Form 5500

Department of fhe iceasun/ Internal Revenue Selvice

Annual ReturnlReport of Employee Benefit Plan

This form is required to be filed for employee benefit plans under sections 104 and 4065 of the Employee Retirement Income Security Act of 1974 (ERISA) and sections 6047(e). and 6058(a) of the Internal Revenue Code (the Code).
)

I
1

OMB Nos. 1210-0110

1210-0089

Empiayee Bene6le Secunly Adminislalion

Oeparlmenl of Labor

Complete all entries i n accordance with the instructions to the Form 5500.

I Annual Report Identification Information 0110112010 - a multiemployer plan; U A This returnlreport is for: 1a single-employer plan:
Part I
For calendar plan year2010 or fiscal plan year beginning

This Form is Open t o Public Inspection

U a multiple-employerplan: or
a DFE (specify) the ilnal returnlrepori;

and endlng

1213112010

6 This returnlreport is:

the first returnlreport: an amended returnireport;

a short plan year returnireport (less than 12 months).

C If the plan is a collectively-bargainedplan, check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

,0

Check box if filing under:

[ Form 5558:
special extension (enter description)

automatic extension;

the DFVC program;

Part 11 Basic Pian information-enter all requested information 1a Name of plan

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETlRE.MENT PLAN

1b

Three-digit plan 003 number (PN) 1 C Effective date of plan 0110111968

2a Plan sponsor's name and address (employer, if for a single-employer plan)

(Address should include room or suite no.) KAISER FOUNDATION HEALTH PLAN INC

2b Employer Identincation
Number (EINI

ONE KAISER PLAZA SUITE 2001 OAKLAND, CA94612

number 510-271-5940 instructions) 621491

- -

Caution: A penalty for the late or incomplete filing of this returnlrepott will be assessed unless reasonable cause i s established. Under penalties of perjury and other penalties set forth in the instructions. I declare that I have examined this returnlreport, including accompanying schedules, statements and attachments, as well as the electronic version of this returnlre~ort. and to the best of mv knowledae and belief. it is true, correct. and comolete. SIGN Filed with authorizedlvaiidelectronlc signature. HERE Signature of plan administrator SlGN HERE Signature of employerlplan sponsor SlGN HERE Signature of DFE Dale Enter name of individual signing as DFE For Paperwork Reduction Act Notice and OM6 Control Numbers, see the instructions for Form 5500. Form 5500 iZOlOI Date Enter name of individual slgning as employer or plan sponsor 1011412011 Date HARRIET GUBERMAN Enter name of individual signing as plan administrator

Form 5500 (2010)

Page 2

3a

Plan administrator's name and address (if same as plan sponsor, enter"Samen) KAISER FOUNDATION HEALTH PLAN. INC.

3b 3c

Administrator's EIN 94-1340523 Administrator's telephone number 510-271-5940

ONE WISER PLAZA SUITE 2001 OAKLAND. CA 94612

the plan number from the last returnlreport:

Sponsor's name
1

Total number of participants at the beginning of the plan year Number of participants as of the end of the plan year (welfare plans complete only lines 6a, 6b, 6c, and 6d). Active participants Retired or separated participants receiving hen

1 5 1

36990

6
a
b

c Other retired or separated participants entitled to future benefit

d Subtotal. Add lines 6a, lib, and 6

Deceased participants whose beneficiaries are receiving or are entitled to receive benefits

f Total. Add lines 6d and 6

g h

Number of participants with account balances as of the end of the plan year (only defined contribution plans complete this item Number of oarticioants thnt terminnled ernnlovment dorinn the "Ian veer with arrnled henefits that were

I
-

8a

If the plan provides pension benefits, enter the applicable pension feature codes from the List of Plan Characteristic Codes in the instructions:

b If the plan provides welfare benefits, enter the applicable welfare feature codes from the List of Plan Characteristic Codes in the instructions:

9a

Plan funding arrangement (check all that apply) (1)

9b

(2) (3)

Insurance Code section 412(e)(3) insurance contracts Trust General assets of the sponsor

Plan benefit arrangement (check all that apply) Insurance Code section 412(e)(3) insurance contracts General assets of the sponsor

10 a

Check all applicable boxes in 10a and l o b to indicate which schedules are attached, and, where indicated, enter the number attached. (See instructions)

I "' F
(2)
(3)

Pension Schedules R (Retirement Plan Information)

MB (Multiemployer Defined Benefit Plan and Certain Money Purchase Plan Actuarial Information) signed by the plan actuary

General Schedules (1) H (Financial Information)

SB (Single-Employer Defined Benefit Plan Actuarial Information) signed by the plan actuary

(4) 15) (6)

::

I (Financial lnformation -Small Plan)

- A (Insurance Information)
C (Service Provider Information)

fl

D (DFEIParticipating Plan Information) G (Financial Transaction Schedules)

SCHEDULE C
(Form 5500)

Service Provider Information

OMB

NO.

1210-0110

This schedule is required to be filed under section 104 of the Employee oepartment the T~~~~~~~ of lnieinal ~evenue sewice Retirement Income Security Act of 1974 (ERISA). oepar,meni or Labor This Form is Open to Public Employee ~eneflir secunfy ~ d m ~ ~ i ~ t ~ ~ t ~ ~ h File as an attachment to Form 5500. Inspection. pension ~enefi! u a r a n t y ~ corporabon and ending 1213112010 For calendar plan year 2010 or fiscal plan year beginning 0110112010

2010

Name of plan KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN

B Three-digit
plan number (PN)

003

C Plan sponsor's name as shown on lhne 2a of Form 5500

KAISER FOUNDATION HEALTH PLAN INC

D Employer ldentlflcat~on Number (EIN)

94-1340523

Part I

l~ewice Provider lnformation (see instructions) -- -

Yo.. r r ~ sc2r ~1611? s Par1 in i~::onl'lo:E nlr. l o r r.;lr..r.lloi~s, l o rc2orl llle niornl:itlrln rel-lrc7 for each person :.nl ra~.d'be11 rcrlly 01 In0 ICCI y 55 000 l 111 ri .>r rnnrc in lotal Colrprosallon l e . , money c r 2n,in ng else 01 muntlary \:I LC, n conl~etl'uorv 1 ;i!Nlr:r~s rcnocrc7 to lne $an or Ilia i l e r d ~ ~:.oi111011 6% th lnc ., is p a n our:ry lh6 p1.1~ )car 1a p6rSU I r E ~ 5 i ~only sirjl.,~! nrl rr!r:l rorrpcnsatoo lor wn ch t r c plan rezelreo !he r d ? ~ ' r 6 3 S I : O S J ~ ~ ! SYO.. act rcq.uec lo ! e LI , answer line 1 but are not required to include that person when completing the remainder of this Part.

1 lnformation on Persons Receiving Only Eligible Indirect Compensation a Check "Yes" or"No" to indicate whether you are excluding a person from the remainder of this Part because they received only eligible
indirect compensation for which the plan received the required disclosures (see instructions for definitions and conditions).. . . . . . . . . . . . . . . [ y e s b If you answered line l a "Yes," enter the name and EIN or address of each person providing the required disclosures for the service providers who received only eligible indirect compensation. Complete as many entries as needed (see instructions) (b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation THE VANGUARD GROUP. INC.

0No

(b) Enter name and EIN or address oioerson who provided vou disclosure on elioible indirect comoensation

(b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation

(b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation

For Paperwork Reduction Act Notice and OM6 Control Numbers, see the instructions for Form 5500

Schedule C (Form 5500) 2010 v.092308.1

Schedule C (Form 5500) 2010

Ibl Enter name and EIN or address of Derson who provided vou disclosures on eliaible indirect ComDensation

(bl Enter name and EIN or address o i person who provided you disclosures on eliqible indirect compensation

(b) Enter name and EIN or address o i person who provided you disclosures on eligible indirect Compensation

(b) Enter name and EIN or address of person who provided you disclosures an eligible indirect compensation

(b) Enter name and EIN or address of person who provided you disclosures on eligible indirect compensation

Ibl Enter name and EIN or address of Derson who provided vou disclosures on eliaible indirect compensation

Ibl Enter name and EiN or address of person who provided vou disclosures on eliaible indirect comoensation

(b) Enter name and EIN or address of person who provided you disclosures on eliqible indirect compensation

Schedule C (Form 5500) 2010

Page 3

2. Information on Other Service Providers Receiving Direct or Indirect Comaensation. Exceut ior those oersons for whom vou answered "yes' to line l a above, complete as many entries as needed to list each person receiving, directly or indirectly, $5,000 or more in total compensation (i.e., money or anything else oivalue) in connection with services rendered lo the ulan or their uosition with the ulan durinq the ulan vear. (See instructions).

