kaiser tax sheltered annuity 5500 for 2010

8/3/2019 Kaiser Tax Sheltered Annuity 5500 for 2010

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PsnslonBenefll Guaranty Coipaiation I I This Form is O ~ e no PublicI Part I I Annual Report Identification Information

Fnr r a rnnar plan ycar 2010 or fsco plan year ocg nn no 11 11 20.3 an d mu 1)s i;-:!.ll.ll

OM6 Nos. 1210-01101210-0089

2010Form 5500

oepartment ofthe ~ i e a s u r yInternalRevenue Sew~ce

oeparlment or LabarEmployee Benefits Securily~dm!n~stratian

A This returnlreport is for: a multiempioyer plan; 0 multiple-employerplan; ora single-employerplan: a DFE (specify)-

Annual ReturnlReport of Employee Benefit PlanThis 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) andsections 6047(e), and 6058(a) of the Internal RevenueCode (the Code).) Complete al l entries in accordance with

the instructions to the Form 5500.

B This returnlreport is: the first relurnlreport: 0 he final returnlreport:an amended returnlreport; a short plan year returnlreport (less than 12 months).

C If the plan is a collectively-bargainedplan, check here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r C]D Check box if filing under: [ orm 5558; automatic extension: 0 he DFVC program;

special extension (enter description)

KAISER PERMANENTE TAX SHELTERED ANNUiTY PLAN number (PN) b1C Effective date of plan

KAISER FOUNDATION HEALTHPLAN. INC

1 0110111982

ONE KAISER PLAZASUITE 2001OAKLAND, CA 94612

2a Plan sponsor's name and address (employer, if for a singie-employer plan)(Address should include room or suite no.)

.510-271-5940

2d Business code lsee

2b Employer identificationNumber (EIN)

Caution: A penalty for the late or incomplete filing of this returnlreporl wil l be assessed unless reasonable cause is established...ndcr pcnaillcs of per.ry a l l ! 01118r lrl?niltrs set font1 in lne nsll..-llons. 1 d c ~ a r enal i "ad6 exa~llncdh s rcIU(n,rCpon, nc .O ng .lc:.oml,.lny n.3 suoeJ. esslalcmcnls and allacnme~~ls.% vreli ;I:, lhe r eulroic renion o'lnls rct. n ropon and lo !he beslo'm y rnocicogc an0 3cl cf . l IS tr..P r:nrrt.cl. ;io


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ONE KAISER PLAZASU ITE ZOO1OAKLAND CA 94612

Form 5500 (2010) Page 2

3c Administrator's telephonenumber510-271-5940+-a Plan administrator's name and address (if same as plan sponsor, enter 'Same')KAISERFOUNDATION HEALTH PLAN. INC. 3b Administrator's EIN94-1340523a Sponsor's name 14c PNI I5 Total nu mber of participants at the beginning of the plan year 1 5 1 4844 If the nam e and/or EIN of the plan sponsor has changed since the last returnlreport filed forth is plan , enter the name , EIN andthe plan num ber from the last returnireport: ~ ~a Active participantb Retired or separated participants receiving benefitC Other retired or separated participants entitled to future benefits..........................................................................................d Subtotal. Add lines 6a, 6b, and 6

4b EI N

c? Deceas ed participants whose beneficiaries are receiving or are entitled to receive b enefits ............................................f Total. Add lines 6d an d 6e..................................................................................................................................................... 503g Numb er of participants with account balances as of the end of the plan year (only defined contribution planscomplete this item)................................................................................................................................................................... 6 4951.

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

h Number of parlicipants that terminated employment during the plan year with accrued benefits that wereless than 100% vested ............................. ..........................................................................................................................7 Enter the total number of employers obligated to contribute to the plan (only multiemployer plans complete this item) ........

a Pension Schedules b General SchedulesR (Retirement Plan Information) (1) H (Financial Information)

(2)I ' 1 MB (Multiemployer Defined Benefit Plan and Certain Money i (Financial Information - Small Plan)Purchase Plan Actuarial Information) - signed by the plan ' A (Insurance information)actuary ii;4) 1- (Service Provider information)(3) 0 SB (Single-Employer Defined Bene fit Plan Actuarial (5) (DFEiParlicipating Plan Information)Information) - s ioned bv the ~ l a nctuarv 161 n G (Financial Transaction Schedules)

8a if the plan provides pension benefits. enter the applicable pension feature codes from the List of Plan Characteristic Codes in the instructions:2E 2F 2G 2J 2K 2~ 2T 3H

6h7

9

9a Plan funding arrangem ent (check all that apply)

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

9b Plan benefit rrangemen t (check all that apply)InsuranceCode section 412(e)(3) insurance contractsTrustGeneral assets of the sponsor

(1)(2)(3)(4)

(1)(2)(3)(4)

X

----

InsuranceCode section 412(e)(3 ) insurance contractsTrustGeneral assets o f the sponsor


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SCHEDULEA(Form 5500)

oepartment of the ~ r e a r u i yinternal ~ e v s n u eewice

Departmen1or LaborEmployee aensl~ts ecurily ~dminstratton~snsion snsflluaranb,cornoration

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

1 Coverage Information:

Insurance InformationThis schedule is required to be Rled under section 104 of theEmployee Retirement income Security Ac t of 1974 (ERISA).

b File as an attachment to Form 5500.b Insurance companies are required to provide the information

pursuant to ERISA section 103(a)(2).

D Employer IdentificationNumber (EIN)94-1340523Part I

(a) Name of insurance carrierMETLIFE

OMB No. 210-0110

2010This Form i s Open to Public

InspectionFo r calendar plan year2010 or Rscai plan year beginning 0110112010 and ending 1213112010

Information Concerning lnsurance Contract Coverage, Fees, and Commissions Provide information for each contracton a separate Schedule A. individual contracts grouped as a unit in Parts ii and Il l can be reported on a single Schedule A.

03 3Name of planKAISER PERMANENTE TAX SHELTERED ANNUITY PLAN

3 Persons recelvlng commissions and fees. (Complete as many entries as needed to report all persons).(a ) Name and address of the agent. broker, or other person to whom commissions or fees were paid

B nree-d ig i tplan number (PN) 1

2 Insurance fee and commission nformation. Enter the total fees an d total commissions paid. List in item 3 the agents. brokers, an d other persons indescending order of the amount paid.

(e) Approximate number ofpersons covered at en d ofpollcy or contract year12195

(d) Contract oridentification numberGA C 24742

(b) EIN13-5581829

(a) Total amount of commissions paid

i I I(a ) Name and address of the agen t, broker, or other person to whom commlsslons or fees were pald

(C) NAiCcode65978

(b) Total amount of fees paid

Policy or contract year

0 1 0

(e) Organization code(b) Amount of sales and basecomm issions pald

I I IFor Paperwork Reduct ion Act Not ice and OM6 Contro l Numbers, see the instructions for Form 5500. Sched ule A (Form 5500) 20v.092308

(4 From0110112010

(9) TO1213112010

Fees and other com missions pald

(e) Organlzatlon code(b) Amount of sales and basecomm~ss~onsald

(c )Amount (d) Purpose

Fees and other com mlsslons pald(c) Amount (d) Purpose


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Schedule A (Form 5500) 2010 Page2 - a(a) Name and address of the agent, broker, or other person to whom commissionsor fees were paid

(a) Name and address of the agent, broker. or other person to whom commissions or iees were paid

(b) Amount of sales and basecommissions paid

I I I(a) Name and address of the agent, broker, or other person to whom commissions or iees were paid

