Form 5500

oepartment ofthe ~ i e a s u r y
Internal Revenue Sew~ce

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).
)

OM6 Nos. 1210-0110

1210-0089

oeparlment or Labar Employee Benefits Securily

Psnslon Benefll Guaranty

2010

~dm!n~stratian Coipaiation

Complete all entries in accordance with the instructions to the Form 5500.

I
11 11 20.3

I
a multiempioyer plan; a single-employer plan:

This Form i s O ~ e tn Public o

Part I
A

I Annual Report Identification Information

Fnr r a rnnar plan ycar 2010 or fsco plan year ocg nn no This returnlreport is for:

0 0

and m 1)s u

i - ! ;?ll.ll . :

a multiple-employer plan; or

a DFE (specify) the final returnlreport:

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

B
C

This returnlreport is:

the first relurnlreport: an amended returnlreport;

If the plan is a collectively-bargainedplan, check here. . . . . . . . . . Check box if filing under:

. .. ... . ....... . ... . . . ... . . . ..... . ... . . ... . ....... . r

automatic extension:

C]

[ Form 5558;
special extension (enter description)

the DFVC program;

KAISER PERMANENTE TAX SHELTERED ANNUiTY PLAN

1
2a
Plan sponsor's name and address (employer, if for a singie-employer plan) (Address should include room or suite no.) KAISER FOUNDATION HEALTH PLAN. INC

number (PN) b 1 C Effective date of plan 0110111982

2b

Employer identification Number (EIN)

. . 510-271-5940

ONE KAISER PLAZA SUITE 2001 OAKLAND, CA 94612

2d

Business code lsee

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

I
SIGN Flied with authorbzedlvaildelectronic signature HERE Signature of plan admlnlstrator SlGN HERE Signature o f employerlplan sponsor SlGN HERE Date 1011412011 Date

I
HARRIET GUBERMAN Enter name of lndlvldual slgnlng as plan admlnlstrator

Enter name of individual signing as employer or plan sponsor

Enter name of individual signing as DFE Signature of DFE Date For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500.

Form 5500 (2010) v.092307.1

Form 5500 (2010)

Page 2

3a Plan administrator's name and address (if same as plan sponsor, enter 'Same')
KAISERFOUNDATION HEALTH PLAN. INC. ONE KAISER PLAZA SUITE ZOO1 OAKLAND CA 94612

I If the name and/or EIN of the plan sponsor has changed since the last returnlreport filed forthis plan, enter the name, EIN and the plan number from the last returnireport:

+3b Administrator's EIN

94-1340523 number 510-271-5940

3c Administrator's telephone

4b EIN

a Sponsor's name
5
Total number of participants at the beginning of the plan year
~ ~

14c PN
I

1 5

48407

a Active participant

b Retired or separated participants receiving benefit

C Other retired or separated participants entitled to future benefits ..........................................................................................

d
c ?

Subtotal. Add lines 6a, 6b, and 6 Deceased participants whose beneficiaries are receiving or are entitled to receive benefits................. . . .......................... . Total. Add lines 6d and 6e ..................................................................................................................................................... Number of participants with account balances as of the end of the plan year (only defined contribution plans complete this item) ................................................................................................................................................................... Number of parlicipants that terminated employment during the plan year with accrued benefits that were less than 100% vested ............................. . . ......................................................................................................................... Enter the total number of employers obligated to contribute to the plan (only multiemployer plans complete this item) ........ 2F 2G 2J 2K 50322

g h

1 .
6
49567

6h

935

7 7 8a if the plan provides pension benefits. enter the applicable pension feature codes from the List of Plan Characteristic Codes in the instructions:
2E

2~

2T

3H

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) (2)

9b Plan benefit arrangement (check all that apply) (1) (2)

X -

Insurance Code section 412(e)(3) insurance contracts

10

Trust Trust (3) General assets of the sponsor General assets of the sponsor (4) (4) 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)

(3)

X X

Insurance Code section 412(e)(3) insurance contracts

a Pension Schedules
(I' (2)

1
0

b General Schedules
(1)
H (Financial Information)

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

ii;
(4) (5) 161

(3)

SB (Single-Employer Defined Benefit Plan Actuarial Information) sioned bv the ~ l a actuarv n

1
n

'

i (Financial Information - Small Plan) A (Insurance information)

- C (Service Provider information)

(DFEiParlicipating Plan Information) G (Financial Transaction Schedules)

SCHEDULE A
(Form 5500)
oepartment of the ~ r e a r u i y internal ~ e v s n u e sewice Departmen1or Labor Employee aensl~ts Securily ~dminstratton ~snsion ~snsfll ~uaranb, cornoration

Insurance Information
This schedule is required to be Rled under section 104 of the Employee Retirement income Security Act of 1974 (ERISA).

OMB

No. 1210-0110

2010
This Form i s Open to Public Inspection 1213112010 033

b File as an attachment to Form 5500. b Insurance companies are required to provide the information
pursuant to ERISA section 103(a)(2). and ending

For calendar plan year2010 or Rscai plan year beginning 0110112010 Name of plan KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN

nree-digit plan number (PN)

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

KAISER FOUNDATION HEALTH PLAN, INC.

Employer Identification Number (EIN) 94-1340523

Part I

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

Coverage Information:

(a) Name of insurance carrier

METLIFE (b) EIN 13-5581829 (C) NAiC code 65978 (d) Contract or identification number GAC 24742
(e) Approximate number of

Policy or contract year

persons covered at end of pollcy or contract year 12195

(4

From

(9) T O

0110112010

1213112010

2 Insurance fee and commission information. Enter the total fees and total commissions paid. List in item 3 the agents. brokers, and other persons in
descending order of the amount paid. (a) Total amount of commissions paid 0

(b) Total amount of fees paid 0

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) Amount of sales and base commissions pald

(c) Amount

Fees and other commissions pald (d) Purpose

(e) Organization code

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

(b) Amount of sales and base comm~ss~ons pald

Fees and other commlsslons pald (c) Amount (d) Purpose (e) Organlzatlon code

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

I Schedule A (Form 5500) 2010 v.092308.1

Schedule A (Form 5500) 2010

Page 2

- a

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

(b) Amount of sales and base commissions paid

Fees and other commissions pald (c) Amount Id) Purpose

(e) Organization code

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

(b) Amount of sales and base commissions paid

Fees and other commissions paid

(e) Organization

(c)Amount

(d) Purpose

code

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

(b) Amount of sales and base

Fees and other commissions paid

(e) Organization code

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

(b) Amount of sales and base commissions paid

(c) Amount

Fees and other commissions paid (d) Purpose

(e) Organization code

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

(b) Amount of sales and base commissions paid

(c) Amount

Fees and other commissions paid (d) Purpose

(e) Organization code

Schedule A (Form 5500) 2010

Page 3

Where lnd~vldual contracts are provided, the entire group of such individual contracts with each carrier may be treated as a unit for purposes of
~
~p

Investment and Annuity Contract Information . . .