(a)
THE VANGUARD GROUP, iNC.

Enter name and EIN or address (see instructions)

23-1945930

Service Code@)

(b)

Relationship to Enter direct Did service provider employer, employee compensation paid receive indirect organization, or by the plan. ii none, compensation? (sources person known to be other than plan or plan enter -0.. a party-in-interest

(c)

(d)

(el

Did indirect compensation include eligible indirect compensation. for which the plan received the required disclosures?

(f)

Enter total indirect Did the service compensation received by provider give you a service provider excluding formula instead of eligible indirect an amount or compensation for which you est~mated amount? answered "Yes" to element (f). if none. enter -0-

(9)

(h)

879645 yes

fl

NO

yes

fl

0
NO

yes

NO

(a) Enter name and EIN or address (see instructions)

MORRIS DAVIS AND CHAN LLP

Service Code@)

(b)

Relationship to Enter direct Did service provider Did indirect compensation employer, employee compensation paid receive indirect include eligible indirect organization, or by the plan. If none, compensalion? (sources compensation, for which the other than ulan or ~ l a n ulan received the reouired enter -. person known to be 0. sponsor) ' a party-~n-interest disclosures?

(c)

(d)

(el

(9

(9)

Enter total indirect Did the service compensation received by provider give you a service provider excluding formula instead of an amount or elioible indirect compen&tlon for which you estimated amount? answered "Yes" to element (f). If none. enter -. 0.

(h)

10

NONE

22809 yes

NO

e]

yes

NO

yes

NO

0
1

(a) Enter name and EIN or address (see instructions)

QDRO CONSULTANTS COMPANY

34-1820650

(b)
Service Code@)

(c)

Relationship to Enter direct Did service provider employer, employee compensation paid receive indirect organization, or by the plan. If none, compensation? (sources person known to be enter -0.. other than plan or plan sponsor) a party-in-interest

(d)

(e)

(f)

(9)

Did indirect compansation Enter total indirect Did the service include eligible indirect compensation received by provider give you a compensation, for which the service provider excluding formula instead of eligible indirect plan received the required an amount or disclosures? compensation for which you estimated amount? answered "Yes' to element (f), If none, enter -0..

(h)

15

NONF

Rn75

' 1

yes

NO

fl (

yes

NO

Schedule C (Form 5500) 2010

Page 4

- D

(a) Enter name and EIN or address (see instructions)

Service Code@)

(b)

Did service provider Enter total indirect Did the service Relationship to Enter direct Did indirect compensation employer, employee compensation paid include eligible indirect receive indirect compensation received by provider give you a organization. or by the plan. If none, compensation? (sources compensation. for which the service provider excluding iormula instead oi eligible indirect enter -0.. person known to be plan received the required an amount or other than plan or plan sponsor) disclosures? compensation for which you estimated amount? a party-in-interest answered "Yes' to element (f). If none, enter -0..

(c)

(d)

(4

(r)

(9)

(h)

yes

NO

yes

NO

yes

NO

(a) Enter name and EIN or address (see instructions)

Service Code(s)

(b)

Relationship to Enter direct Did service provider receive indirect employer, employee compensation paid organization, or by the plan. If none, compensation? (sources person known to be other than plan or plan enter -0.. a party-in-interest sponsor)

(4

(dl

(e)

yes
NO

Did indirect compensation Enter total indirect Did the service compensation received by provider give you a include eligible indirect compensation, for which the service provider excluding formula instead of eligible indirect an amount or plan received the required disclosures? compensation for which you estimated amount? answered "Yes" to element (f), If none, enter -0..

(f)

(9)

(h)

yes

NO

yes

NO

(a) Enter name and EIN or address (see instructions)

Service Code(s)

(b)

Relationship to Did service provider Enter direct receive indirect employer, employee compensation paid organization, or by the plan. If none, compensation? (sources enter -0.. person known to be other than pian or plan sponsor) a party-in-interest

(c)

(d)

(el

Enter total indirect Did the service Did indirect Compensation compensation received by provider give you a include eligible indirect compensation, for which the service provider excluding formula instead of eligible indirect an amount or plan received the required compensation ior which you estimated amount? disclosures? answered "Yes' to element (fj If none, enter -0..

(4

(9)

(h)

yes

NO

yes

NO

yes

NO

Schedule C (Form 5500) 2010

Page 5

- r n

Part I

/service Provider Information (continued)

3 If you reported on line 2 receipt of indirect compensation, other than eligible indirect compensation. by a service provider, and the service provider is a fiduciary
or provides contract administrator, consulting, custodial, investmenl advisory. investment management, broker, or recordkeeping services, answer the following questions for (a) each source from whom the service provider received $1,000 or more in indirect compensation and (b) each source for whom the service provider gave you a formula used to determine the indirect compensation instead of an amount or estimated amount of the indirect compensation. Complete as many entries as needed to report the required information for each source.

(a) Enter service provider name as it appears on line 2

(b) Service Codes

lsee instruclionsl

(c) Enter amount of indirect

com~ensation

(d) Enter name and EiN (address) of source of indirect compensation

(e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amount of the indirect comoensation.

(a) Enter service provider name as it appears on line 2

(b) Service Codes

lsee instructions)

(c) Enter amount of indirect

compensation

(d) Enter name and EIN (address) of source of indirect compensation

(e) Describe the indirect compensation, including any formula used to determine the service provider's eligibility for or the amounl of the indirect compensation.

(a) Enter service provider name as it appears on line 2

(b)Service Codes
(see instructions)

(c) Enter amount of indirect

comoensation

(d) Enter name and EiN (address) of source of indirect compensation

(e) Describe the indirect compensation, including any

formula used to determine the service provider's eligibility for or the amount of the indirect compensatioq.

Schedule C (Form 5500) 2010

Page 6-

Part I1 Service Providers Who Fail or Refuse to Provide Information 4 Prov I:$! t t e txlsnl i,.ii.< lne ', JN'IILJ 111Crrl.ati~n i!ii~.n sence jlrov ricr :.OI I, <?<Ir:r rriuseg lo pro. C the r l f c n n ; ~ ~ ncccssary lo rcm?lels lo ble. for ; l r or
this Schedule.

(a)

Enter name and EIN or address of service provider (see instructions)

(b)

Nature o i Service Code(s)

(c) Describe the iniormation thatthe service provider iailed or reiused to

provide

(a) Enter name and EIN or address o i service provider (see

instructions)

(b) Nature o i
Service Code@)

(c) Describe the iniormation that the service provider failed or reiused to
provide

(a) Enter name and EIN or address of service provider (see

instructions)

(b) Nature o i
Service Codels)

( c ) Describe the iniormation that the service provider failed or reiused to

provide

(a) Enter name and EIN or address o i s e ~ i c e provider (see

instructionsi

(b) Nature o i
Service

(c) Describe the iniormation that the service provider failed or refused to
orovide

(a) Enter name and EIN or address of service provider (see

instructions)

(b) Nature o i
Service

(c) Describe the iniormation that the service provider failed or reiused to
provide

(a) Enter name and EIN or address o i service provider (see

instructions)

(b) Nature o i
Service

( c ) Describe the iniormation that the service provider failed or refused to

provide

Schedule C (Form 5500) 2010

page 7

- a

Part Ill a
C

Termination Information on Accountants and Enrolled Actuaries (see instructions)

(complete as many entries as needed)

Name: Position: Address:

b EIN:
e Telephone:

Explanation:

a
C

Name: Position: Address:

b EIN:
e Telephone:

Explanation:

a
C

Name: Position: Address:

b EIN:
e Telephone:

Explanation:

a
C

Name: Position: Address:

Ib

EIN:

e Telephone:

I Explanation:

a c d

Name: Position: Address:

Ib I
1

EIN:

e Telephone:

Explanation:

SCHEDULE D
(Form 5500)
Department of the ireasuly Internal Revenue sewice

DFElParticipating Plan lnformation

This schedule Is required to be filed under section 104 of the Employee Retirement Income Security Act of 1974 (ERISA).

I
I
1213112010

OMB No. 1210-0110

oepartmenlofLabor Employee Benefttr Secuity Adminirlraton

1 File as an attachment t o Form 5500

This Form is Open to Public ~ns~ection.