(b) Amount of sales and basecommissions paid

(b) Amount of sales and base Fees and other commissions paid (e) Organizationcode

(e) Organizationcode

Fees and other commissions pald

(a) Name and address of the agent, broker, or other person to whom commissions or iees were paid

(c) Amount

(b) Amount of sales and base Fees and other commissions paid (e) Organizationcommissions paid (c) Amount (d) Purpose code

Id) Purpose

(e) OrganizationcodeFees and other commissions paid

(a) Name and address of the agent, broker, or other person to whom commissions or fees were paid

(c )Amount

(b) Amount of sales and base Fees and other commissions paid (e ) Organizationcommissions paid (c) Amount (d) Purpose codeI I

(d) Purpose


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ScheduleA (Form 5500) 2010 Page3

Investmentand Annuity Contract Information. . .Where lnd~vldualontracts are provided,the entire group of such individualcontracts with each carrier may be treated as a unit for purposesof~~p -Current value of pian's interestunder this contract in the generalaccount at year end.................................................. 1 4 15 Current value of plan's interestunder this contract in separate accounts at year end ............................................ .......I 5 16 Contracts With Allocated Funds:

a State the basis of premium rates 1b Premiumspaid to carrieC Premiumsdue but unpai .....................................................................................................d If the carrier. selvice, or other organization ncurred any specific costs in connectionwith the acquisitionorretention of the contractor policy, enter amoun

Specify nature of costs )e Type of contract: (1) Individualpolicies (2 ) group deferredannuity

(3) 0 ther (specify) Ff If contract purchased, in whole or in part, to distribute benefits from a terminatingplan check here b 07 ContractsWith UnailocatedFunds (Do not includeportions of these contracts maintained n separate accounts)a Type of contract: (1)0 epositadministration (2) immediateparticipationguarantee

(3) guaranteedinvestment (4) other )

b Balanceat the end of the previousyear 1 7b 42768355......................................................................................................................Additions: (1) Contributionsdepositedduringthe year ................... .. 7 ~ ( 1 )(2 ) Dividendsand credits 7c(2) 13739230

7c(3)3) Interestcredited during the yea(4) Transferred from separateaccoun 7c(4)( 5 )Other (specify below) 7 ~ ( 5 )) CONTRACT ACTIVIT

I I(6)Total additions .............................................. ................................................................................................. 7 ~ ( 6 ) 94037d Totai of balanceand additions (add band ~ ( 6 ) ) . 7d I 6239..................................................................................................e Deductions:(1) Disbursedfrom fund to pay benefitsor purchase annuitiesduring year(2)Administrationcharge made by carrie(3)Transferred to separateaccount' (4) Other (specify below) ...............................................................................F ...


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e 0 Temp orary disability (accident and sicknes s) f 0 ong-term disability g0 upplemental unemployment h Prescription drugi Stop loss (large deductible) j 0 MO contract k0 PO contract I Indemnity contractm jl Other (specify) b

Schedule A (Form 5500) 2010 Page 4

9 Experience-rated contracts:a Premiums: (1) Amount received .............................................................

(2) Increase (decrease) in amount due but unpaid ......................................

b Benefit charges (I)laims paid(2) lncrease (decrease ) in claim reserves

(H) Total retentio(2) Dividends or retro

a Total premiums or s ubscription charges paid to Carrie

Specify nature of costs 1

Part Il l

I Part IV Provision of Information . .

Welfare B enefit Contract lnformationIf more than one contract covers the same group of em ployees of the same emp loyer(s) or mem bers of the same em ployee organization(s). theinformation may be comb ined for reporting purposes if such contracts are experience-rated as a unit. Where contracts cover individual employees,the entire group of such individual contracts with each carrier ma y be treated as a unit for purposes of this report.

11 Did the insurance compa ny fail to provide any information neces sary to complete Sched ule A? ............. Yes NO12 If the answe r to line 1 1 is 'Yes," specify the informa tion not provided. b

8 Benefit and contract type (check all applicable boxes)a Health (other than dental orvision) b Dental c0 is ion d Life insurance


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SCHEDULE C

You must complete this Part, in accordance with the instructions, to report the information required for each person who received, directly or indirectly. $5.000or more in total compensation (i.e.. money or anything else of monetaly value) in connection with services rendered to the plan or the person's position with thplan during the plan year. If a person received only eligible indirect compensation or which the plan received the required disclosures, you are required toanswer line 1 but are not required o include that person when completing the remainder of this Part.

I

1 lnformation on Persons Receiving Only Eligible Indirect Compensationa Check "Yes" 0r"No"to indicatewhether you are excluding a person from the remainder of this Part because they received only eligibleindirect compensation or which the plan received the required disclosures (see instructions or definitions and conditions).. . . . . . . . . . . . . 1 es 0 o

Service Provider Information

C Plan sponsor's name as shown on lhne 2a of Form 5500KAISERFOUNDATION HEALTH PLAN. INC

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 whoreceived only eligible indirect compensation. Complete as many entr ies as needed (see instructions).

(Form 5500)OMB NO. 1210-0110

D Employer ldent~f~cat~onumber (EIN)94-1340523

fb l Enter name and EIN or address of oerson who orovided vou disclosures on elioible indirect comoensation

oepartment of the ~ i e a s u l yinternal ~ e v e n u eew~ceoeparlmenlOf Labor~mp lo y e eenefltssecurity ~dm~n~s tra t ,on

~ e n s , o n enefit ~ u a r a n t ~arparation

THE VANGUARD GROUP, INC

23-1945930

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

This schedule is required to be filed under section 104 of the EmployeeRetirement Income Security Act of 1974 (ERISA).File as an attachment to Form 5500.

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

2010This Form is Open to PublicInspection.

For calendar plan year 2010 or fiscal plan year beginning 01101!2010 and ending 12!3112010

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

Fo r Paperwork Reduction Act Notice and OMB Control Numbers, see the instructi ons for Form 5500 Schedule C (Form 5500) 2v.09230

033A Name of planKAISER PERMANENTE TAX SHELTERED ANNUITY PLAN B Three-digitplan number(PN) k


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ScheduleC (Form 5500) 2010 Page 2 - r n

lb l Enter name and EIN or address of Derson who provided you disclosures on eliqible indirect com~ensat ion

lb l Enter name and EIN or address of person who provided you disclosures on eliqible indirect compensation

( 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 compensaiion


Ib l Enler name and EIN or address of Derson who orovided vou disclosures on eliqible indirect compensation

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



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Schedule C (Form 5500) 2010 Page 3

2. Information on Other Service Providers Receiving Direct or Indirect Compensation. Except for those persons forwhom youanswered "yes' to line l a above. complete as many entries as needed to list each person receivina. directlv or indlrectlv. $5.000 or more in totai compensation-.(i.e., mone; or anything else of valueiin connectionwith services rendered to the plan or their positionwith the plan duringthe plan year. (See instructions).- -(a ) Enter name and EIN or address (see instructions)

THE VANGUARD GROUP, INC

(b) (c)Service Relationship o (d )Enter direct (e ) (0Did service provider Did indirect compensation (9 )Enter totai indirect (h)Did the serviceCode@) employer, employee compensation paid receive indirect include eligible indirect compensation received by provider give youorganization, or by the plan, If none, compensation? (sources compensation, for which the service provider excluding formula insteadperson known to be enter -0.. other than plan or plan plan received the required eligible indirect an amount ora party-in-interest sponsor) disclosures? compensation for which you estimated amounanswered "Yes' to element(f). If none. enter -0..