4 Current value of pian's interest under this contract in the general account at year end .................................................. 5 Current value of plan's interest under this contract in separate accounts at year end ............................................ 6 Contracts With Allocated Funds: a State the basis of premium rates 1

. . .I

4 5

b
C

Premiums paid to carrie Premiums due but unpai ..................................................................................................... If the carrier. selvice, or other organization incurred any specific costs in connection with the acquisition or retention of the contract or policy, enter amoun Specify nature of costs ) Type of contract: (1) (3) Individual policies

(2)

group deferred annuity

0 other (specify)

f If contract purchased, in whole or in part, to distribute benefits from a terminating plan check here b 7 Contracts With Unailocated Funds (Do not include portions of these contracts maintained in separate accounts) a Type of contract: (1) deposit administration (2) immediate participation guarantee

(3)

guaranteed investment

(4)

other )

b
C

Balance at the end of the previous year .............................................................................................................. 7b Additions: (1) Contributions deposited during the year ................... . . 7~(1) ........ 13739230 (2) Dividends and credits 7c(2) (3) Interest credited during the yea (4) Transferred from separate accoun ( 5 ) Other (specify below) ) CONTRACT ACTIVIT

427683551

7c(3) 7c(4) 7~(5)

d e

I (6)Total additions .............................................. .. . .............................................................................................. . Totai of balance and additions (add band ~ ( 6 ) .................................................................................................. ). Deductions: (1) Disbursed from fund to pay benefits or purchase annuities during year (2) Administration charge made by carrie (3) Transferred to separate account (4) Other (specify below)................................................................................

7~(6) I 7d I

940370

623921

'

F
I
i

...
<?

(5) Total deductions ............................................................................................................................................7e(5) Balance at the end of the current year (subtract e(5) from d) ......................................... .... .............................. 7f

I 1

0 45$323921

Schedule A (Form 5500) 2010

Page 4

Part Ill

Welfare Benefit Contract lnformation

If more than one contract covers the same group of employees of the same employer(s) or members of the same employee organization(s). the information may be combined 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 may be treated as a unit for purposes of this report.

Benefit and contract type (check all applicable boxes)

a Health (other than dental orvision) e Temporary disability (accident and sickness) i Stop loss (large deductible) m jl Other (specify) b

b f j

0 0

Dental Long-term disability

HMO contract

c g k

0vision 0Supplemental unemployment 0 contract

PPO

d h I

Life insurance Prescription drug Indemnity contract

Experience-rated contracts: a Premiums: (1) Amount received.......................... . .................................. . (2) Increase (decrease) in amount due but unpaid ......................................

b Benefit charges (I) Claims paid

(2) lncrease (decrease) in claim reserves

(H) Total retentio (2) Dividends or retro

Total premiums or subscription charges paid to Carrie

Specify nature of costs

I Part IV
11 12

Provision of Information .

. -.

Did the insurance company fail to provide any information necessary to complete Schedule A? ............. If the answer to line 11 is 'Yes," specify the information not provided. b

Yes

NO

SCHEDULE C
(Form 5500)
oepartment of the ~ i e a s u l y internal ~ e v e n u e sew~ce

Service Provider Information

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

OMB NO. 1210-0110

2010
This Form is Open to Public Inspection.

1
I

oeparlmenl O f Labor
~mployee seneflts security ~dm~n~strat,on
~ens,on Benefit ~ u a r a ncarparation t~

For calendar plan year 2010 or fiscal plan year beginning 01101!2010

12!3112010

A Name of plan
KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN

B Three-digit
plan number(PN)
I

033

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

KAISER FOUNDATION HEALTH PLAN. INC

D Employer ldent~f~cat~on Number (EIN)

94-1340523

You must complete this Part, in accordance with the instructions, to report the information required for each person who received, directly or indirectly. $5.000 or 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 the plan during the plan year. If a person received only eligible indirect compensation for which the plan received the required disclosures, you are required to 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" 0r"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).. . . . . . . . . . . . . . .

1yes 0No

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). fbl Enter name and EIN or address of oerson who orovided vou disclosures on elioible indirect comoensation THE VANGUARD GROUP, INC

23-1945930

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

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

Schedule C (Form 5500) 2010 v.092308.1

Schedule C (Form 5500) 2010

Page 2

- r n

lbl Enter name and EIN or address of Derson who provided you disclosures on eliqible indirect com~ensation

lbl 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

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

Ibl 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

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

Schedule C (Form 5500) 2010

Page 3

2. Information on Other Service Providers Receiving Direct or Indirect Compensation.

Except for those persons forwhom you answered "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 connection with services rendered to the plan or their position with the plan duringthe plan year. (See instructions).
- --

(a)
THE VANGUARD GROUP, INC

Enter name and EIN or address (see instructions)

Service Code@)

(b)

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 a party-in-interest sponsor)

(c)

(d)

(e)

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

(0

Enter totai 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 estimated amount? answered "Yes' to element (f). If none. enter -0.. 0

(9)

(h)

15 25 26 37 NONE 52 59

1366322 yes

rn

NO

yes

NO

yes

0 NO
I

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

MORRIS, DAVIS, AND CHAN. LLP

I
(4 (e) (f) Did indirect comoensation include eligible indirect compensation, for which the plan received the required disclosures?
I
yes
NO

Service Code@)

(b)

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

(c)

I
10 NONE

1
29905

I
yes

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 estimated amount? answered "Yes" to element (f). If none, enter -0..