For calendar plan year2010 or fiscal plan year beginning

0110112010

and ending

Name of plan KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN

Three-digit plan number (PN)

003

C Plan or DFE sponsor's name as shown on line 2e of Form 5500 KAISER FOUNDATION HEALTH PLAN, INC.

Employer Identification Number (EIN) 94-1340523

Part I
a b

lnformation on interests in MTIAs, CCTs, PSAs, and 103-12 IEs (to be completed by plans and DFEs) (Complete as many entries as needed to report all interests in DFEs)
KAISER FOUNDATION HEALTH PLAN. INC Entity code M

Name of MTIA, CCT. PSA, or 103-12 IE: KAiSER INTEREST INCOME FUND MASTER Name of sponsor of entity listed in (a):

C EIN-PN 94-1340523-001

Dollar value of interest in MTIA, CCT, PSA, or 103-12 IE at end of year (see instructions)

a
b

Name of MTIA, CCT, PSA, or 103-12 IE: KAISER PERMANENTE MARiSCO MASTER TR Name of sponsor of entity listed in (a): EIN-PN 94-6365467-103 KAiSER PERMANENTE MEDICAL CARE PROG

c a b

Entity

Dollar value of interest ili MTIA, CCT, PSA, or

Name of MTIA, CCT. PSA, or 103-12 IE: VFTC INTEREST INCOME FUND Name of sponsor of entity listed in (a): VANGUARD FIDUCIARY TRUST COMPANY
-

c EIN-PN 94-1340523 001

Entlty code

Dollar value of lnterest in MTlA CCT, PSA, or 103-12 IE at end of year (see instructions)

341908859

a b

Name of MTIA. CCT. PSA or 103.12 IE Name of sponsor of entlty lhsted in (a)

KAISER PERMANENTE COLLECTIVE INVEST KAISER PERMANENTE MEDICAL CARE PROGRAM

C EIN-PN 27-6936361-001

Entity code

Dollar value of interest in MTIA, CCT, PSA, or 103-12 IE at end of year (see instructions)

149735287

a b

Name of MTIA. CCT. PSA. or 103-12 IE: Name of sponsor of entity listed in (a):

C EIN-PN

Entity code

Dollar value of interest in MTIA, CCT, PSA, or 103-12 IE at end of year (see instructions)

a b

Name of MTIA, CCT, PSA, or 103-12 IE: Name of sponsor of entity listed in (a):

C EIN-PN

Entity code

Dollar value of interest in MTIA, CCT. PSA, or 103-12 IE at end of year (see instructions)

a b

Name of MTIA, CCT, PSA, or 103-12 IE: Name of sponsor of entity listed in (a):

Entity e Dollar value of interest in MTIA, CCT, PSA, or code 103-12 IE at end of year (see instructions) For Paperwork Reduction Act Notice and OM5 Control Numbers, see the instructions for Form 5500.
C EIN-PN

Schedule D (Form 5500) 2010 v.092308.1

Schedule D (Form 5500) 2010

Page 2

- a

a Name of MTIA, CCT, PSA, or 103-12 IE: b Name of sponsor of entity listed in (a):
C EIN-PN

d Entity
code

Dollar value of interest in MTIA. CCT, PSA, or 103-12 IE at end of year (see instructions)

a Name of MTIA. CCT. PSA. or 103-12 IE: b Name of sponsor of entity listed in (a):
C EIN-PN

d Entity
code

Dollar value of interest in MTIA. CCT, PSA, or 103-12 IE at end of year (SF tin"^^

Name of MTIA, CC-

b Name of sponsor of entity listed in (a):

C EIN-PN

Entity code

Dollar value of interest in MTIA, CCT, PSA, or 103-12 IE at end of year (see instructions)

a Name of MTIA, CCT. PSA. or 103-12 IE: b Name of sponsor of entity listed in (a):
C EIN-PN

d Entity
code

Dollar value of interest in MTIA, CCT, PSA, or 103-12 IE at end of year (see instructions)

a Name of MTIA, CCT, PSA, or 103-12 IE: b Name of sponsor of entity listed in (a):
C EIN-PN

Entity code

Dollar value of interest in MTIA, CCT. PSA. or 103-12 IE at end of year (see instructions)

a Name of MTIA, CCT, PSA, or 103-12 IE:

Name of sponsor of entity listed in (a):

C EIN-PN

Entity code

Dollar value of interest in MTIA, CCT. PSA. or 103-12 IE at end of year (see instructions)

a Name of MTIA, CCT, PSA, or 103-12 IE: b Name of sponsor of entity listed in (a):
C EIN-PN

Entity code

Dollar value of interest in MTiA, CCT, PSA, or 103-12 IE at end of year (see instructions)

a Name of MTIA, CCT. PSA, or 103-12 IE:

b Name of sponsor of entity listed in (a):

b Name of sponsor of entity listed in (a):

C EIN-PN

d Entity
code

Dollar value of interest in MTIA, CCT, PSA, or 103-12 IE at end of year (see instructions)

a Name of MTIA, CCT. PSA, or 103-12 IE:

Name of sponsor of entity listed in (a):

C EIN-PN

d Entity
code

Dollar value of interest in MTIA. CCT, PSA. or 103-12 IE at end of year (see instructions)

Schedule D (Form 5500) 2010

page 3

- n

Part II

Information on Participating Plans (to be completed by DFEs)

(Complete as many entries as needed to report all participating plans)

a Plan name b Nameof

plan sponsor
C

EIN-PN

a Plan name b Nameof

plan sponsor
C

EIN-PN

a Plan name

b Nameof
plan sponsor

EIN-PN

Plan name
C

b Nameof
plan sponsor

EIN-PN

a Plan name

Nameof plan sponsor

EIN-PN

a Plan name b Nameof

plan sponsor
C

EIN-PN

a Plan name b Nameof

plan sponsor
C

EIN-PN

a Plan name b Nameof

plan sponsor
C

EIN-PN

a Plan name b Narneof

plan sponsor
C

EIN-PN

a Plan name b Name of

plan sponsor
C

EIN-PN

a Plan name b Nameof

plan sponsor
C

EIN-PN

a Plan name b Nameof

plan sponsor
C

EIN-PN

SCHEDULEH
oepariment of ,he Treasury
internal Revenue Service

Financial Information
This schedule is required to be filed under section 104 oithe Employee Retirement Income Security Act of 1974 (ERISA), and section 6058(a) ofthe Internal Revenue Code (the Code).

OM0 No. 1210-0110

2010
This Form i s Open t o Public

Depaitmeniof Labor Employee Benefits Securly Adrn~nistrailon

I File as an attachment to Form 5500.

01/01/2010 and ending

For calendar plan year2010 or fiscal plan year beginning

12131/2010

A Name of plan
KAiSER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN

Three-digit plan number (PN)

003

C Plan sponsor's name as shown on line 2a of Form 5500 WISER FOUNDATION HEALTH PLAN, INC
I

Employer identification Number (EIN) 94-1340523

I Part I I Asset and Liability Statement

1
Current value of plan assets and liabilities at the beginning and end of the plan year. Combine the value of plan assets held in more than one trust. Report the value of the plan's interest in a commingled fund containing the assets of more than one plan on a line-by-line basis unless the value is reportable on lines lc(9) through lc(14). Do not enter the value of that portion of an insurance contract which guarantees, during this plan year. to pay a specific dollar benefit at a future date. Round off amounts to the nearest dollar. MTIAs, CCTs, PSAs, and 103-12 IEs do not complete lines I . . I . . lc(81, l g , I b(l), b(2). . . - h and l i . CCTs, PSAs, end 103-12 IEsalso do not complete lines I d and l e . See instructions.

a b

Total noninterest-bearing cash Receivables (less allowance for doubtful accounts): (1) Employer contribution

(2) Participant contributions

(4) Corporate stocks (other than employer securities):

( 6 ) Real estate (other than employer real property) ..................................

(7) Loans (other than to participants) .........................................

. .......... . .

(8) Participant loans ...................................................................................

(9) Value of interest in common/collectivetrust (10) Value of interest in pooled separate accounts ........................................ (11) Value of interest in master trust investment accounts .................... ..

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500

Schedule H (Form 5500) 2010 v.092308.1

Schedule H (Form 5500) 2010

Page 2 (b) End of Year

Id

Employer-related investments: (1) Employer securities (2) Employer real prop

e f

Buildings and other property used in plan operation........................

............. .
1470438817 1692661060

Total assets (add all amounts in lines l a through l e ) ....................................

