. Exam gloves. Medical product categories for which at least 95% of purchased products were free of harmful DEHP included: 1. Infusion pumps, sets, and solutions; and 2. Vascular catheters. F.1.2. Purchased over 7 million kilowatt-hours of Clean Wind renewable power. F.1.3. Improved our energy use intensity (kBtu/rentable square foot) by 8% compared to our 2010 baseline year. F.1.4. Responsibly reused, recycled or composted over 1,700 tons of materials. F.1.5. Improved our water use intensity (gallons/rentable square foot) by 9% since our 2013 baseline year.”

“Description:purchased medical service total fees:xxx-xx-xxxx”

“Description:purchased other non-medical sv total fees:70982048”