(9)

(h)

NO

I
QDRO CONSULTANTS COMPANY

rn

0 yes

NO

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

34-1820650

Ssrbicr CudE(n,

(b) . ,

Ic) II Id) I fe) , , Re s: onsn p 10 Erwr u rect D u serv r e pru,iuer ctnp ober an 11lrl)i.c rcn-pr?ns:lIr>o1,:l:u rc<:c? + >(I r<.<:l $ orr?an#Zal or on by lrle plat# 1 nJne, compen?al:cn? soJr;Es I person known to be I 1 other than plan or plan enter -0.. a party-in-interest sponsor)
8

..

I I

15

NONE

12350

fa) fh) (4 , , i n l c r iolili Iu r c c ~ D a ine scrv cc Did indirect compensation I include eligible indirect (o1npe11siiton rcr:cl\ro o j provloer g,vc {c,. 4 compensation, for which the service provider excluding formula instead of eligible indirect an amount or plan received the required compensation for which you estimated amount? disclosures? answered 'Yes'' lo element (f). If none, enter -0..
I

.-,

yes

fl

0 yes
NO

NO

e]

yes

NO

rn

Schedule C (Form 5500) 2010

Page 4

- r n

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

Code@)

Enter direct Did service orovidar Did indirect comoensation receive indirect include eligible indirect employer. emi;loyee compensation paid organization, or by the plan, l i none, compensation? (sources compensation, ior which the other than plan or plan plan received the required 0. person known to be enter -. sponsor) disclosures? a party-in-interest

(d)

(el

(f)

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

(9)

(h)

Yes

NO

Yes

NO

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

Service Code@)

(b)

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

(c)

(dl

(4

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

(f)

(9)

(h)

yes

0 0
NO

yes

NO

yes

NO

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

Service Code@)

(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)

(c)

(4

(e)

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 plan received the required an amollnt or compensation for which you estimated amount? disclosures? answered "Yes" to element (f). If none, enter -0..

(f)

(9)

(h)

yes

NO

yes

0 0
NO

yes

NO

Schedule C (Form 5500) 2010

page 5

- r n

Part I l ~ e r v i c e Provider 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 .
~ ~

n.eslmcn; rni.r>;yvrnr;t, nrzlier "r rr~c:rakcc?p scw ccs: answr!r l o r fo cb:r.b vg or .>rLvi.;s ~urlra.1 ill!!. 11 SIIBICI C O ~ S J ~ I ~ C-slod1a nvcstlrcnl aa;i20ry (J q.ds1 0"s lor ( 2 ) ea:h so..rr:rJ i r m -hot?. lo sen cc pm,lIli!r r,?l:C! lco S1 000 or inor,! n nair;l comjlrnsat.cn anu (11)m z h SOJr<:c? lvhonl llle SeNice lllr C>mplels as pro" rlrr J ~ Y I ' in.. i) 'ortn. a .st-a 10 ueterm.nn i r e increcl cornpersoton nilei.c o'an smJ..nl or r;~omat~?it .r(rw .nl cf irr lllirecl r o m p c n s n l ' ~ ~ ~ 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

(see instructionsl

(c) Enter amount of indirect

com~ensation

formula used to determine the service provider's eligibility for or the amount 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

compensation

. .

a .scd to rle!tr!rllllllr llle serf c6 PrOl jer's c TJ J 111, for or tor?;llnoui Iof Ill I,C r . ccnlpersallon e1

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

(b) Service Codes

(see lnstructlons)

( c ) Enter amount of indirect

compensation

(d) Enter name and ElN (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 compensatioo.

Schedule C (Form 5500) 2010

Page 6-

Part II Service Providers Who Fail or Refuse to Provide Information 4 Provide. to the extent oossible, the iollowina information for each service orovider who failed or refused to orovide the information necessary to complete this Schedule.

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

instructions)

(b) Nature of
Service Code@)

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

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

instructions)

(b) Nature of
Service Code@)

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

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

instructions)

(b) Nature of
Service Code@)

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

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

instructions)

(b) Nature of
Service Code@)

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

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

instructions)

(b) Nature of
Service Code(s)

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

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

instructions)

i(b) Nature of
Service Code($

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

Schedule C (Form 5500) 2010

Page 7

(complete as many entries as needed)

a
C

Name: Position: Address:

EIN:

e Telephone:

Explanation:

a
C

Name: Position: Address:

EIN:

e Telephone:

Explanation:

a
C

Name: Position: Address:

e Telephone:

I Explanation:

a
C

Name: Position: Address:

EIN:

e Telephone:

Explanation:

a
C

Name: Position: Address:

EIN:

e Telephone:

I Explanation:

SCHEDULE H
(Form 5500)
oepanment 01,tie
Treasury lnterno ~ e v e n u e Sewice

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

I
and ending

OM6 No. 1210-0110

2010

nDns,,mom, hn, "$8 -""" Employee Benefits Secunly Admnirlral#on

~snslon e n e n ~ u a r a n t y ~ t corparefion

.....

1 File as an attachment to Form 5500.

For calendar plan year2010 or fiscal plan year beginning 0110112010 Name o i plan KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN

This Form i s Open to Public Inspection 12/3112010

Three-digit plan number (PN)

033

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

Employer Identification Number (EIN) 94-1340523

I Part I I Asset and Liability Statement

1
Current value o i plan assets and liabilities at the beginning and end of the plan year. Combine the value o i 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 t o the nearest dollar. MTIAs, CCTs, PSAs, and 103-12 IEs do not complele lines lb(1). lb(2). lc(8). l g , 1h. and l i . CCTs, PSAs, and 103-12 IEs also do not complete lines I d and l e . See instructions.

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

(2) U.S. Government securiti

(3) Corporate debt instrume

(5) Partnershipqoint venture interests

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

(10) Value of interest in pooled separate accounts ........................................ (11) Value o i interest in master trust investment accounts ............................

For Paparwork 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
(a) Beginning of Year (b) End of Year

1d Employer-related investments:
(1) Employer securities (2) Employer real prope

e f

Buildings and other pro Total assets (add all amounts in lines l a through l e ) ...................................... 2298526995 2732233085

Liabilities
g Benefit claims payable

h i j k
I

Operating payable Acquisition indebtedness Other liabilitie Total liabilities (add all amounts in lines l g throughlj) .....................................
1k

52348 52348

10035 10035

Net Assets
Net assets (subtract line l k from line I f
II

2298474647

2732223050

I Part II 1 Income 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
fund(s) and any paymentslreceipts tolirom insurance carriers. Round off amounts to the nearest dollar. MTIAs. CCTs. PSAs, and 103-12 IES do not complete lines 2a, 2b(l)(E), 2e. 2f. and 29.