Liabilities

Operating payable

Net Assets I
Net assets (subtract line I from line 1 k

TI

1470438817

1692661060

Part II lncome and Expense Statement 2 Plan income, expenses, and changes in net assets for the year, Include all income and expenses of the plan, including any trust(s) or separately maintained
fundis) and anv oavmentslreceiotstolfrom insurance carriers. Round off amounts to the nearest dollar. MTiAs, CCTs, PSAs, and 103-12 IEs do not complete lines'2a. 2b(l)ii). ie,21, and 29.

Income
a Contributions:
(1) Received or receivable in cash from: (A) Employers................................ (6) Participants (C) Others (including rollovers (2) Noncash contributions ............................................................................ (3) Total contributions. Add lines 2a(l)(A), (B), (C), and line Za(2) 2a(2) 243)

(a) Amount

(b) Total

.................

151063666

Earnings on investments: (1) interest: (A) interes-bearing cash (including money market accounts and certificates of deposit) (6) U.S. Government securities (C) Corporate debt instruments (D) Loans (other than la participants

(E) Participant loans

(F)

Other

( G ) Total interest. Add lines 2b(l)(A) through (F) ..................................

(2) Dividends: (A) Preferred stoc (6) Common stoc (C) Registered investment company shares (e.g. mutual funds) ............. (D) Total dividends. Add lines 2b(2)(A), (6). and (C) (3) Rents (4) Net gain (loss) on sale of assets: (A) Aggregate proceeds ...................... (6) Aggregate carrying amount (see instructions) ................................... (C) Subtract line 2b(4)(6) from line 2b(4)(A) and enter result .................

Schedule H (Form 5500) 2010

Page 3
(a) Amount

(b) Total

2b

(5) Unrealized appreciation (depreciation) of assets: (A) Real estate......................

2b(5)(A) 2b(5)(B) 0

(6) Net investment gain (loss) from commonlcollective trusts ......................

(7) Net investment gain (loss) from pooled separate accounts ........................
(8) Net investment gain (loss) from master trust lnvestment accounts ............ (9) Net investment gain (loss) from 103-12 investment entities ....................... (10) Net investment gain (loss) from registered investment companies (eg., mutual funds
C Other incom

..

43256913

101806771 2c 2d 324601666

d Total incame. Add all income amounts in column (b) and enter total...................... Expenses e Benefit payment and payments to provide benefits:
(1) Directly to participants or beneficiaries, including direct rollovers ..............

. ............... . (2) To insurance carriers for the provision of benefits ................ .

(3) Othe (4) Total benefit payments. Add linesZe(1) through (3) ................ . . .......... .

f g h i

Corrective distributions (see instructions) Certain deemed distributions of participant loans (see instructions)................. Interest expense Administrative expenses: (1) Professional fees (2) Contract administrator fees

. .......... . (3) Investment advisory and management fees .............................

(4) Othe

(5) Total

.........................

j k I

Total expenses. Add all expense amounts in column (b) and enter total .........

Net Income and Reconciliation

Net income (loss). Subtract line 2 j from line 2 Transfers of assets: 222222243

Part Ill

Accountant's Opinion

Complete lines 3a through 3c if the opinion of an independent qualified public accountant Is attached to this Form 5500. Complete line 3d if an opinion is not attached.

a The attached opinion of an independent qualified public accountant for this plan is (see instructions):
(1)

[ Unqualified

(2)

0Qualified

(3)

0Disclaimer

(4)

0Adverse

b Did the accountant ~ e r i o r m limited s c o ~ e a audit ~ursuant 29 CFR 2520.103-8 andlor 103-12(d)? to
C Enter the name and EIN of the accountant (or accounting firm) below:

yes

fl

NO

(1) Name:MORRIS, DAVIS 8 CHAN LLP

(2) ElN: 94-2214860

(2)

d The opinion of an independent qualified public accountant is not attached because:

(1)

This form is filed for a CCT, PSA, or MTIA.

It will be attached to the next Farm 5500 pursuant l o 29 CFR 2520.104-50.

Schedule H (Form 5500) 2010

Page 4

I Part IV I Compliance Questions

4
CCTs and PSAs do not complete Part IV. MTIAs, 103-12 IEs, and GlAs do not complete 4a, 4e, 4f. 49, 4h, 4k, 4m. 4". or 5. 103-12 IEs also do not complete 4j and 41. MTlAs also do not complete 41. During the plan year: Was there a failure to transmit to the plan any participant contributions within the time period described in 29 CFR 2510.3-102? Continue to answer "Yes" for any prior year failures until fully corrected. (See instructions and DOLs Voluntary Fiduciary Correction Program.) ......
Were any loans by the plan or fixed income obligations due the plan in default as of the close of the plan year or classified during the year as uncolleclible? Disregard participant loans secured by participant's account balance. (Attach Schedule G (Form 5500) Part I if "Yes' is . . checked.) .................. ................................................................................................................
:,.t

2r.. . . .I ,.

.;.;r*p:us3~>;
I::.

.3

.r.-.. .
#.

Were any leases to which the plan was a party in default or classified during the year as uncollectible? (Attach Schedule G (Form 5500) Part II if"Yes" is checked.) .............................. Were there any nonexempt transactions with any party-in-interest? (Do not include transactions reporied on line 4a. Attach Schedule G (Form 5500) Part Ill if "Yes" is . ................................................................................................................ . checked.) .............. . Was this plan covered by a fidelity bon Did the plan have a loss, by fraud or dishonesty? .......................................................................................................... Did the plan hold any ass established market nor set by an independent third party appra Did the plan receive any noncash contributions whose value was neither readily determinable on an estab Did the plan have assets held far investment? (Attach schedule(s) of assets if 'Yes' is checked, 4i and see instructions for format requirements.)............................................................................. Were ally l~lao Ir.msaclo3s o.ser#csrV Ir;lns;l..llnn? n nxccss 0' 9 , of lne c ~ r r e n l val..~ plan assels? (Al1;~:hs~:oe,l~le lrans8ttion~f Yes' s L.IIBC~~!O and cf 01 see instructions for format requirement plan, or brought under the control of the PBGC
,.

f
Q

. . ~ .

i j

I I
4k 41 4m

X X X
X

Has the plan failed to provide any benefit when due under the pla

n 5a

If 4m was answered 'Yes," check the "Yes" box if you either provided the required notice or one of the exceptions to providing the notice applied under 29 CFR 2520.101-3. ............................. Has a resolution to terminate the plan been adopted during the plan year or any prior plan year? If yes, enter b e amount of any plan assets that reverted to the employer this year ............................

4 ,

0Yes

NO

Amount:

5b

If, during this plan year. any assets or liabilities were transferred from this plan to another plan(s), identify the pian(s) to which assets or liabilities were transferred. (See instructions.) %(I) Name of pian@)

MORRIS, DAVIS & CHAN LLP

Certif~ed Public Aeconntarits

INDEPENDENT AUDITORS' REPORT Investment Committee liaiser Permanente Supplemental Savings ant1 Retirement Plan Trust No. 92528 We have autlited the accot~ipanyii~g statements of net assets available for benefits of the Iiaiser Permanente Supplemental Savings and Retirement Plan (the Plaii) as of Decembel31, 2010 ai~cl2009, ancl the related statements of changes in net assets available for benefits for the years then ended. These financial statements are the responsibility of the Plan's n~anagemei~t. responsibility is to express an opinion on these financial statements based Out on 0111- audits. \Ve conducted our atidits in accordance wilh U.S. generally accepted auditing standards. Those standat-ds require that we plan and perform the audit to obtain reasonable assurance about whether the financial statetnents are free of material misstatement. An atidit inciiides col?sideratiol~of intemal control over financial repo~ting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the piirpose of expressing an opinion on the effectiveness of the Plan's inter-nal control over financial reporting. Accordingly, we express no si~chopinion. An audit includes examining, on n test basis, and disclosures in the financial statements. ,417audit also evidence supporting the amoui~ts incli~des assessing the accoiinting principles used and significant estimates made by management, as well as evaluating the ovel-all financial statement presentation. We believe that our audits provide a reasonable basis for our opinion. In our opinion, the financial statements, referred to above, present fairly, in all material respects, the net assets available for benefits as of Decernber 31, 2010 and 2009 and the changes in net assets available for benefits for the years then ended in confol-mity with U.S. generally accepted accounting principles. 01.1s atidits were perfot-ined fol- the purpose of forming an opinion on the basic financial stateinents taken a s a whole. The suppleinei~tal schedule of assets held for investment pitiposes as of December 31, 2010 is presented for the puqlose of additional analysis and is not a I-equired part of the basic financial statements but is supplementary inforrnatiol? required by the Department of Labor's Rules and Regulations for Reporting and Disclosure under the Einployee Retirement Income Security i\ct of 1974. This supplemental schedule is the responsibility of the Plan's management. The supplemental schedule has been sub!ected to tile auditing procedures applied in the audits of the basic financial statenlents and, in our opinion, is fairly stated in all material respects in relation to the basic financial statements taken as a whole.