15 25 26 37 NONE 1366322 052 59 yes rn NO yes 1 O yes 0 O

(a ) Enter name and EIN or address (see instructions)MORRIS, DAVIS, AND CHAN. LLP

(b) (c )Service Relatlonshio to ( 4Enter direct (e ) ( )Did service orovider Did indirect comoensation (9 )Enter total indirect (h )Did the serviceCode@) employer. em&oyee compensation paid receive indirect include eligible indirect compensation received by provider give youorganization, or by the plan. If none, compensation? (sources compensation, for which the service provider excluding formula insteadperson known to be enter -0.. other than plan or plan plan received the required eligible indirect an amount ora party-in-interest sponsor) disclosures? compensation for which you estimated amounanswered "Yes" to element(f). If none, enter -0..I 1 I I I I10 NONE 29905 0

yes NO [ yes 0 O rn yes 0 O [I

(a ) Enter name and EIN or address (see instructions)QDRO CONSULTANTS COMPANY

34-1820650

(b ) I Ic ) I Id ) I fe) I. , 8 . . I , . , .Ssrbicr Re s: onsn p 10 Erwr u rect Du serv r e pru,iuerCudE(n, ctnp ober an 11lrl)i.c rcn-pr?ns:lIr>o1,:l:u rc(I r


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Schedule C (Form 5500) 2010 Page4 - r n

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

(d)Enter directCode@)

(f)Did indirect comoensation(elDid service orovidar

Yes NO 0

employer. emi;loyeeorganization, orperson known to bea party-in-interest

Yes NO 0

(9)Enter total indirect

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

(b)ServiceCode@)

(h)Did the servicecompensation paidby the plan, l i none,enter -0..

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

(9)Enter total indirectcompensation received byservice provider excludingeligible indirect

compensation for which youanswered "Yes' t o element(f) . If none, enter -0..

(b)ServiceCode@)

(h )Did the serviceprovider give youformula instead o

an amount orestimated amoun

yes NO

(c)Relationship oemployer. employeeorganization, orperson known to bea party-in-interest

(f)Did indirect compensationinclude eligible indirectcompensation, for which theplan received the requireddisclosures?

yes 0 O 0

receive indirectcompensation? (sourcesother than plan or plan

sponsor)

(c)Relationship toemployer, employee

organization. orperson known to bea party-in-interest

(dlEnter directcompensation paidby the plan. If none,

enter -0..

(9)Enter total indirectcompensation received byservice provider excluding

eligible indirectcompensation for which youanswered "Yes" to element(f). If none, enter -0..

include eligible indirectcompensation, or which theplan received the required

disclosures?

(h)Did the serviceprovider give youformula instead o

an amollnt orestimated amoun

yes NO

(4Enter directcompensation paid

by the plan. If none,enter -0..

(4Did service providerreceive indirectcompensation? (sources

other then plan or plansponsor)

yes 0 O 0

(e)Did service providerreceive indirectcompensation? (sourcesother than plan or plansponsor)

yes NO

compensation received byservice provider excludingeligible indirectcompensation or which you

answered "Yes' to element(f). If none, enter -0..

(f )Did indirect compensationInclude eligible indirectcompensation, for which theplan received the required

disclosures?

yes NO

provider give youformula instead oan amount orestimated amoun


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Schedule C (Form 5500) 2010 page 5 - r n

Part I l~ e rv ic e rovider Information (continued)3 if vou reoorted on line 2 receiot of indirect comoensation, other than elioible indirect comoensation. bv a service orovider, and the service orovider is a fiduciaw~ ~ .~~ ~~~or .>rLvi.;s ~urlra.1 ill!!. 11 SIBICI C O ~ S J ~ I ~ ( J-slod1a nvc stl rcnl aa;i20ry n.eslmcn; rni.r>;yvrnr;t, nrzlier "r rr~c:rakcc?p g scw ccs: answr!r l or fo cb:r.b

q.ds1 0"s lor ( 2 ) a:h so..rr:rJ i r m -hot?. lo sen cc pm,lIli!r r,?l:C! lco S1 000 or inor,! n nar comjlrnsat.cn anu (11) m z h SOJr


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Schedule C (Form 5500) 2010 Page 7 - n

Explanation:

(complete as many entries as needed)

a Name: I b EIN:

a Name:C Position:d Address:

b EIN:e Telephone:

Explanation:

C Position:d Address:

a Name:

e Telephone:

IExplanation:

C Position:d Address: e Telephone:

IExplanation:


b EIN:e Telephone:

IExplanation:


b EIN:e Telephone:


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SCHEDULEH Financial Information I OM6 No. 1210-0110(Form 5500)oepanment 01 tie Treasurylnterno ~ e v e n u e ewice

nDns,,mom,$8 hn,

A Name o i planKAISER PERMANENTE TAX SHELTERED ANNUITY PLAN

-""" ....Employee Benefits Secunly Admnirlral#on~snslon e n e n t u a r an tyorparefion

This schedule is required to be filed under section 104of the EmployeeRetirement Income Security Act of 1974 (ERISA)..and section 6058(a) of theInternal Revenue Code (the Code).2010

For calendar plan year2010 or fiscal plan year beginning 0110112010 and ending 12/31120101 File as an attachment to Form 5500.

6 Three-digitplan number (PN) h

I Part I IAsset and Liability Statement1 Current value o i plan assets and liabilitiesat the beginning and end of the plan year. Combine the value o i plan assets held in more than one trust. Reportthe value of the plan's interest in a commingledfund containing the assets of more than one plan on a line-by-linebasis unless the value is reportable onlines 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 dollarbenefit at a future date. Round off amounts t o he nearest dollar. MTIAs, CCTs, PSAs, and 103-12 IEs do not complele lines lb(1). b(2). lc(8). l g , 1h.

This Form is Open to PublicInspection

033

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

and l i . CCTs, PSAs, and 103-12 IEs also do not complete lines I d and le . See instructions.

D Employer Identification Number (EIN)94-1340523

(1) Employer contributions...........................................................................(2) Participant contributions........................................................................

(2) U.S. Government securiti(3) Corporate debt instrume

(5) Partnershipqointventure interests.....................................

(8) Participant loans

(10) Value of interest in pooled separate accounts........................................(11) Value oi nterest in master trust investmentaccounts ............................

Fo r Paparwork Reduction Act Notice and OMB Control Numbers, see the instructions fo r Form 5500 Schedule H (Form 5500) 20v.092308

I


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Schedule H (Form 5500)2010 Page21d Employer-relatedinvestments: (a) Beginningof Year (b) End of Year

(1) Employer securities(2 ) Employer real prope

e Buildings and other prof Total assets (add all amounts in lines l a hrough l e ) ..................................... 2298526995 273223308

Liabilitiesg Benefit claims payableh Operating payablei Acquisition indebtednessj Other liabilitie 52348 1003k Total liabilities (add all amounts in lines l g hroughlj) ..................................... 1k 52348 1003

Net Assets

(1) Interest:

I Net assets (subtract line l k rom line I fI Part II 1 Income and Expense Statement2 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 maintainedfund(s) and any paymentslreceiptstolirom insurance carriers. Round off amounts to the nearest dollar. MTIAs. CCTs. PSAs, and 103-12 IES do not complet

lines 2a, 2b(l)(E), 2e. 2f. and 29.

(A) Interest-bearingcash (including money market accounts andcertificates of deposit( 6 ) U.S. Governmentsecuritie(C ) Corporate debt instruments(D ) Loans (other tha(E ) Participant loans

Incomea Contributions:

273222305

(a) Amount

305210311) 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 2a(2) .................