Income

(a) Amount

(b) Total

Contributions:
(1) Received or receivable in cash from: (A) Employers ................................ (6) participants .................................................................................. (C) Others (including rollovers (2) Noncash contributions Za(l)(A) 2a(l)(B) 2a(l)(C) 2a(2)

30521031

9684797

(3) Total contributions. Add lines 2a(l)(A), (B), (C), and line 2a(2)

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

2a(3)

301654967

Earnings on investments:
(1) Interest: (A) Interest-bearing cash (including money market accounts and certificates of deposit (6) U.S. Government securitie (C) Corporate debt instruments (D) Loans (other tha (E) Participant loans
(F) Othe

2b(l)(F) 2b(l)(G)

(G) Total interest. Add lines 2b(l)(A) through (F) ..................... . ....... . (2) Dividends: (A) Preferred stoc

(6) Common stock

46236041

(D) Total dividends. Add lines 2b(2)(A), (B), and (C) (3) Rent
(4) Net gain (loss) on sale o i assets: (A) Aggregate proceeds ....................... 2b(4)(A) (6) Aggregate carrying amount (see instructions) ................................. (C) Subtract line 2b(4)(B) from line Zb(4)(A) and enter result .................. 2b(4)(B) 2b(4)(C)

46236041

Schedule H (Form 5500) 2010

Page 3

2b

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

(6) Other .......................... . . ................................................................ . ( C ) Total unrealized appreciation of assets. Add lines 2b(5)(A) and (B

(6) Net investment gain (loss) from common/collectivetrusts ..........................

(7) Net investment gain (loss) from pooled separate accounts .......................

(8) Net investment gain (loss) from master trust investment accounts ............

(9) Net investment gain (loss) from 103-12 investment entities ....................... (10) Net investment gain (ioss) from registered investment companies (e.g.. mutual funds)...................................................................
C Other incom

d
e

Total income. Add ail income amounts in column (b)and entertotal......................

Expenses
Benefit payment and payments to provide benefits: (1) Directly to participants or beneficiaries, including direct roilovers .............. (2) To insurance carriers for the provision of benefits ....................................

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

Corrective distributions (see instructions Interest expense.......................................................................................... Administrative expenses: (1) Professional fee (2) Contract administratorfee

h i

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

Net Income and Reconciliation

k
I

Net income (ioss). Subtract line 2j from line 2d Transfers of assets: (1) To this pla (2) From this plan
.......

I Part Ill
3
a
(1)

Accountant's Opinion

Complete lines 3a through 3c if the opinlon of an independent qualified public accountant is attached to this Form 5500. Complete line 3d if an opinion is not attached. The attached opinion of an independent qualified public accountant for this plan is (see instructions):

Unqualified

(2)

0Qualified

(3)

0Disclaimer

(4)

0Adverse
121 EiN: 94-2214860 ,,

b Did the accountant ~eriorm limited s c o ~ e a audit oursuantta 29 CFR 2520.103-8 and/or 103-qzldl? ~,
C Enter the name and EIN of the accountant (or accounting firm) below:

n yes

NO

IllName: MORRIS. DAVIS 8 CHAN LLP

..

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

(1)

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

(2)

It will be attached to the next Form 5500 pursuant to 29 CFR 2520.104-50.

Schedule H (Form 5500) 2010

Page 4

- n

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. 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 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 DOVs 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 uncollectible? Disregard participant loans secured by participant's account balance. (Attach Schedule G (Form 5500) Part I if 'Yes'' is checked.) .......... . . .................................................................................................................. . Were any leases to which the plan was a party in deiauit or classified during the year as uncollectible? (Attach Schedule G (Form 5500) Part I1 if "Yes'is checked.) .............................. Were there any nonexempt transactions with any party-in-interest? (Do not include transactions reported on line 4a. Attach Schedule G (Form 5500) Parl Ill if "Yes' is checked.).............. . . .................................................................................................................. Was this plan covered by a fidelity bon Did the plan have a loss, whether or not reimbursed by the plan's fidelity bond, that was caused by iraud or dishonesty? ................................ . ........................................................................... Did the plan hold any assets whose current value was neither readily determinable on an established market nor set by an independent third party appraise Did the plan receive any noncash contributions whose value was neither readily determinable on an established marke
: , .
~

,,

i
J

Did the plan have assets held ior investment? (Attach schedule(s) of assets if "Yes'is checked, and see instructions for iormat requirements.) ............................................................................. Were any plan transactions or series of transactions in excess of 5% of the current value of plan assets? (Attach schedule of transactions if "Yes'is checked, and see instructions ior format requirements.) .................................................................................... Were all the plan assets either distributed to participants or beneficiaries. transferred to another plan, 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 this is an individual account plan, was there a blackout period? (See instructions and 29 CFR 2520.101-3.) ................................................................................................................................

n
5a 5b

li4m was answered "Yes,' check the "Yes' box ii 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 the amount ofany plan assets thatrevertedto the employerthis year .............................

0Yes 1

NO

Amount:

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 were transferred. (See instructions.) 5b(l) Name of pian(s) 5b(2) EIN(s) I 5b(3) PN(s)

MORRIS, DAVIS & CHAN LLP

C e r t ~ f ~ Publlc Accountants ed

Investiiieiit Committee Kaiser Permanente Tax Sheltered Annuity Plan 'Tn~stNo. 90998 We have audited the accompanyiiig statements of net assets available for benelits of the Kaiser Permanente T a x Sheltered Annuity Plan (the Plan) as of December 31, 2010 and 2009, and the related statements of changes in net assets available for benefits for the years then ended. Tliese financial statements are the respons~bilityof the Plan's management. Our responsibility is to express an opinion on these financial statements based on our audits. . We conducted our audits in accordance with U.S. generally accepted auditing standards. Those standards require that we plan and perfom? the auclit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes consideration of intenral control over financ~al repol-ting as a basis for designing audit proceclnres that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the Plan's inteilral control over financial reporting. Accordingly, we expl-ess no such opinion. An a u d ~ ti~lcludesexanlini~lg,on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audits provide a reasonable basis for our opinion.
In oiir opinion, the financial statements, referl-ed to above, present fairly, in all material respects, the nel assets available for benefits as of December 31, 2010 and 2009 and the changes in net assets available for benefits for the years then ended in confo~mity with U.S. generally accepted accounting principles.