r/llAhn** && .v,

Oaltland, California September 30.201 1

& C & C ,

1111 Broadway, Suit,e 1505 ' Oakland, California 94607

' (510) 250-1000 Fax (510) 250-1032 Office.$i n SR?II . 7 r ~ i ? ~ ~ ~ i ' i ~ ~ o , mid Clmrlotte, North Carolinn Cnlijor71io

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN

TRUST NO. 92528 FINANCIAL STATEMENTS AND SUPPLEMENTAL SCHEDULE TOGETHER WITH INDEPENDENT AUDITORS' REPORT DECEMBER 3 1,2010 AND 2009

MORRIS, DAVIS & CHAN LLP Certified Public Accountants

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN

TABLE OF CONTENTS

Independent Auditors' Repolt Statements of Net Assets Available for Benefits Statelnents of Changes in Net Assets Available for Benefits Notes to Financial Statelnetits Schedule H, Line 4i
-

Schedule of Assets Held for Investnient Purposes

MORRIS, DAVIS & CHAN LLP

Gel t ~ f i e d u b l i ~ r c o t ~ ~ ~ t a ~ l t i P A

INDEPENDENT AUDITORS' REPORT Investment Committee Kaiser Permanente Supplemental Savings a n d Retirement Plau Trust No. 92528 We have audited the accompanying statements of net assets available for benefits of the Kaiser Permanente Supplemental Savings a n d Retirement Plan (the Plan) as of Decenibel31, 2010 ant1 2009; and the related statements of changes in net assets available for benefits for the years theii ended. These financial statements are the responsibility of the Plan's management. 0 u 1 responsibiliiy is to express an opinioil on these financial statements based 011o i ~ audits. r \Ve conducted our audits in accordance with U.S. generally accepted a~iditingstandards. Tliose standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statenients are free of material misstatement. An audit includes co~isideration of ilitc~iial co~ltrol over filiancial reporting as a basis for d e s ~ g n ~ naudit g procedures that are appropriate in the circ~lmstances,but not for the purpose o f expressing an opinio~i on the effectiveness of the Plan's internal control over financial reporting. Accordingly, we express no such opinion. An audit includes examining, on n test basis: evide~icesupporting the alnoilnts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by ~na~iagernent, ~vellas evaluating the overall financ~al as staternelit presentatioii. We believe that our audits provide a reasonable basis for our opinion. In oiir opin~oii,the financial statements, referred to above, present fairly, in all material respects, the net assets available for benefits as of December 31, 2010 and 2009 and the changes i l l net assets available for benefits for the years then ended in conformity with U.S. generally accepted accounting principles. Our audits were performed for the putpose of formling an opinion on the basic financial statements talien as a whole. The supplemental schedule of assets held for investment pillposes as o f December 3 1, 201 0 is presented for the purpose of additional aiialysis and is not a required part o f t h e basic financial statements but is supplementary information required by the Department of Labor's Rules and liegulations for Reporting and Disclosure t~nder the E~nployee Retirement Income Security Act of 1973. This supple~i~enral schedule is the responsibility of the Plan's management. The supplemental schedule has been si~bjectedto the auditing procedures applied in the audits of the basic financial statements and, in our opinion. is fairly stated in all material respects in I-elation to the basic financial stateme~its taken as a whole.

& k ,$& t
Oaltland, Cal~fomia September 30, 201 1

&N -

4
(510) 250-1000

1111 Broadway. Suite 1505 ' Oakland, Cnlifor~~ia 94607

. Fax (510) 250-103!!~

Offices in S/,?l I.'l-[~~~ci.sco, Cnlvoo,7rin nnd Ctrnrlolte, North Cnroli7m

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN STATEMENTS OF NET ASSETS AVAILABLE FOR BENEFITS DECEMBER 3 1.2010 AND 2009

Assets Investments, at fair value Mutual funds Collective investment funds

Contribution receivables Ernployer Participants Notes receivable from participants Total assets Liabilities Net assets reflecting investments at fair value Adjustment fro111 fair value to contract value for fully benefit-responsive investt~lent contracts
Net assets available for benefits

(14,711,392)

(7,705,070)

notes are an integral part of the financial statements. The acco~npanying

-2-

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN STATEMENTS OF CHANGES IN NET ASSETS AVAILABLE FOR BENEFITS FOR THE YEARS ENDED DECEMBER 3 1,2010 AND 2009

Additions Investment incolne Net appreciation in fair value of invest~nents Interest and dividends Contributions En~ployer Participants

Interest income on notes receivable from participants Total additions Deductions Benefits paid to participants Administrative expenses Total deductions Net increase Net assets available for benefits Beginning of year End of year

The acco~npanying notes are an integral part of the financial statements.

-3-

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 AND 2009 NOTE A - Description of tlie Plan The following description of the Kaiser Permanente Supplemental Savings and Retirement Plan (the Plan) provides only general information. Participants should refer to the Plan document for a more complete description of the Plan's provisions. General The Plan is a money purchase pension plan which is intended to comply with the provisions of Section 401(a) and other applicable provisions of the Internal Revenue Code (IRC) and the Employee Retirement Income Security Act of 1974 (ERISA), as amended. The purpose of the Plan is to provide additional retirement benefits for participants who meet specified requirements. Particivant Accounts Each participant's account is credited with the participant's contributions, as well as any relevant Employer's contributions plus allocated Plan earnings and losses, and charged with administrative expenses. Allocations are based on participant account balances, as defined. The benefit to which a participant is entitled is based on the participant's vested account balance. Contributions A participant may elect to rnake contributions, through payroll deduction, in increments of 1% up to a maximum of 10% of after-tax cornpensation subject to applicable limitations prescribed by the Plan document. The E~nployercontribntes 5% of the compensation of after 2 years of employn~ent. participating en~ployees

VestinF:
Each participant is innnediately and 100% vested in his or her accounts. Notes Receivable fiom Participants A participant with an account balance of at least $2,000 may bo~row to the lesser of 50% up of his or her account balance or $50,000, reduced by the highest outstanding loan balances carried by the participant in this and/or all other Enlployer plans during the 12-month period prior to the new loan. The term of the loan is limited to not more than 5 years, except for residential loans which may be extended up to 15 years. The interest rate is "Prime Rate" plus 1%. Loati repayments are made through payroll deductions and are credited to the participant's account. Payment of Benefits A participant shall be entitled to receive all or a portion of his or her account upon occurrence of the earlier of the participant's retirement, death, disability, or termination of employment, as defined by the Plan document. Participant may take a distribution of any after-tax contribution and applicable earnings at any time.

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FTNANCIAL STATEMENTS DECEMBER 3 1,2010 AND 2009

NOTE B - Significant Accounting Policies Basis of Accounting The accompanying financial statements are prepared on the accrual basis of acco~ultingin accordance with U.S. generally accepted accounting principles (GAAP). New Accounting Pronouncen~ent In Janua~y 2010, Accounting Standard Update (ASU) 2010-06, Improving Disclosures about Fair value Measurements, expanded the required disclokres about fair value measurements. ASU 2010-06 requires 1) separate disclosure of significant transfers into and out of Level 1 and Level 2, along with reasons for such transfers; 2) separate presentation of gross purchases, sales, issuances, and settlements in the Level 3 reconciliation; aud 3) presentation of fair value disclosures by "nature and risk" class for all fair value assets aud liabilities. The requirements of ASU 2010-06 are effective for the current reporting period except for the level 3 reconciliation disaggregation which is required in 201 1 reporting. The requirements of ASU 2010-06 have no impact on the Plan's financial statements. Use of Estimates The preparation of financial statements in accordance with GAAP requires Plan management to make estitnates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results maJ differ from those estimates. Investment Valuation and Income Recognition Investments are reported at fair value. Fair value is the price that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date (see Note E-Fair Value Measurements). Fully benefit-responsive investment contracts held by a defined-contribution plan are required at to be repo~ted fair value. However, contract value is the relevant measurement attribute for that portion of the uet assets available for benefits of a defined-contribution plan attributable to fully benefit-responsive investment contracts because contract value is the amount participants would receive if they were to initiate pelmitted transactions under the terms of the plan. The Statements of Net Assets Available for Benefits present the fair value of the investment contracts from fair value to contract value. The Statement of Changes in Net Assets Available for Benefits is prepared on a contract value basis.