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

(2) Dividends: (A ) Preferredstoc(6) Common stock

46236041(D) Total dividends. Add lines 2b(2)(A), (B), and (C) 4623604

(3) Rent

2298474647

(b ) Total

Za(l )(A)2a(l )(B)2a(l )(C)2a(2)2a(3)

(4 ) Net gain (loss) on sale oi assets: (A ) Aggregate proceeds ........................................................6 ) Aggregate carrying amount (see instructions)..................C) Subtract line 2b(4)(B) from line Zb(4)(A) and enter result

9684797

30165496b Earnings on investments:

2b(4)(A)2b(4)(B)2b(4)(C)


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Schedule H (Form 5500) 2010 Page 3

2b (5) Unrealizedappreciation (depreciation)of assets: (A) Realestate ........................(6) Other ............................................................................................( C ) Total unrealizedappreciation of assets.Add lines 2b(5)(A) and (B

(6 ) Net investmentgain (loss) from common/collective rusts ..........................(7) Net investmentgain (loss) from pooled separate accounts .......................(8) Net investmentgain (loss) from master trust investment accounts ............(9) Net investmentgain (loss) from 103-12 investmententities .......................

(10) Net investmentgain (ioss) from registered investmentcompanies (e.g.. mutual funds) ..................................................................

C Other incomd Total income.Add ail income amounts n column (b)and entertotal .....................

Expensese Benefit payment and payments to provide benefits:

(1) Directly to participantsor beneficiaries, ncluding direct roilovers ..............(2) To insurance carriers for the provision of benefits ...................................

...................................f Corrective distributions (see instructionsh Interest expense .........................................................................................i Administrative expenses: (1) Professional ee

(2) Contract administrator ee

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

Net Income and Reconciliationk Net income (ioss).Subtract line 2j from line 2dI Transfers of assets:

(1) To this pla ....... -2) From this plan

attached.I Part Illa The attached opinion of an independentqualified public accountant for this plan is (see instructions):

(1)1 nqualified (2)0 ualified (3)0 isclaimer (4)0 dverseb Did the accountant ~eriorm limited s c o ~ eudit oursuantta 29 CFR 2520.103-8 and/or 103-qzldl? n yes NO

Accountant's Opinion

~, u -C Enter the name and EIN of the accountant (or accounting firm) below:IllName:MORRIS. DAVIS8 CHAN LLP 121EiN: 94-2214860

3 Complete lines 3a through 3c if he opinlon of an independent qualified public accountant s attached to this Form 5500. Complete line 3d if an opinion is no

. . , ,d The opinion of an independent qualified public accountant is no t attached because:(1)n This form is filed for a CCT, PSA, or MTIA. (2)n t will be attached to the next Form 5500 pursuant to 29 CFR 2520.104-50.


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Schedule H (Form 5500) 2010 Page 4 - nI Part IV I Compliance Questions4 CCTs and PSAs do not complete Part IV MTIAs, 103-12 IEs, and GlAs do not complete 4a. 4e. 4i. 4q, 4h, 4k, 4m. 4n , 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 contributionswithin the timeperiod described in 29 CFR 2510.3-102? Continue to answer "Yes' for any prior year failures

......ntil fully corrected. (See instructionsand DOVs Voluntary Fiduciary Correction Program.)Were any loans by the plan or fixed income obligations due the plan in default as of theclose of the plan year or classified during the year as uncollectible? Disregard participant oanssecured by participant's account balance. (Attach Schedule G (Form 5500) Part I if 'Yes'' ischecked.) ..............................................................................................................................Were any leases to which the plan was a party in deiauit or classified during the year asuncollectible? (Attach Schedule G (Form 5500) Part I1 if "Yes'is checked.) ..............................Were there any nonexempt ransactions with any party-in-interest? (Do not include transactions : , ~reported on line 4a. Attach ScheduleG (Form 5500) Parl Ill if "Yes' ischecked.) ................................................................................................................................Was this plan covered by a fidelity bonDid the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was causedby iraud or dishonesty? ...........................................................................................................Did the plan hold any assets whose current value was neither readily determinableon anestablished market nor set by an independent hird party appraiseDid the plan receive any noncash contributionswhose value was neither readilydeterminableon an establishedmarke

i Did the plan have assets held ior investment? (Attach schedule(s) of assets if "Yes'is checked,and see instructions for iormat requirements.).............................................................................J Were any plan transactions or series of transactions n excess of 5% of the currentvalue of plan assets? (Attach schedule of transactions if "Yes'is checked, and

see instructions or format requirements.)....................................................................................k Were all the plan assets either distributed to participants or beneficiaries. ransferred to anotherplan, or brought under the control of the PBGC? .............................. ....................................I Has the plan iailed to provide any benefit when due under the plan? .........................................m l i his is an individual account plan, was there a blackout period? (See instructions and 29 CFR2520.101-3.) ................................................................................................................................n li 4m was answered "Yes,' check the "Yes' box ii you either provided the required notice or oneof the exceptions to providing the notice applied under 29 CFR 2520.101-3. ............................

5a Hasa resolution to terminate the plan been adopted during the plan year or any prior plan year?.............................f yes, enter the amount ofany plan assets thatreverted o the employerthis year 0 es 1 O Amount:

5b li, during this plan year, any assets or liabilities were transferred irom this plan to another plan(s), identity the plan(s) to which assets or liabilities weretransferred. (See instructions.)5b( l) Name of pian(s) 5b(2) EIN(s) 5b(3) PN(sI


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MORRIS,DAVIS & CHANLLPC e r t ~ f ~ e du b l l c Accountants

Investiiieiit CommitteeK a i s e r P e r m a n e n t e Tax She l t e r ed A nnu i t y P l an'Tn~stNo. 90998We have audited the accompanyiiig statements of net assets available for benelits of theK a i s e r Pe r m a nen t e Ta x She l t e r ed A nnu i t y P l an ( the P lan) a s o f D ecem ber 31 , 2010 and2009, and the related statements of changes in net assets available for benefits for the yearsthen ende d. Tliese financial statements are the respo ns~b ili ty f the Plan 's manage ment. Ourresponsibil ity is to express an opinion on these financial statements based on o ur audits . .We conducted our audits in accordance with U.S. enerally accepted auditing standards.Those standards require that we plan and perfom? the auclit to obtain reasonable assuranceabout wh ether the financial statements are free of material missta teme nt. An audit includesconsideration of intenral control over f ina nc ~a l epol-t ing as a b asis for de signing auditproceclnres that are appropriate in the circumstances, but not for the purpose of expressing anopinion on the effectiveness of the Plan's inteilral control over financial reporting.Accordingly, we expl-ess no such opinion. An a u d ~ t ~lc ludes xanl in i~ lg ,on a test basis,evidence suppor t ing the amounts a nd disclosures in the financial statem ents. An audit alsoincludes assessing the accounting principles used and significant estimates made bymanag ement, as well as evaluating the overall f inancial statem ent presentation. We believethat our audits provide a reasonab le basis for our opinion.In oiir opinion, the financial statements, referl-ed to above, present fairly, in all materialrespects, the nel assets available for benefits as of December 31, 2010 and 2009 and thechanges in net assets available for benefits for the years then ended in confo~mitywith U.S.generally accepted a ccounting principles.Our audits were performed for the purpose of foiming an opinion on the basic financialstatements talten as s who le. Th e suppleinental sche dule o f assets held for investineli tpurposes as of December 3 1, 2010 is presented for the pulyose of additional analysis and isnot a requ ~re tl art of the basic t inancia1 statements but is si~ pp lem en ta iynform ation ]requiredby the Depar tment of Labor ' s Rules and Regulat ions for Repor t ing and D isclos i~ re nder theEmployee Ret i i -ement Income Secur i ty Act of 1974. The supplemental schedule is theresponsibil ity o f the Plair's manag ement. Th e supplemental sched ule has been subjected tothe auditing procedures applied in the audits of the basic financial statements and, in ouropinion, is fairly stated in all material respects in relation to the basic financial statementstaken as a wlrole.