Our audits were performed for the purpose of foiming an opinion on the basic financial statements talten as s whole. The suppleinental schedule of assets held for investinelit purposes as of December 3 1, 2010 is presented for the pulyose of additional analysis and is information ]required not a requ~retlpart of the basic tinancia1 statements but is si~pplementaiy by the Department of Labor's Rules and Regulations for Reporting and Disclosi~reunder the Employee Retii-ement Income Security Act of 1974. The supplemental schedule is the responsibility of the Plair's management. The supplemental schedule has been subjected to the auditing procedures applied in the audits of the basic financial statements and, in our opinion, is fairly stated in all material respects in relation to the basic financial statements taken as a wlrole.

Oakland, C a l i f o ~ n ~ a September 30, 201 1

1111 Broadway, Suite 1505 ' Oakland, California 91607 ' (510) 250-1000 ' Ftax (510) 2 5 0 - 1 0 3

Offices in So71 Fr,z~~rlSco, CnlLj%rnia and C%arlottc,North C'al-olinn

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN

TRUST NO. 90998 FINANCIAL STATEMENTS AND SUPPLEMENTAL SCHEDULE TOGETHER WITH INDEPENDENT AUDITORS' REPORT DECEMBER 3 1,20 10 AND 2009

MORRIS, DAVIS & CHAN LLP Certified Public Accouiltants

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN TABLE OF CONTENTS

Independent Auditors' Report Statements of Net Assets Available for Benefits Statenlents of Changes in Net Assets Available for Benefits Notes to Financial Statements Schedule H, Line 4i - Schedule of Assets Held for Investment Purposes

MORRIS, DAVIS & CHAN LLP

Crrt~f~ed Pubhc Accountantr INDEPENDENT AUDITORS' REPORT Investnlent Lommlttee ICaiser Permanente Tax Sheltered Annuity Plan 'rntst No. 90998 We have audited the accompanying statemei~tsof lief assets available for benelits of the Kaiser Permanente Tax Sheltered Annuity Plan (the Plan) as of December 31, 2010 and 2009, and 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 management. Our responsibility is to express an opinion on these financial statements based on OLII-audits.

We conducted our audits in accordance with U S . generally accepted auditing standards. Those staildards require that we plan and perfonn the audit to obtain reasonable assurance about wlietller the financial statements are free of material misstatement. An audit includes consideration of internal control over financial repol-ting as a basis for designing audit procedures that are appropriate in the circumstances, but not for the purnose of expressing an opinion on the cffectiveness of the Plan's ilite~nal control over financial reporting. Accordingly, we express no such opinion. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estililates made by management, as well as evaluating the overall financial statement presei~tation. We believe ts ~ that our a ~ ~ d iprovide a reasoilable basis for O L I opinion.
In our opinion, the financial statements, referred to above, present fairly, in all material ]respects, the net assets available for benefits as of December 3 I, 2010 and 2009 and the changes in net assets available for benefits for the years then ended in conformity with U.S. gene]-ally accepted accounting principles. ts Our a ~ ~ d i were performed for the pupose of forming ail opinion on the basic financial stateme~itstaken as a whole. The supplemental schedule of assets held for investment purposes as of December 31, 2010 is presented for the putpose of additional analysis and is not a requ~reti part of the basic financial statements but is supplementa~y information ]required by the Department of Labor's Rules and Regulations for Reporting and Disclosure under tile Employee Retirement Income Security Act of 1974. The supplemental schedule is the responsibil~tyof the Plai-i's management. The supplemental schedi~lehas been subjected to the auditing procedures applied in the audits of the basic financial statements and, in OLIS opinion, is fairly stated in all material respects in relation to the basic financial statements talten as a whole.

Oaltland, California September 30, 201 1

1111 Broadway, Suite 1505 ' Ot~Liland, California 91607 ' (510) 250-1000 ' Fax (510) 250-1032

O f c r in Sna F ~ ( ~ n c t s c C'nlfirnia arid fze o,

Charlotte, A'orth Calolz?m

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN STATEMENTS OF NET ASSETS AVAILABLE FOR BENEFITS DECEMBER 3 1,20 10 AND 2009

Assets Investments, at fair value Mutual funds Investment contract with insurance company Contribution receivables Enlployer Participants Notes receivable from participants Other receivable Total assets Liabilities Excess contributions refundable Other Total liabilities Net assets reflecting investments at fair value Adjustnlent from fair value to contract value for fully benefit-responsive investment contracts Net assets available for benefits

The acconlpanying notes are an integral part of the financial statements. -2-

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN STATEMENTS OF CHANGES IN NET ASSETS AVALABLE FOR BENEFITS FOR THE YEARS ENDED DECEMBER 31,2010 AND 2009

Additions Investment income Net appreciation in fair value of investments Interest and dividends Contributions Employer Participants Interest income on notes receivable from participants Total additions Deductions Benefits paid to participants Administrative expenses Total deductions Net increase Transfer from other plans Net assets available for benefits Beginning of year End of year

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

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,20 10 and 2009 NOTE A - Description of the Plan The following description of the Kaiser Permanente Tax Sheltered Annuity Plan (the Plan) provides only general infornlation. Participants should refer to the Plan document for a Inore complete description of the Plan's provisions. General The Plan is a 403(b)(7) defined contribution plan sponsored by Kaiser Permanente, a taxexempt organization under Section 501(c) of the Internal Revenue Code (IRC). Participants Account 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 contribute from 1% to 75% of eligible compensation subject to the limits set by the IRC. The E~nployermakes contributions for certain enlployee groups as defined by the Plan document. Each participant is 100% vested in his or her Employee Contribution Account and his or her Employer Contribution Account vests as specified in the Plan. Notes Receivable from Participants A 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 all other Ernployer plans during the 12-month period prior to the new loan. The ten11 of the loan is limited to not more than 5 years, except for residential loan which may be extended up to 15 years. The interest rate is "Prime Rate" plus 1%. Loan repayments are tnade 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 occussence of the earlier of the participant's retirement, death, disability, termination of employment, upon attainment of 59% , or the participant's hardship, as defined by the Plan document.