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 AND 2009 NOTE B - Significant Accounting Policies (Continued) Recognition (Continued) Investment Valuation and Inco~ne Purchases and sales of securities are recorded on a trade date basis. Net realized and Statenlent of Changes unrealized appreciation (depreciation) is recorded in the acco~npanying in Net Assets Available for Benefits as net appreciation (depreciation) in fair value of investnlents. Interest income is recorded on tlie accrual basis. Dividends are recorded on tlie ex-dividend date. Notes Receivable from Participants Notes receivable from participants are measured at their unpaid principal balance plus any accrued but unpaid interest. Delinquent notes receivable from participants are reclassified as distributions based upon the terms of tlie Plan document. Payment of Benefits Benefits are recorded when paid. Administrative Expense Certain investnient funds charge transaction fees. These fees are deducted from participant accounts and are reflected in the acconlpanying financial statements as administrative expenses. Subsequent Event The Plan's financial statements have been evaluated for subsequent events or transactions for potential recognition tlirougli September 30, 201 1, the date the financial statements are available to be issued. Plan lnanagenient determined that there are no subsequent events or transactions that require disclosure to or adjustnlent in the financial statements. Reclassification In September, 201 0, ASU 201 0-25, Reporting Loans to Participants by De$ned Contribution Pension Plans, clarified the classification and measurement of the participant loans by defined contribution plans. ASU 2010-25 urovided that in defined contribution ulans' financial statements, participant loans should be classified as notes receivable from participants, which are segregated from plan investments and measured at their unpaid principal balance plus any accrued but unpaid interest. Plan management reclassified participant loans on tlie Statements of Net Assets Available for Benefits for all years present as notes receivable from participants. The net assets of the Plan were not affected by the reclassification. As ASU 2010-25 applies only to financial staternelits prepared in accordance with GAAP, it will not affect the classification of notes receivable from participants on the Fo~in5500. Notes receivable from participants continue to be reported as investments on

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1.201 0 AND 2009

NOTE B - Significant Accounting Policies (Continued) Reclassification (Continued) Form 5500, Schedule H, line lc(8) of the Plan. Because ASU 2010-25 will not result in a difference between total net assets reported in the Form 5500 and the Plan's financial statements, there is no reconciling note in the Plan's financial statements. Additionally, notes receivable from participants are exempt from (i) the disclosure requirements about fair value in paragraphs 825-10-50-10 through 50-16 of the Financial Accounting Standard Board (FASB) Accounting Standards Codification (ASC); and (ii) credit quality disclosures required by the amendments in ASU No. 2010-20, Receivables (Topic 310): Disclosures about the Credit Quality of Financing Receivables and the Allowance for Credit Losses. FASB believes that any individual credit risk related to notes receivable from participants is mitigated by the fact that these notes are secured by the participant's vested balance. If a participant were to default, the participant's account balance would be offset by the unpaid balance of the note and the participant would be subject to tax on the unpaid balance. As such, the participant is the only party affected in the event of a default. NOTE C - Restructuring of the Kaiser Perinanente Master and Collective Trust, and the Kaiser Interest Income Trust Prior to December 29, 2010, portions of the Plan's assets were held in the Kaiser Permanente Master and Collective Tmst (KPMCT) and the Kaiser Interest Income Trust (KIIT). The KPMCT held the Defined Benefit Investment Fund for participating defined benefit plans as well as the Marsico Growth Equity Fund and the Stable Income Fund for participating defined contribution plans sponsored by Kaiser Foundation Health Plan, Inc. (KFHP) and the Pe~inanenteMedical Groups (PMGs). The KIIT holds the Kaiser Interest Income Fund for participating defined contribution plans sponsored by KFHP and the PMGs. State Street Bank and Tlust Company (State Street) served as trustee of the KPMCT and Vanguard Fiduciary T ~ u sConlpany (Vanguard) selves as the trustee of the KIIT. t On December 29, 201 0, the KPMCT was amended and restated into the Kaiser Perlnanente Group Trust (KPGT), a 103-12 investnlent entity, and the Kaiser Permanente Collective Inveshnent T ~ u s (KPCIT) was established. State Street continued on to be the trustee of the t KPGT.

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FTNANCIAL STATEMENTS DECEMBER 3 1,2010 AND 2009

NOTE C - Restructuring of the Kaiser Permauente Master and Collective Trust, and the Kaiser Interest Income Trust (Continued) The net assets of the Marsico Growth Equity Fund and the Stable Income Fund were transferred froin the KPMCT to the KP Growth Equity Fund and the KP Stable Income Fund, respectively, in the KPCIT. Global Trust Company (Global Trust) became the trustee of KPCIT and State Street became its custodian. In December 2010, the KIIT agreement was amended and restated into a collective trust and the Kaiser Interest Incon~e Fund held by KIIT was renamed the Vanguard Fiduciaiy Trust Company Interest Income Fund (VFTC Interest Income Fund). Vanguard remains the tiustie for the KIIT. For plan year 2010, the Plan reports its investments held by KPCT and KIIT as investments in commoi~/collective trusts for F o i ~ n 5500 pnlposes. For plan year 2009, the Plan repotted its investments held by KPMCT and KIIT as investments in master trust investment accounts for Foml 5500 purposes. See Note K - Reconciliation of Financial Statements to Form 5500. NOTE D - Investnlents The following presents investments that represent 5% or more of the Plan's net assets as of December 3 1.2010 and 2009:

Mutual funds Vanguard Lifestrategy Conservative Growth Fund $ Vanguard Total Bond Market Index Fund Vanguard Wellington Fund Vanguard Total Stock Market Index Fund Collective investment funds VFTC Interest Income Fund (forn~erly Kaiser Interest Income Fund)* KP Growth Equity Fund** Marsico Growth Equity Fund**

321,088,719 151,432,566 109,212,987 193,011,803

$ 246,982,626

136,745,825 100,123,960 164,461,669

341,908,859 149,735,287

Contract valtre M'o.~ $327,197,467 rind $333,588,271 or ofDrce,>?hev 2010 nnd 2009. respectively. 31,

** KP Growtlz Equity Ftrad replaced the A4arsicu G~.owfhEqrtify Fund os oil inveslnienl option in 2010.

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FTNANCIAL STATEMENTS DECEMBER 3 1,2010 AND 2009 NOTE D - Investments (Continued) For the years ended December 3 1, 2010 and 2009, the Plan's illvestinents (including gaiils and losses on investment bought and sold, as well as held duiing the year) appreciated in value as follows:

Mutual funds Collective investment funds Net appreciation in fair value of investinents NOTE E - Fair Value Measurements FASB ASC 820, Fair Value Measurements and Disclosures, establishes a framework for measuring fair value. That framework provides a fair value hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The hierarchy gives the highest priority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1 measurements) and the lowest priority to unobservable inputs (Level 3 measurements). The three levels of the fair value hierarchy are described below: Level I Inputs to the valuatiotl methodology are unadjusted quoted prices for identical assets or liabilities in active markets that the Plan has the ability to access. Level 2 Inputs to the valuation nlethodology include: Quoted prices for similar assets or liabilities in active markets; Quoted prices for identical or similai-assets or liabilities in inactive markets; Inputs other than quoted prices that are obset-vable for the asset or liability; and Inputs that are derived principally from or corroborated by observable market data by correlation or other means. Level 3 Inputs to the valuation methodology are unobservable and significant to the fair value measurement. The asset's or liability's fair value measurement level within the fair value hierarchy is based on the lowest level of any input that is significant to the fair value measurement. Valuation techniques used need to maxiiuize the use of observable inputs and ininimize the use of unobservable inputs.

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 AND 2009

NOTE E - Fair Value Measurements (Continued) Following is a description of the valuation methodologies used for investlnents measured at fair value. There have been no changes in the methodologies used as of December 31, 2010 and 2009.

Mutual fi~nds valued at the net asset value of shares held by the Plan at year end. are Collective investment funds are stated at fair values as determined by the issuers based on the unit values of the funds. Unit values are determined by dividing the funds' net assets, which represent the unadjusted prices in active markets of the underlying investments, by the number of outstanding at the valuation date. While not publicly traded, the funds are comprised primarily of underlying securities represeuted by a variety of asset classes that are publicly traded on exchanges or over-the counter, and price quotes for the assets held by the funds are readily observable and available.