O a k l a n d , C a l i f o ~ n ~ aSeptemb er 30, 201 1

1111 Broadway, S u i t e 1505 ' O akland , California 91607 ' (510) 250-1000 ' Ftax ( 51 0) 2 5 0 - 1 0 3Offices in So71 Fr,z~~rlSc o,nlLj%rnia and C%arlottc,North C'al-olinn


19/38

KAISER PERMANENTETAX SHELTERED ANNUITY PLAN

TRUST NO. 90998FINANCIAL STATEMENTS

AND SUPPLEMENTAL SCHEDULETOGETHER WITH INDEPENDENT

AUDITORS' REPORTDECEMBER 3 1,2010 AND 2009

MORRIS, DAVIS & CHAN LLPCertified Public Accouiltants


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KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN

TABLE O F CONTENTS

Independent Auditors' ReportStatements of Net Assets Available for BenefitsStatenlents of Chan ges in Ne t Assets A vailable for BenefitsNotes t o Financial StatementsSchedule H, Line 4i - Schedule of Assets Held for Investment Purposes


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M O R R I S , D A V I S & C H A N LLPC r r t ~ f ~ e dubhc Accountantr

INDEPENDENT AUDITORS' REPORT

Investnlent LommltteeICa iser Pe r ma nen te Tax She l te red Annui ty P lan'rntst No. 90998We have audited the accompanying statemei~tsof lief assets available for benelits of theK a i se r P e r m a n e n t e Tax Shel tered Annuity Plan ( the Plan) as of December 31, 2010 and2009, and the related statements of changes in net assets available for benefits for the yearsthen end ed. The se financial statements are the responsibility of the Plan's m anagem ent. Ourresponsibility is to express an opinion on these financial statem ents based on OLII-audits.We conducted our audits in accordance with U S . generally accepted a uditing standards.Those staildards require that we plan and perfonn the audit to obtain reasonable assuranceabout wlietller the financial statements are free of material misstatem ent. An audit includesconsideration of internal control over financial repol-ting as a basis for designing auditprocedures that are appropriate in the circumstances, but not for the purnose of expressing anopinion on the cffectiveness of the Plan's i l i t e~n al control over financial reporting.Accord ingly, we express no such opinion. An audit includes exam ining , on a test basis,evidence supporting the amounts and disclosures in the financial statem ents. An audit alsoincludes assessing the accounting principles used and significant estililates made bymanag ement, as well as evaluating the overall financial statement pre sei ~ta tion . We believeth at o u r a ~ ~ d i t srovide a reasoilable basis for O L I ~pinion.In our opinion, the financial statements, referred to above, present fairly, in all material]respects, the net assets available for ben efits as of D ecem ber 3 I, 20 10 and 2009 and thechanges in net assets available for benefits for th e years then ended in conformity with U.S.gene]-ally accepted accounting principles.O u r a ~ ~ d i t sere performed for the pupose of forming ail opinion on the basic financials ta teme~its aken as a whole. The supplemental schedule of assets held for investmentpurposes as of Dec ember 31, 2010 is presented for the putpose o f additional analysis and isnot a requ~ reti art of the basic financial statements but is su pp le me nt a~ ynformation ]requiredby the Department of Labor's Rules and Regulations for Reporting and Disclosure under tileEmployee Retirement Income Security Act of 1974. The supplemental schedule is therespo nsibi l~ty f the Plai-i's management. The supplemental sch ed i~ le as been subjected tothe auditing procedures applied in the audits of the basic financial statements and, in OLISopinion, is fairly stated in all material respects in relation to the basic financial statementstalten as a whole.

Oaltland, CaliforniaSeptember 30, 201 11111 Broadway, Suite 1505 ' Ot~Liland, alifornia 91607 ' (510) 250-1000 ' Fax (510) 250-1032

Offzcer in Sna F ~ ( ~ n c t s c o ,' n l f i rn ia arid Char lot te, A'orth Calolz? m


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KAISER PERMA NENTE TAX SHELTERED ANNUITY PLANSTATEMENTS OF NET ASSETS AVAILABLE FOR BENEFITSDECEMBER 31 , 2 010 AN D 2009

AssetsInvestments, at fair valueMutual fundsInvestment contract with insurance compan yContribution receivablesEnlployerParticipantsNotes receivable from participantsOther receivable

Total assetsLiabilitiesExcess contributions refundableOther

Total liabilitiesNet assets reflecting investments at fair valueAdjustnlent from fair value to contract value forfully benefit-responsive investment contractsNet assets available for benefits

The acconlpanying notes are an integral part o f the financial statemen ts.-2-


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KAISER PERMAN ENTE TAX SHELTERED ANNUITY PLANSTATEMENTS OF CHANGES IN NET ASSETS AVALAB LE FOR BENEFITSFOR THE YEARS ENDED DECEMBER 31 ,201 0 AND 2009

AdditionsInvestment incomeNet appreciation in fair value of investmentsInterest and dividendsContributionsEmployerParticipantsInterest income on notes receivable fromparticipants

Total additionsDeductionsBenefits paid to participantsAdm inistrative expenses

Total deductionsNet increase

Transfer from o ther plansNet assets available for benefitsBeginning o f year

End of year

The accompanying notes are at1 integral part of the financial statem ents.-3-


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KAISER PERM ANENTE TAX SHELTERED ANNUITY PLANNOTES TO FINANCIAL STATEMENTSDECEMBER 31,2 0 10 and 2009

NOTE A - Description of the PlanThe following description of the Kaiser Permanente Tax Sheltered Annuity Plan (thePlan) provides only general infornlation. Participants should refer to the Plan docum ent for aInore complete description of the Plan's provisions.GeneralThe Plan is a 403(b)(7) defined contribution plan sponsored by Kaiser Permanente, a tax-exempt organization under Section 501(c) of the Internal Revenue Code (IRC ).Participants AccountEach participant's account is credited with the participant's contributions, as well as anyrelevant Employer's contributions plus allocated Plan earnings and losses, and charged withadministrative 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 accountbalance.ContributionsA participant may elect to contribute from 1% to 75% of eligible compensation su bject to thelimits set by the IRC. The E~n plo yermakes contributions for certain enlployee groups asdefined by the Plan document. Each participant is 100% vested in his or her EmployeeContribution Account and his or her Emp loyer Contribution Account vests as specified in thePlan.Notes Receivable from ParticipantsA participant may borrow up to the lesser of 50% of his or her account balance or $50,000,reduced by the highest outstanding loan balances carried by the participant in this and/or allother Ernployer plans during the 12-month period prior to the new loan. The ten11 of the loanis limited to not more than 5 years, except for residential loan which may be extended up to15 years. The interest rate is "Prime Rate" plus 1%. Loan repayments are tnade throughpayroll deductions and are credited to the participant's account.Payment of BenefitsA participant shall be entitled to receive all or a portion of his o r her account upon occussenceof the earlier of the participant's retirement, death, disability, termination of emp loyment,upon attainment of 59% ,or the participant's hardship, as defined by the Plan document.