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 and 2009 NOTE B - Siguificant Accounting Policies Basis of Accounting The accompanying financial statements are prepared on the accrual basis of accounting in accordance with U.S. generally accepted accounting principles (GAAP). New Accounting Pronouncement In January 201 0, Accounting Standard Update (ASU) 2010-06, Improving Disclosures about Fair Value Measzlrements, expanded the required disclosures 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; and 3) presentation of fair value disclosures by "nature and risk" class for all fair value assets and liabilities. The requirements of ASU 2010-06 are effective for the current reporting period except for the level 3 reconciliation disaggregation whicli 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 estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results may differ from those estimates. Investment Valuation and Income Recognition Investn~ents reported at fair value. Fair value is the price that would be received to sell an are asset or paid to transfer a liability in an orderly transaction between market participants at the measurement date (see Note D-Fair Value Measurements). Fully benefit-responsive irivestrnent conhacts held by a defined-contribution plan are required to be reported at fair value. However, contract value is the relevant measurement attribute for that portion of the net assets available for benefits of a defiried-contribution plan attributable to fully benefit-responsive investment contracts because coutract value is the amount participants would receive if they were to initiate perniitted transactions under the terms of the plan. The Statements of Net Assets Available for Benefits present the fair value of the investnient contracts from fair value to conhact value. The Statement of Changes in Net Assets Available for Benefits is prepared on a contract value basis. Purchases and sales of securities are recorded on a trade date basis. Net realized and Statement of Changes unrealized appreciatiori (depreciation) is recorded in the acco~npanying in Net Assets Available for Benefits as net appreciation (depreciation) in fair value of investments. Interest inconle is recorded on the accrual basis. Dividends are recorded on the ex-dividend date.

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 and 2009 NOTE B - Significant Accounting Policies (Continued) 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 the Plan document. Payment of Benefits Benefits are recorded when paid. Administrative Exuenses Certain investment funds charge transaction fees. These fees are deducted from participant accounts and are reflected in the accompanying financial statements as administrative expenses. Subsequent Event The Plan's financial statements have been evaluated for subsequent events or transactions for statements are potential recognition through September 30, 201 1, the date the fina~~cial available to be issued. Plau management determined that there are no subsequent events or transactions that require disclosure to or adjustment in the financial statements. Reclassification In September, 2010, ASU 2010-25, Reporting Loans to Participants by DeJined Contribution Pension Plans, clarified the classification and nieasure~nentof the participant loans by defined contribution plans. ASU 2010-25 provided that in defined contribution plans' financial statements, participant loans should be classified as notes receivable from participants, which are segregated from plan investmeuts and measured at their unpaid principal balance plus any accrued but unpaid interest. Plan management reclassified participant loans on the Statements of Net Assets Available for Benefits for all years present as notes receivable fro111 participants. The net assets of the Plan were not affected by the reclassification. As ASU 2010-25 applies only to financial statements prepared in accordance with GAAP, it will not affect the classification of notes receivable f?om participants on the Form 5500. Notes receivable from participants continue to be reported as investments on Fonn 5500, Schedule H, line Ic(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.

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 and 2009

NOTE B - Siguificant Accounting Policies (Continued) Reclassification (Continued) 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) 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 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 uotes 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 balauce 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 - Investments The following presents investments that represent 5% or Inore of the Plan's net assets as of December 31,2010 and 2009:

Mutual funds: Vanguard International Growth Fund Vanguard Lifestrategy Conservative Growth Fund Janus Advisory Forty Fund Vanguard Total Bond Market Index Fund Vanguard Total Stock Market Index Fund Vanguard Wellington Fund Invest~nent contract with insurance company at contract value For 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 and $3 15,714,796, respectively.

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 and 2009

NOTE D - Fair Value Measurements FASB ASC 820, Faiv Value Measuvements and Disclosures, establishes a fiamework for measuring fair value. That fiamework provides a fair value hierarchy that prioritizes the inputs to valuation techniques used to measure fair value. The liierarcliy 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 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 for 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 or liability; and Inputs that are derived principally from or con.oborated by observable market data by co~relation other means. or Level 3 Inputs to the valuation methodology are unobservable and significant to tlie fair value measnremeut. The asset's or liability's fair value measurement level within tlie fair value hierarchy is based on the lowest level of any input that is significant to tlle fair value measurement. Valuation techniques used need to maximize the use of observable inputs and minimize tlie use of unobse~vable inputs. Following is a description of the valuatio~imetliodologies used for investments measured at fair value. There have bee11 no changes in the metliodologies used as of December 3 1, 2010 and 2009. Mutual funds are valued at the net asset value of shares held by the Plan at year end. Investment contract with insurance company is reported at contract value. The methods described above may produce a fair value calculation tliat may not be indicative of net realizable value of reflective of future fair values. Furthermore, while the Plan believes its valuation methods are appropriate and consistent with other market participants, the use of different methodologies or assumptions to determine the fair value of certain financial instruments could result in a different fair value measurement at the reporting date.

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,20 10 and 2009

NOTE D - Fair Value Measurenlents (Continued) The following table sets forth the level, within the fair value hierarchy, the Plan's invest~nents at fair value as of December 3 1,20 10 and 2009:
Level 1 Muhlal funds Domestic stock futids Inrernntional/alabnl stock Bond fund Balanced filiids Other funds Investment contract with insurance conipany Inr~cstments,at fair value Investments at Fair Value a3 of Dccelnber 31,2010 Lcvcl 2 Level 3 Total

209,469,208 993,383,777 1,763,470 453,623,921

$ 2,227,741,133

209,469,268 993,383,777 1,763,470 453,623,921

453,623,921

$ 2,681,365,054

Level I Mutual filnds Dolncstic stack funds Intel-nationallglobal stock Bond fund Balanced funds Other funds Investment contract with insurance colnpany

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

Total

193,140,462 172,581,802 8 19,050,690 1,312,847 427,683,551

193,140,462 172,581,802 819,050,690 1,3 12,847 427,683,551

$ 2,260,647,283

Investments, at fair valuc

$ 1,832,963,732

427,683,551

NOTE E - Investme~lt Contract with Insurance Company The Plan holds a benefit-responsive investment contract with Metropolitan Life Insurance Company (MetLife). MetLife maintains the contributions in separate accounts. These accounts are credited with earnings on the underlying investments and charged for pasticipant withdrawals and adininistrative expenses. The guaranteed investment contract issuer is contractually obligated to repay the principal and a specified interest rate that is guaranteed to the Plan.