The methods described above may produce a fair value calculation that may not be indicative of net realizable value of reflective of future fair values. Furthermore. while the Plan believes its valuatiou methods are appropriate and consistent with other market participants, the use of different ~nethodologiesor assumptions to deter~ninethe fair value of certain financial irlstruments could result in a different fair value measurement at the reporting date. The following tables set forth by level, within the fair value hierarchy, the Plan's investments at fair value as of December 3 1, 2010 and 2009:
Level I Mutual funds Domestic stock funds InternationalIglobaI stack funds Bond fund Balanced filnds Other funds Collective investment funds Investments, at fair value Investments at Fair Value as of December 31, 2010 Level2 Level 3 Total

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FTNANCIAL STATEMENTS DECEMBER 31,201 0 AND 2009

NOTE E - Fair Value Measurements (Continued)

Level I Mutual funds Domestic stock furids Internationall~lobalstock funds Bond fund Balanced funds Other funds Collective investinellt fi~nds Investments, at fair value lrivcst~nents Fair Value as of December 31. 2009 at Level 2 Level 3 Tntal

NOTE F - Tax Status The Plan obtained its latest determination letter on February 3, 201 1, in which the Internal Revenue Service (IRS) stated that the Plan, as then designed, was in con~pliancewith the applicable requirements of the IRC. Subsequent to the issuance of the dete~minationletter, the Plan was amended and restated. Once qualified, the Plan is required to operate in confo~mity with the IRC to maintain its qualification. The plan administrator believes that the Plan is currently designed and being operated in compliance with the applicable requirements of the IRC and, therefore, believes that the Plan, as amended and restated, is qualified and the related trust is tax-exempt as of the financial statement date. GAAP requires Plan management to evaluate tax positions taken by the Plan and recognize a tax liability (or asset) if the Plan has taken an uncertain tax position that would not meet the more likely than not standard and be sustained upon examination by the IRS. The Plan administrator has analyzed the tax positions taken by the Plan, and bas concluded that as of December 31, 2010, there are no uncertain tax positions taken or expected to be taken that would require recognition of a liability (or asset) or disclosure in the financial statements. The Plan is subject to routine audits by taxing jurisdictions. The Plan administrator believes it is no longer subject to income tax examinations for years prior to 2007. NOTE G - Plan Te~mination Although it has not expressed any intent to do so, the Employer has the right under the Plan to the discontinue its contributions at any time and to te~ininate Plan subject to the provisions of ERISA. Should the Plan be te~minated, net assets are to be distributed to participants, the the value of their adjusted accounts.

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 AND 2009 NOTE H - Party-in-Interest Transactions Certain Plan investments are managed by Vanguard and State Street. Vanguard and State Street are the trustees of the Plan. Vanguard also selves as the recordkeeper. Transactions with the trustees and recordkeeper qualify as party-in-interest transactions. NOTE I - Risks and Uncertainties The Plan invests in various investment securities. Investment securities are exposed to various risks such as interest rate, market and credit risks. Due to the level of risk associated with certain investment securities, it is at least reasonably possible that changes in the values of investment securities will occur in the near tern1 and that such changes could materially affect participants' account balances and the amounts reported in the statement of net assets available for benefits. NOTE J - Plan Obligatio~ls In accordance with GAAP, benefits due to terminated participants are included in net assets available for benefits. There are no benefits due to terminated participants as of December 31,2010 and 2009. NOTE K - Reconciliation of Financial Statements to Form 5500 The following is a reconciliation of net assets available for benefits per the financial statements to Forn15500 as of December 3 1,2010 and 2009:

Net assets available for benefits per the financial statements Adjustnlent from contract value to fair value for fully benefit-responsive investnlent contracts Net assets available for benefits per Fonn 5500

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN NOTES TO FTNANCIAL STATEMENTS DECEMBER 3 1,2010 AND 2009

NOTE K - Reconciliation of Fitla~lcialStatements to Fonn 5500 (Continued) per The following is a reconciliation of investment inco~ne the financial statements to Form 5500 for the years ended December 3 1,2010 and 2009:

per Investment inco~ne the financial statements Change in adjustment from contract value to fair value for fully benefit-responsive investment conbacts Investme~lt income per Fosn15500

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN EIN 94-1340523 PLAN NO. 003 SCHEDULE H, LINE 4i - SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSES DECEMBER 31,2010

Identity of Issue, Borrower, Lessor, or Siinilar Party AllianceBernstein Global Research Growth Fund T. Rowe Price International Discovery Fund Vanguard Explorer Fund Vanguard FTSE Social Index Fund Vanguard International Growth Fund Growth Fund Vanguard LifeStrateg Co~lservative Vanguard LifeStrdteg Growth Fund Fund Vanguard LifeStrategy Inco~ne Vanguard LifeStrategy Moderate Growth Fund Vanguard PRIMECAP Fund Vanguard Total Bond Market Index Fund Vanguard Total Stock Market Index Fund Vanguard Value Index Fuud Vanguard Wellington Fund Collective Investnlent Trust Kaiser Per~nanente (KP Growth Equity Fund) VFTC Interest Incoine Fund VGI Brokerage Option Total investments per fiilailcial statements Notes receivable froin participants Total invest~nents Fonn 5500 per

Description of Inveshl~ent Including Maturity Date, Rate of interest, Collateral, Par, or Maturity Value Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Collective investment fund Collective investment fund Self-directed brokerage account
$

Cost 5,597,115 40,659,844 26,186,430 2,693,545 68,458,673 297,805,927 57,707,5 13 13,775,792 54,635,262 42,364,091 145,105,691 149,809,239 47,348,964 102,394,467

Current Value
$

5,059,376 45,691,702 29,491,550 3,302,612 72,024,544 321,088,719 60,906,453 14,525,638 57,255,677 47,133,240 151,432,566 193,011,803 56,011,723 109,212,987

Investments in parties-in-interest as defined under ERISA

92528

KAISER PERMANENTE SUPPLEMENTAL SAVINGS AND RETIREMENT PLAN EIN 94-1340523 PLAN NO. 003 SCHEDULE H, LINE 4i - SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSES DECEMBER 3 1,2010

Identity of Issue, Borrower, Lessor, or Sinlilar Party AllianceBernstein Global Research Growth Fund T. Rowe Price International Discovery Fund Vanguard Explorer Fund Vanguard FTSE Social Index Fund Vanguard International Growth Fund Vanguard LifeStrategy Conservative Growth Fund Vanguard LifeStrategy Growth Fund Vanguard LifeStrategy Incoinc Fund Vanguard LifeStrategy Moderate Growth Fund Vanguard PRIMECAP Fund Vanguard Total Bond Market Index Fund Vanguard Total Stock Market Index Fund Vanguard Value Index Fund Vanguard Wellington Fund Collect~ve Inveshnent Trust Kaiser Per~nanente (KP Growth Equity Fund) VFTC Intcrest Incoine Fund VGI Brokerage Option Total itlvest~neuts financial statements per Notes receivable from participants Total investments per Form 5500

Description of Inveshnent Illeluding Maturity Date, Rate of Interest, Collateral, Par, or Maturity Value Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual fi~nd Mutual fund Mutual fund Mutual fund Mutual fund Mutual fund Mutual find Mutual fuild Mutual fund Collective inveshllent fund Collective investinel~t fund Self-directed brokerage account
$

Cost 5,597,115 40,659,844 26,186,430 2,693,545 68,458,673 297,805,927 57,707,513 13,775,792 54,635,262 42,364,091 145,105,691 149,809,239 47,348,964 102,394,467

Current Value
$

5,059,376 45,691,702 29,491,550 3,302,612 72,024,544 321,088,719 60,906,453 14,525,638 57,255,677 47,133,240 151,432,566 193,011,803 56,O 11,723 109,212,987

Investinents in parties-in-interest as defined under ERISA.

92528

SCHEDULE R
(Form 5500)
Department of the ~ r e a s u n lntemal ~evenussswics
E
Department of ~ a b o r ~~ ~~ secuity~drninrtraton~ t ~ I ~ ~ n

Retirement Plan Information

This schedule is required to be filed under section 104 and 4065 of the Employee Retirement Income Security Act of 1974 (ERISA) and section 6058(a) of the lnternai Revenue Code (the Code).
~~
~

OMB NO. 1210-0110

2010
This Form i s Open to Public Inspection.

pension Benefli Guaianly corporation

b File as an attachment to Form 5500.