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KAISER PERMAN ENTE TAX SHELTERED ANNUITY PLANNOTES T O FINANCIAL STATEMENTSDECEMBER 3 1,2010 and 2009

NOTE B - Siguificant Accounting PoliciesBasis of AccountingThe accompanying financial statements are prepared on the accrual basis of accounting inaccordance with U.S. generally accepted accounting principles (GAAP ).New Accounting PronouncementIn January 201 0, Accounting Standard Upd ate (ASU) 2010-06, Improving D isclosures a boutFair Value Measzlrements, expanded the required disclosures about fair valuemeasuremen ts. ASU 2010-06 requires 1) separate disclosure of significant transfers into andout of Level 1 and Level 2, along with reasons for such transfers; 2) separate presentation ofgross purchases, sales, issuances, and settlements in the Level 3 reconciliation; and 3)presentation of fair value disclosures by "nature and risk" class for all fair value assets andliabilities. The requirements of A SU 2 010-06 are effective for the current reporting periodexcept for the level 3 reconciliation disaggregation whicli is required in 20 1 1 reporting. Therequirements of ASU 2010-06 hav e no impact on the Plan's financial statements.Use of EstimatesThe preparation of financial statements in accordance with GAAP requires Plan managementto make estimates and assumptions that affect certain reported amounts and disclosures.Accordingly, actual results m ay differ from those estimates.Investment Valuation and Incom e RecognitionInv estn ~en ts re reported at fair value. Fair value is the price that would be received to sell anasset or paid to transfer a liability in an orderly transaction between market participants at themeasuremen t date (see Note D -Fair Value Measurem ents).Fully benefit-responsive irivestrnent conhacts held by a defined-contribution plan are requiredto be reported at fair value. However, contract value is the relevant measurement attribute forthat portion of the net assets available for benefits of a defiried-contribution plan attributableto fully benefit-responsive investment contracts because coutract value is the amountparticipants would receive if they were to initiate perniitted transactions under the terms ofthe plan. The Statements of Net Assets Available for Benefits present the fair value of theinvestnient contracts from fair value to con hac t value. The Statement of Changes in NetAssets A vailable for Benefits is prepared on a contract value basis.Purchases and sales of securities are recorded on a trade date basis. Net realized andunrealized appreciatiori (depreciation) is recorded in the acc o~n pan ying tatement of Changesin Net Assets Available for Benefits as net appreciation (depreciation) in fair value ofinvestments. Interest inconle is recorded on the accrual basis. Dividends are recorded on theex-dividend date.


26/38


27/38

KAISER PERMANENTE TAX SHELTERED ANNUITY PLANNOTES TO FINANCIAL STATEMENTSDECEMBER 3 1,2010 and 2009

NOTE B - Siguificant Accounting Policies (Continued)Reclassification (Continued)Additionally, notes receivable from participants are exempt from (i) the disclosurerequirements about fair value in paragraphs 825-10-50-10 through 50-16 of the FinancialAccounting Standard Board (FASB) Accoutltitlg Staudards 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 theAllowance for Credit Losses. FASB believes that any individual credit risk related to notesreceivable from participants is mitigated by the fact that these uotes are secured by theparticipant's vested balance. If a participant were to default, the participant's account balancewould be o ffset by the unpaid balauce of the note and the participant would be subject to taxon the unpaid balance. As such, the participant is the only party affected in the event of adefault.NOTE C - InvestmentsThe following presents investments that represent 5% or Inore of the Plan's net assets as ofDecember 31,20 10 and 2009:

Mutual funds:Vanguard International Growth FundVanguard Lifestrateg y Conservative Growth FundJanus Advisory Forty FundVanguard Total Bond M arket Index FundVanguard Total Stock Market Index FundVanguard Wellington FundInv est~ nen t ontract with insurance companyat contract valueFor the years ended December 31, 2010 and 2009, the Plan's investments in mutual fu11ds(including gains and losses on investments bought and sold, as well as held during the year)appreciated in value by $197,293,841 an d $ 3 15,714,796, respectively.


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KAISER PERMA NENTE TAX SHELTERED ANNUITY PLANNOTES T O FINANCIAL STATEMENTSDECEMBER 3 1,2010 and 2009

NOTE D - Fair Value MeasurementsFASB ASC 820, Faiv Value Measuvements and Disclosures, establishes a fiamework formeasuring fair value. That fiamework provides a fair value hierarchy that prioritizes theinputs to valuation techniques used to measure fair value. Th e liierarcliy gives the highestpriority to unadjusted quoted prices in active markets for identical assets or liabilities (Level 1measurements) and the lowest priority to unobservable inputs (Level 3 measurements). Thethree levels of tlie fair value hierarchy are described below:Level 1 Inputs to tlie valuation methodology are unadjusted quoted prices for identical assets

or liabilities in active markets tliat tlie Plan has tlie ability to access.Level 2 Inputs to the valuation methodology include:

Quoted prices fo r sinlilar assets or liabilities in active markets;Quoted prices for identical or similar assets or liabilities in inactive markets;Inputs other than quoted prices tliat are observable for the asset o r liability; andInputs that are derived principally from or con.oborated by observable marketdata by co ~re lation r other means.Level 3 Inputs to the valuation methodology are unobservable and significant to tlie fairvalue measnremeut.The as set's or liability's fair value measurement level within tlie fair value hierarchy is basedon the lowest level of any input that is significant to tlle fair value measuremen t. Valuationtechniques used need to maximize the use of observable inputs and minimize tlie use ofunobse~vablenputs.Following is a description of the valuatio~imetliodologies used for investments measured atfair value. There have bee11 no changes in the metliodologies used as of December 31, 2010and 2009.

Mutual funds are valued at the net ass et value of shares held by the Plan at year end .Investment contract with insurance company is reported at contract value.

The m ethods described above may produce a fair value calculation tliat may not be indicativeof net realizable value of reflective of future fair values. Furthermore, while the Plan believesits valuation methods are appropriate and consistent with o ther market participants, the use ofdifferent methodologies or assumptions to determine the fair value of certain financialinstruments could result in a different fair value m easurement at the reporting date.


29/38

KAISER PERMANENTE TAX SHELTE RED ANNUITY PLANNOTES T O FINANCIAL STATEMENTSDECEMBER 31 , 2 010 and 2009

NOTE D - Fair Value Measurenlents (Continued)The following table sets forth the level, within the fair value hierarchy, the Plan's inv es t~n en tsat fair value as of Decem ber 31 , 2 010 and 2009:

Investments at Fair Value a3 of Dccelnber 31,2010Level 1 Lcvcl 2 Level 3 TotalMuhlal fundsDomestic stock futidsInrernntional/alabnl stockBond fund 209,469,208 209,469,268

Balanced filiids 993,383,777 993,383,777Other funds 1,763,470 1,763,470Investment contract with insurance conipany 453,623,921 453,623,921Inr~cstments, t fair value $ 2,227,741,133 $ 453,623,921 S $ 2,681,365,054

lnvestinents at Fair Value as of December 31, 2009Level I Level 2 Level 3 Total

Mutual filndsDolncstic stack fundsIntel-nationallglobal stock 193,140,462 193,140,462Bond fund 172,581,802 172,581,802Balanced funds 8 19,050,690 819,050,690Other funds 1,312,847 1,3 12,847Investment contractwith insurance colnpany 427,683,551 427,683,551

Investments, at fair valuc $ 1,832,963,732 $ 427,683,551 $ $ 2,260,647,283

NOTE E - Investme~ltContract with Insurance Com panyThe Plan holds a benefit-responsive investment contract with Metropolitan Life InsuranceCompany (MetLife). MetLife maintains the contributions in separate accounts. Theseaccoun ts are credited with earnings on the underlying investments and charge d for pasticipantwithdrawals and adininistrative expenses. The guaranteed investment contract issuer iscontractually obligated to repay the principal and a specified interest rate that is guaranteed tothe Plan.