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 and 2009

NOTE E - Investment Coutract witli Insurance Company (Continued) As described in Note B, because tlie guaranteed investment contract is fully betiefitresponsive, contract value is the relevant measurement attribute for that portion of the net assets available for benefits attributable to the guaranteed investnieut contract. Contract value, as reported to tlie Plan by MetLife, represents contributions made under tlie contract, plus earnings, less participant withdrawals and administrative expenses. Participants may ordinarily direct the withdrawal or transfer of all or a portion of their investment at contract value. There are no reserves agaiust contract value for credit risk of the contract issuer or othe~wise. The crediting interest rate is based on a formula agreed upon with tlie issuer, but may not be less than 3.00%. Such interest rates are reset on an anuual basis. Certain events limit the ability of tlie Plan to transact at contract value with the issuer. Such events include the following: (1) amendments to the plan docun~ents (including cotnplete or partial plan termination or merger with another plan), (2) changes to plan's prohibition on competing investmeut options or deletion of equity wash provisions, (3) bankruptcy of the plan sponsor or other plan sponsor events (for example, divestitures or spin-offs of a subsidiary) that cause a significant withdrawal fiom the plan, or (4) the failure of the trust to qualify for exemption from federal income taxes or any required prohibited transaction exemption under Etnployee Retirement Income Security Act of 1974. The Plan administrator does not believe that the occui-rence of any such value event, which would limit the Plan's ability to transact at contract value witli pa~ticipants, probable. is The guaranteed investment contract does not permit the insurance cornpauy to terminate the agreement prior to the scheduled maturity date.

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

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 and 2009 NOTE E - Investment Contract with Insurance Company (Continued)

MetLife Separate Account No.

Major Credit Rating

Contract at Fair Value

Wrap Contract at Fair Value

Adjustment to Contract Value

Total 2009 MetLife Separate Account No. Major Credit Rating Investment Contract at Fair Value Wrap Contract at Fair Value Adjustment to Conkact Value

$ 425,468,581 $ 2,214,970 $ (14,818,351) Total The following represents reconciliation of adjustment from fair value to contract value for the years ended December 3 1,2010 and 2009:

Balance, beginning of year Decrease in adjustment from fair value to contract value Balance, end of year

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FTNANCIAL STATEMENTS DECEMBER 31,2010 and 2009 NOTE F - Transfer of Plan Assets The Investment Committee may authorize the trustees to accept (transfer in) or disburse as (transfer out) any assets from, or to, any qualified and tax-exempt t~usts requested by the participants. NOTE G - Plan Termination Although it has not expressed any intent to do so, the Employer has the right under the Plan to discontinue its contributions at any time and to terminate the Plan subject to the provisions of the Einployee Retirement Income Security Act of 1974, as amended. Should the Plan be terminated, tlie net assets are to be distributed to participants, the value of their adjusted accounts. NOTE H -Tax Status The Plan ad~ninistrator believes the Plan nieets the qualification requirements under Section 403(b), and is tax exempt under provisions of the Internal Revenue Code (the Code). The Plan administsator believes the Plan is designed and is currently being operated in conlpliance with the applicable requirements of the Code. NOTE I - Party-in-Interest Transactions Certain Plan investments are managed by Vanguard. Vanguard is the trustee. Vanguard also selves as tlie recordkeeper. Transactions with the tlustee and recordkeeper qualify as party-ininterest transactions. NOTE J - Risks and Uncertainties The Plan invests in various invest~nentsecurities. 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 term and that such changes could materially affect participants' account balances and the amounts reported in the statement of net assets available for benefits. NOTE K - Plan Obligations In accordance with GAAP, benefits due to terminated participants are included in net assets participants as of December available for benefits. There were no benefits due to te~ininated 31,2010 and 2009.

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN NOTES TO FINANCIAL STATEMENTS DECEMBER 3 1,2010 and 2009
NOTE L - Excess Contributions Refundable As of December 31, 2010 and 2009, liabilities of $0 and $52,348, respectively, are recorded for amounts refundable by the Plan to participants for contributions made in excess of amounts allowed by the Internal Revenue Service. NOTE M - Reconciliation of Financial Statements to Foiln 5500 The following is a reconciliation of net assets available for benefits per the financial statements to Form 5500 as of December 3 I, 20 10 and 2009:

Net assets available for benefits per the financial statements Adjustment from contract value to fair value for fully benefit-responsive investment colltracts Net assets available for benefits per Forin 5500

22,505,966 $2,732,223,050

14,818,351 $2,298,474,647

The following is a reconciliation of investment income per the financial statenlents to Form 5500 for the years ended December 3 1,2010 and 2009:

Investment income per the financial statements Change in adjustment from contract value to fair value for fully benefit-responsive investment contracts Investinent income per Form 5500

$ 257,043,562

$ 368,885,446

7,687,615

11,179,669

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN EIN 94-1340523 PLAN NO. 033 SCHEDULE H, LINE 4i - SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSES DECEMBER 31,2010

Identity of Issue, Borrower, Lessor, or Similar Party AllianceBerustein Global Research Growth Fund Janus Adviser Forty Fund, Class I T. Rowe Price Inte~llational Discovery Fund Alger Capital Appreciatiou Retirement Poitfolio : Vanguard Explorer Fund : Vatlguard FTSE Social Index Fund ' Vanguard International Growth Fund ' Vanguard LifeStrategy Conservative Growth Fund * Vanguard LifeStrategy Growtb Fund * Vanguard LifeStrategy Illcome Fund * Vauguard LifeStrategy Moderate Growth Fuud * Vanguard PRIMECAP Fund * Vanguard Total Bond Market Index Fuud * Vanyard Total Stock Market Index Fund V a n g u a r d Value Index Fund M a n g u a r d Welliugton Fund < MetLife Separate Accounts VGI Brokerage Option Total investments per financial statements Notes receivable from participants Total iuvest~nents Form 5500 per