OllOlnOlO

For calendar plan year 2010 or fiscal plan year beginning

and ending

1213112010 Three-digit plan number (PN)

Name of plan KAISER PERMANENTE SUPPLEMENTAL SAVtMGS AND RETlREMENT-PLAN

003

C Plan sponsor's name as shown on line 2a of Form 5500 KAISER FOUNDATION HEALTH PLAN, INC

D Employer Identification Number (EIN)

94-1340523

I Part I I
1 2

Distributions

All references t o distributions relate only to payments of benefits during the plan year. Total value of distributions paid in property other than in cash or the forms of property specified in the instructions............................................................................................................................................................ Enter the EIN(s) of payor@)who paid benefits on behalf of the plan to participants or beneficiaries during the year (if more than two, enter EINS of the two payors who paid the greatest dollar amounts of benefits): EIN(s): 23-2186884 and stock bonus plans, skip line 3.
3

Profit-sharing plans, E O ?, S P.

Number of participants (living or deceased) whose benefits were distributed in a single sum, during the plan bear .......................... ............ .....

I
5

Part II

Funding lnformation ( f tne plan s no! sLb.e-;l to !he n, nim..m f..ndnq req.. rcmcnts of se!:tion of 012 of l o r ,Irroal Rcven~e Corlr! ni . . ERISA section 302, skip this Part) Yes No NIA Is the plan administrator making an election under Code section 412(d)(2) or ERISA section 302(d)(2)?.......................

I
I

1
[i3

1EC7

If the plan i s a defined benefit plan, go to line 8. If a waiver of the minimum funding standard for a prior year is being amortized in this plan year, see instructions and enter the date of the ruling letter granting the waiver. Date: Month Day Year

If you completed line 5, complete lines 3, 9, and 10 of Schedule ME and do not complete the remainder of this schedule.

a Enter the minimum required contribution for this plan year b Enter the amount contributed by the employer to the plan for this plan year
C

Subtract the amount in line 6b from lhe amount in line 6a. Enter the result (enter a minus sign to the left of a negative amount)

If you completed line 6c, skip lines 8 and 9.

7
8

Will the minimum funding amount reported on line 6c be met by the funding deadline? .................................

..

Yes

17 NO

0 NIA

If a change in actuarial cost method was made for this plan year pursuant to a revenue procedure providing automatic approval for the change or a class ruling letter, does the plan sponsor or plan administrator agree with the chanae?.................................................................................................................................................

Part Ill
9

yes

NO

NA I

Amendments
increase

I Part IV
I

If this is a defined benefit pension plan. were any amendments adopted during this plan year that increased or decreased the value of benefits? If yes, check the appropriate box(es), no, check the -NO"box ......................................................................................

0Decrease

60th

0'
Yes yes Yes yes

NO

I
I

ESOPs (see instructions). If this is not a plan described under Section 409(a) or 4975(e)(7) of the Internal Revenue Code,
skip this Part. No
NO NO

10 Were unallocated employer securities or proceeds from the sale of unallocated securities used to repay any exempt loan? .............. 11 a Does the ESOP hold any preferred stoc b If the ESOP has an outstanding exempt (See instructions for definition of "back-to-back loan.) ............................................................................................................ 12 Does the ESOP hold any stock that is not readily tradable an an established securities market
For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions far Form 5500.

I] NO

Schedule R (Form 5500) 2010 v.092308.1

Schedule R (Form 5500) 2010

Page 2

- r n
. .- 0

-.. [ art^ Additional Information for Multiemployer Defined Benefit Pension Plans . .. lnan 13 Entcr tnr 'lllloc nq niorn,zl on 'or rduo wnl. o y r r lnal ConlrlbLled o l ~ r a 5.0of to131 Lonlr o.lo?s 10 ine p 3 0 u.r nq In* lion ,ear (rlltas.rrll

dollars). See instructions. Complete as many entries as needed to repod all applicable employers. Name of contributing employer EIN
C

b
d

Dollar amount contributed by employer

Date collective bargaining agreement expires (If employer contributes under more than one coNective bargaining agreement, check b o x 0 and see instructions regarding required aiiachmenf. Otheiwise, enter the applicable date.) Month Day Year Contribution rate information (If more than one rate applies, check this box and see instructions regarding required attaciiment. Otherwise, complete items 13e(l) and 13ef2j.j (1) Contribution rate (in dollars and cents) (21 Base unit measure: Hourlv Weeklv Unit of Droduction fl Other (s~eciiv): .. .. ..

n
I I

n
I I

a
d

Name of contributing employer

Date collective bargaining agreement expires (If empioyercontributes undermore than one collective bargaining agreement, check b o x 0 and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month Day Year Contribution rate information (if more than one rate applies, check this b o x 0 and see instructions regarding required attachment. Otherwise, complete iterns 13e(l) and 13e(2).) (1) Contribution rate (in dollars end cents) (2) Base unit measure: Hourly Weekly Unit of production Other (specify):

II

II

a b d e

Name o i contributina emulover EIN

C

Dollar amount contributed by employer

Date collective bargaining agreement expires (If empioyercontribbutes undermore than one collective bargaining agreement, check b o x 0 and see instructions regarding required attachment. Othenwise, enter the applicable date.) Month Day Year Contribution rate information (if more than one rate applies, check this b o x 0 and see instructions regarding requiredattachment. Otherwise, complete items 13e(l) and 13e(2).) (1) Contribution rate (in dollars and cents) Weekly Unit of production Other (specify): (2) Base unit measure: Hourly

II

a b d e

Name of contributing employer ElN

Dollar amount contributed by employer

Date collective bargaining agreement expires (if empioyer contributes under mare than one collective bargaining agreement, check box and see instructions regarding required attachment. Otherwise, enter the applicable date.) Month Day Year Contribution rate information (If more than one rate applies, check this b o x 0 and see instructions regarding requrred attachment. Otheiwise, complete items 13e(l) and 13e(2).) (1) Contribution rate (in dollars and cents) Unit of production Other (specify): (2) Base unit measure: Hourly Weekly

II

a b d e

Name of contributing employer EIN

C

Dollar amount contributed by employer

Date collective bargaining agreement expires (if employer contributes under mare than one coNective bargaining agreement, check box and see instructions regarding required attachment Otherwise, enter the applicable date.) Month Day Year

Contribution rate information (If more than one rate applies, check this box and see instructions regarding required attachment. Otherwise, complete items 13e(l) and 13e(2).) (1) Contribution rate (in dollars and cents) (2) Base unit measure: Hourly Weekly Unit of production Other (specify): Name of contributing employer EIN
C

a b d e

Dollar amount contributed by employer

Date collective bargaining agreement expires (If empioyer contributes under more than one collective bargaining agreement, check box and see instructions regarding required anachment. Otheiwlse, enter the applicable date.) Month Day Year Contribution rate information (If more than one rate applies, check this box and see instructions regarding required attachment. Otherwise, colnpiete items 13e(l) and 13e(2).) (1) Contribution rate (in dollars and cents (2) Base unit measure: Hourly Unit of production Other (specify):

Schedule R (Form 5500)2010

Page 3

14

Enter the number of participants on whose behalf no contributions were made by an employer as an employer of the participant for:

a b

The current yea The plan year immediately preceding the current plan yea

employer contribution during the current plan year to:

a The corresponding number for the plan year immediately preceding the current plan year ...............................
n orma ,on w~ respec o any em

b if item 163 is greater than 0,en

17

if assets and liabilities from another plan have been transferred to or merged with this plan during the plan year, check box and see instructions regarding supplemental information to be included as an attachment. .......................................................................................................................

Part VI I Additional Information for Single-Employer and Multiemployer Defined Benefit Pension Plans pax) c 18 faoy l a u ales to ;lnrtcfpanls or t11eir oene!cnarles under l n r &kiln ;is nf tnc cr.d 0' II,~ bear :cnsit I n Nnor or ' 8 1 p.irt) of an ~ t ~ loss:cn

pan c ~301s LvIIcmCnIa ano Scncficaries uouer lrro or morc licnson l~lans of imnie3 ately before sucn plan ycar cnccn Sox and sco nstr.cl ons roqaro as information to be included as an attachment ............................................................................................................................................................................ If the total number of participants is 1,000or more, complete items (a) through (c)

-I 1

19

a b
c

Enter the percentage of plan assets held as: Stock: % Investment-GradeDebt: % High-Yield Debt: % Real Estate: Provide the average duration of the combined investment-grade and high-yield debt: 0-3years 3-6 years 6-9years 9-12years 12-15years 15-18years

% Other:

% years or more

[1

0 18-21

years

021

What duration measure was used to calculate item 19(b)? Effective duration Macauiay duration Modified duration

Other (specify):