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KAISER PERMANENTE TAX SHELTERED ANNUITY PLANNOTES TO FINANCIAL STATEMENTSDECEMBER 3 1,2010 and 2009

NOTE E - Investment Coutract witli Insurance Com pany (Continued)As described in Note B, because tlie guaranteed investment contract is fully betiefit-responsive, contract value is the relevant measurement attribute for that portion of the netassets available for benefits attributable to the guaranteed investnieut contract. Contract value,as reported to tlie Plan by MetLife, represents contributions made under tlie contract, plusearnings, less participant withdrawals and administrative expenses. Participants mayordinarily direct the withdrawal or transfer of all or a portion of their investment at contractvalue.There are no reserves agaiust contract value for credit risk of the contract issuer or oth e~ wi se .The crediting interest rate is based on a formula agreed upon with tlie issuer, but may not beless than 3.00%. Such interest rates are reset on an an uual basis.Certain events limit the ability of tlie Plan to transact at contract value with the issuer. Suchevents include the following: (1 ) amendments to the plan doc un~ ents including cotnplete orpartial plan termination or merger with another plan), (2) changes to plan's prohibition oncompeting investmeut options or deletion of equity wash provisions, (3) bankruptcy of theplan sponsor or other plan sponsor events (for example, divestitures or spin-offs of asubsidiary) that cause a significant withdrawal fiom the plan, or (4) the failure of the trust toqualify for exemption from federal income taxes or any required prohibited transactionexemption under Etnployee Retirement Income Security Act of 1974. The Plan administratordoes not believe that the occui-rence of any such value event, which would limit the Plan'sability to transact at contract value witli pa ~ti cip an ts,s probable.The guaranteed investment contract does not permit the insurance cornpauy to terminate theagreement prior to the scheduled maturity date.

Average yields:Based on actual earningsBased on interest rate credited to participants


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KAISER PERMA NENTE TAX SHELTER ED ANNUITY PLANNOTES TO FINANCIAL STATEMENTSDECEMBER 3 1,201 0 and 2009

NOTE E - Investment Contract with Insurance Company (Continued)

MetLifeSeparate Ma jor Credit Contract at Fair Wrap Contract Adjustment toAccount No. Rating Value at Fair Value Contract Value

Total2009MetLife Investment

Separate Major Credit Contract at Fair Wrap Contract Adjustm ent toAccount No. Rating Value at Fair Value Conk act Value

Total $ 425,468,581 $ 2,214,970 $ (14,818,351)The follow ing represents reco nciliation of adjustment from fair value to contract value for theyears ended December 3 1,2010 and 2009:

Balance, beginning of yearDecrease in adjustment from fair value

to contract valueBalance, end of year


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KAISER PERMAN ENTE TAX SHELTERED ANNUITY PLANNOTES TO FTNANCIAL STATEM ENTSDECEMBER 31,2010 and 2009

NOTE F - Transfer of Plan AssetsThe Investment Committee may authorize the trustees to accept (transfer in) or disburse(transfer out) any assets from, or to, any qualified and tax-exempt t~ u s t s s requested by theparticipants.NOTE G - Plan TerminationAlthough it has not expressed any intent to do s o, the Em ployer has the right under the Plan todiscontinue its contributions at any time and to terminate the Plan subject to the provisions ofthe Einployee Retirement Income Security Act of 1974, as amended. Should the Plan beterminated, tlie net assets are to be distributed to participants, the value of their adjustedaccounts.NOTE H -Tax StatusThe Plan ad~ninistrator elieves the Plan nieets the qualification requirements under Section403(b), and is tax exempt under provisions of the Internal Revenue Code (the Cod e). The Planadministsator believes the Plan is designed an d is currently being operated in conlpliance withthe applicable requirements of the Code.NOTE I - Party-in-Interest TransactionsCertain Plan investments are managed by Vanguard. Vanguard is the trustee. Vanguard alsoselves as tlie recordkeeper. Trans actions with the tlustee and recordkeeper qualify as party-in-interest transactions.NOTE J - Risks and U ncertaintiesThe Plan invests in various in ves t~n ent ecurities. Investment securities are exposed tovarious risks such as interest rate, market and credit risks. Due to the level of risk associatedwith certain investment securities, it is at least reasonably possible that changes in the valuesof investment securities will occur in the near term and that such changes could materiallyaffect participants' account balances and the amounts reported in the statement of net assetsavailable for benefits.NOTE K - Plan ObligationsIn accordance with GAAP, benefits due to terminated participants are included in net assetsavailable for benefits. There were no benefits due to te~ininated articipants as of December31,2 010 and 2009.


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KAISER PERMANENTE TAX SHELTERED ANNUITY PLANNOTES TO FINANCIAL STATEMENTS

DECEMBER 3 1,2010 and 2009

NOTE L - Excess Contributions RefundableAs of December 31, 2010 and 2009, liabilities of $0 and $52,348, respectively, are recordedfor amounts refundable by the Plan to participants for contributions made in excess ofamounts allowed by the Internal Revenue Service.NOTE M - Reconciliation of Financial Statements to Foiln 5500The following is a reconciliation of net assets available for benefits per the financialstatements to Form 5500 as of December 3 I, 20 10 and 2009:

Net assets available for benefits per the financialstatements

Adjustment from contract value to fair value forfully benefit-responsive investment colltracts 22,505,966 14,818,351Net assets available for benefits per Forin 5500 $2,732,223,050 $2,298,474,647The following is a reconciliation of investment income per the financial statenlents to Form5500 for the years ended December 3 1,2010 and 2009:

Investment income per the financial statements $ 257,043,562 $ 368,885,446Change in adjustment from contract value to fair

value for fully benefit-responsive investmentcontracts 7,687,615 11,179,669

Investinent income per Form 5500


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KAISER PERMANENTE TA X SHELTERED ANNUITY PLANEIN 94-1340523 PLAN NO. 033SCHEDU LE H, LINE 4i - SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSESDECEMBER 31,2010

Identity of Issue, Borrower,Lessor, or Sim ilar Party

AllianceBerustein Global Research Growth FundJanus Adv iser Forty Fund, Class IT. Rowe Price Inte~llationalDiscovery FundAlger Capital Appreciatiou Retirement Poitfolio: Vanguard Explorer Fund: Vatlguard FTSE S ocial Index Fund' Vanguard International Growth Fund' Vanguard L ifeStrategy Conservative Growth Fund* Vanguard LifeStrategy Growtb Fund* Vanguard L ifeStrategy Illcome Fund* Vauguard LifeStrategy Moderate Growth Fuud* Vanguard PRIMECAP Fund* Vanguard Total Bond Market Index Fuud* V an ya rd Total Stock Market Index FundV a n g u a r d Value Index FundM a n g u a r d Welliugton Fund< MetLife Separate AccountsVGI Brokerage OptionTotal investments per financial statements

Notes receiv able from participantsTotal iuvest~nents er Form 5500

Description of Iuv est~ne ntucludiugMaturity Date, Rate of Interest,Collateral, Par, or Maturity Value

Mutual fundMutual fuudMutual fundM utual h dMutual fundMutual fundMutual fuudMutual fiindMutual fundMutual fundMutual fnndMutual fundMutual fundMutual fuudMutual fnndMutual fundInvestnlent cotltract with insurance conlpanySelf-directed brokerage account

Cost$ 12,612,125143,864,64782,434,37527,123,08458,900,0696,329,520133,343,416358,174,833115,956,03628,204,192104,321,043103,635,855201,867,363

245,928,92684,352,385320,857,419431,117,9551,753,435

Current Value$ 11,470,391135,205,73094,409,64533,712,83366,851,6017,737,533141,715,861385,484,811124,331,19229,647,29011 1,322,927115,825,353209,469,208

3 16,072,272100,123,459342,597,557453,623.921

* Iuvestlnents in parties-in-interest as d efined under ER ISA.