Description of Iuvest~nent Iucludiug Maturity Date, Rate of Interest, Collateral, Par, or Maturity Value

Cost

Current Value
$

$ 12,612,125 Mutual fund 143,864,647 Mutual fuud 82,434,375 Mutual fund 27,123,084 Mutual h d 58,900,069 Mutual fund 6,329,520 Mutual fund 133,343,416 Mutual fuud 358,174,833 Mutual fiind 115,956,036 Mutual fund 28,204,192 Mutual fund 104,321,043 Mutual fnnd 103,635,855 Mutual fund 201,867,363 Mutual fund 245,928,926 Mutual fuud 84,352,385 Mutual fnnd 320,857,419 Mutual fund 431,117,955 Investnlent cotltract with insurance conlpany 1,753,435 Self-directed brokerage account

11,470,391 135,205,730 94,409,645 33,712,833 66,851,601 7,737,533 141,715,861 385,484,811 124,331,192 29,647,290 111,322,927 115,825,353 209,469,208 3 16,072,272 100,123,459 342,597,557 453,623.921

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

KAISER PERMANENTE TAX SHELTERED ANNUITY PLAN EIN 94-1340523 PLAN NO. 033 SCHEDULE H, LINE 4i - SCHEDULE OF ASSETS HELD FOR INVESTMENT PURPOSES DECEMBER 31,2010

Identity of Issue, Borsower, Lessor, or Similar Party AllianceBer~~stein Global Research Growth Fund Janus Adviser Forty Fund, Class I T. Rowe Price International Discovery Fund Alger Capital Appreciation Retirement Portfolio Vanguard Explorer Fund Vanguard FTSE Social Index Fund Va~lguard International Growth Fuud Vanguard LifeStrategy Conservative Growth Fund Vanguard LifeStrategy Growth Fund Vanguard LifeStrategy Incoine Fund Vatiguard LifeStrategy Moderate Growth Fund Vanguard PRIMECAP Fund Vanguard Total Bond Market Index Fund Vanguard Total Stock Market Index Fund Vanguard Value Index Fund Vanguard Welli~lgton Fund MetLife Separate Accouilts VGI Brokerage Option Total iuvest~nents fillancia1 statements per
:

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

Cost

Curreilt Value
$

$ 12,612,125 Mutual fund 143,864,647 Mutual fund 82,434,375 Mutual fund 27,123,084 Mutual fund 58,900,069 Mutual fund 6,329,520 Mutual fund 133,343,416 Mutual fund 358,174,833 Mutual fund 115,956,036 Mutual fund 28,204,192 Mutual fund 104,321,043 Mutual fund 103,635,855 Mutual h n d 201,867,363 Mutual fund 245,928,926 Mutual fund 84,352,385 Mutual fund 320,857,419 Mutual fund 431,117,955 Investment contract with insurance company 1,753,435 Self-directed brokerage account

11,470,391 135,205,730 94,409,645 33,712,833 66,85 1,601 7,737,533 141,715,861 385,484,811 124,331,192 29,647,290 111,322,927 115,825,353 209,469,208 3 16,072,272 100,123,459 342,597,557 453.623.921

Notes receivable

fi.0111 participants

Total iilvest~nents Form 5500 per

Iilvest~neiits pal-ties-in-interest as defi~ied in under ERISA.

SCHEDULER
(Form 5500)
Oeparfment of the ireasuly internal ~ e v e n sewice ~e E

I
~~ ~ ~i ~ ~~ ~ ~ ~

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 Internal Revenue Code (the Code).
t

OM5 No. 1210-0110

2010
This Form i s Open to Public inspection. 1213112010

oepanment 01 Labor ~senenis ~ security ~ I d

Pension Benefit Guaanly coipora,,on For calendar plan year 2010 or fiscal plan year beginning

) File as

an attachment t o Form 5500.

and ending

0110112010

Name of plan KAISER PERMANENTE TAX SHELTERED ANNUiTY PLAN

6 Three-digit
plan number (PN) 033

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

D Employer Identification Number (EIN)

94-1340523

Part 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 instruction

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 ElNs of the two payors who paid the greatest dollar amounts of benefits): EIN(s): 23-2186884

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

N ve
p~

3
~- - p ~

part II

Funding lnformation (If the plan is not subject to the minimum funding requirements of section of 412 of the Internal Revenue Code or ERISA section 302, skip this Part)
Yes No

4 5

is the plan administratarmding an election under Code section 412(d)(2) or ERiSAsection 302(d)(2)?...................... If the plan i s a defined benefit plan, go t o 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

0 NIA

Day

Year

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

a b
C

Enter the minimum required contribution for this plan year ................................................ Enter the amount contributed by the employer to the plan for this plan year 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 amoun

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

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

F
i] Yes
Yes No

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

0 NIA 0 NIA
No

No

Part Ill
9

Amendments

I Part lV
1

If this is a defined benefit oension olan, were anv amendments adoDted durina this.Dlan year that increased or dedreased the velue of benefits? If yes, chec'k the appropriate box(es), If no. check the '"No"box...................................................................................

0Increase Decrease

Both

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. Yes 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 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.) .............. . . .......................................................................................... .
12 Does the ESOP hold any stock that is not readily tradable on an established securities market? ......................................................
For Paperwork Reduction Act Notice and OMB Control Numbers, see the instructions for Form 5500.

0Yes 0 No
Yes
NO

fl

Yes

0 No

Schedule R (Form 5500) 2010 v.092308.1

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 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 an employer contribution during the current plan year to:

a The corresponding number for the plan year immediately preceding the current plan year ...............................

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 regarding supplemental information to be included as an attachment. .............................................................................................................

Part VI I Additional Information for Single-Employer 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 participants
and beneficiaries under two or more pension plans as of immediately before such plan year, check box and see instructions regarding supplemental information to be included as an attachment .................... .................................................................................................................................................... . .

19

If the total number of participants is 1,000 or more, complete items (a) through (c)

b
C

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

% Olhei:

O h

0 18-21 years 021 years or more

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

Other (specify):