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KAISER PERMAN ENTE TAX SHELTERED ANNUITY PLANEIN 94-1340523 PLAN NO. 033SCHEDU LE H, LINE 4i - SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSESDECEMBER 31,2010

Identity of Issue, Borsower,Lessor, or Sim ilar Party

All ianceBer~~steinlobal Research Growth FundJanus Adviser Forty Fund, C lass IT. Row e Price International Discovery FundAlger Cap ital Appreciation Retirement PortfolioVanguard Explorer FundVanguard FTSE Social Index FundVa~lguard nternational Growth FuudVanguard LifeStrategy Conservative Growth FundVanguard LifeStrategy Growth FundVanguard L ifeStrategy Incoine FundVatiguard LifeStrategy Moderate G rowth FundVanguard PRIMECAP FundVanguard Total Bond Market Index FundVanguard Total Stock M arket Index FundVanguard Value Index FundVanguard Welli~lgton undMetLife Separate Accou iltsVGI Brokerage OptionTotal iu ves t~n ent s er fillancia1 statements

: Notes receivable fi.0111participantsTotal iilvest~nents er Form 5500

Description of Investment IncludingMaturity Date, Rate of Interest,Collateral, Par, or Maturity Value

Mutual fundMutual fundMutual fundMutual fundMutual fundMutual fundMutual fundMutual fundMutual fundMutual fundMutual fundMutual hn dMutual fundMutual fundMutual fundMutual fundInvestment contract with insurance companySelf-directed brokerage account

Cost$ 12,612,125143,864,64782,434,37527,123,08458,900,0696,329,520133,343,416358,174,833115,956,03628,204,192104,321,043103,635,855201,867,363

245,928,92684,352,385320,857,419431,117,9551,753,435

Curreilt Value$ 11,470,391135,205,73094,409,64533,712,83366,85 1,6017,737,533141,715,861385,484,811124,331,19229,647,29011 1,322,92711 5,825,353209,469,208

3 16,072,272100,123,459342,597,557453.623.921

* Iilvest~neiitsn pal-ties-in-interest as de fi~ ied nder ER ISA.


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SCHEDULER I Retirement Plan Information I OM 5 No. 1210-0110

C Plan rliorasor's name as snohn on ne 2;1 01 Form 5500X I%SEK FOLhDA'l Oh , ~ r \ - i . ? A \ , h(:

(Form 5500)Oeparfment of the ireasulyinternal ~ e v e n ~ eewice

oepanment 01 LaborE ~ ~ I ~ ~ ~ ~enenisecurity ~ d ~ ~ i ~ ~ ~ ~ t i ~ ~PensionBenefitGuaan ly coipora,,on

D Employer Identification Number (EIN)94-1340523

This schedule is required to be filed under section 104and 4065 of theEmployee Retirement income Security Act of 1974 (ERISA)and section6058(a) of the Internal Revenue Code (the Code).

) File as an attachment to Form 5500.

2010This Form is Open to Public

inspection.For calendar plan year 2010 or fiscal plan year beginning 0110112010 and ending 1213112010

I Part I I DistributionsAl l references to distributions relate only to payments of benefits during the plan year.

If the plan is a defined benefit plan, go to line 8

1 Total value of distributionspaid in property other than in cash or the forms of property specified in theinstruction

part II

5 If a waiver of the minimumfunding standard for a prior year is being amortized in thisplan year, see instructionsand enter the date of the ruling letter granting the waiver. Date: Month Day YearIf yo u completed line 5, complete lines 3, 9, and 10 of Schedule ME and do no t 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 yearC Subtract the amount in line 6b from the amount in line 6a. Enter the result

(enter a minus sign to the iefl of a negative amounIf yo u completed line 6c, skip lines 8 and 9.

7 Will the minimumfunding amount reported on line 6c be met by the funding deadline?

F.................................. i] Yes No 0 IA

033A Name of planKAISER PERMANENTE TAX SHELTERED ANNUiTY PLAN

1

p~ - --p~Funding lnformation (If the plan is not subject to the minimum funding requirementsof section of 412 of the Internal RevenueCode orERISA section 302, skip this Part)

6 Three-digitplan number(PN) 1

4 is the planadministratarmding an election underCode section 412(d)(2) or ERiSAsection302(d)(2)?...................... Yes No 0 IA

- .year that increased or dedreased the velue of benefits? If yes, chec'k the appropriatebox(es), If no. check the '"No"box .................................................................................. 0 ncrease Decrease Both NoI Part lV I ESOPs (see instructions). If this is not a plan described under Section 409(a) or 4975(e)(7) of the Internal Revenue Code,

2 Enter the EIN(s) of payor@)who paid benefits on behalf of the plan to participantsor beneficiariesduring the year (if more than two, enter ElNs of the twopayors who paid the greatest dollar amounts of benefits):EIN(s): 23-2186884

Profit-sharing plans, ESOPs, and stock bonus plans, skip line 3.

8 if a change in actuarial cost method was made for this plan year pursuant to a revenue procedure providingautomatic approval for the change or a class ruling letter, does the plan sponsor or plan administrator agreewith the change? ............................................................................................................................................... Yes No 0 IA

1 I skip this Part...............0 Were unallocated employer securities or proceeds from the sale of unallocated securities used to repay any exempt loan? Yes NO

11 a Does the ESOP hold any preferred stoc 0 es 0 ob If the ESOP has an outstanding exempt loan with the employer as lender, is such loan part of a "back-to-back loan?(See instructions for definition of "back-to-back loan.) .......................................................................................................... Yes NO......................................................2 Does the ESOP hold any stock that is not readily tradable on an established securities market? fl Yes 0 o

For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500. Schedule R (Form 5500) 20v.092308

3 Nve

Part Ill

3

Amendments9 If this is a defined benefit oension olan, were anv amendments adoDted durina this Dlan


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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 theparticipant for:a The current yea

15 Enter the ratio of the number of participants under the plan on whose behalf no employer had an obligation to make anemployer contribution during the current plan year to:a The corresponding number for the plan year immediately preceding the current plan year ...............................

a Enter the number of employers who withdrew during the preceding plan year

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 regardingsupplemental information to be included as an attachment. ............................................................................................................. 0

I Part VI I Additional Information for Single-Emp loyer and Multiemploycr Defined Benefit Pension Plans . .18 If any liabilities to participants or their beneficiaries under the plan as of the end of the plan year consist (in whole or in part) of liabilities to such participantsand beneficiaries under two or more pension plans as of immediately before such plan year, check box and see instructions regarding supplementalinformation to be included as an attachment ........................................................................................................................................................................19 If the total number of participants is 1,000 or more, complete items (a) through (c)

a Enter the percentage of plan assets held as:Stock: % Investment-Grade Debt: % High-Yield Debt: % Real Estate: % Olhei: O

b Provide the average duration of the combined investment-grade and high-yield debt:0-3 years 0 -6 ears 6-9 years 9-12 years 0 2-15 years 0 5-18 years 0 8-21 years 0 1 years or moreC What duration measure was used to calculate item 19(b)?nEffective duration nMacaulay duration nModified duration nOther (specify):

kaiser tax sheltered annuity 5500 for 2010

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