Memorandum Date:

November 17, 2008

From:

Benjamin K. Chu, MD, MPH, President, KFHP/H, Southern California, Jeffrey A. Weisz, MD, Executive Medical Director, SCPMG Walter Allen, Executive Director, OPEIU, Local 30 Coalition of Kaiser Permanente Unions

To:

Kaiser Permanente Southern California Employees and Physicians

Subject:

Southern California Wildfires Disaster Assistance

The fires that continue to spread across Southern California have affected many of our employees and physicians who are part of the Kaiser Permanente family. Some have lost homes, many have been evacuated from their neighborhoods, and others still face an uncertain future. That is why we are coming together during this time of need to offer several forms of emergency assistance for employees and physicians whose lives have been touched by this terrible disaster. Our hope is that these resources will offer individuals and families the help they need to cope with the difficulties and destruction these fires have created. Descriptions of the programs, along with application forms, are provided with this message. Please check in with the Inside KP Web portal—http://insidekp.kp.org/scal/—for additional information and resources that may become available. Thank you.

Kaiser Permanente Southern California Region Employee and Physician Bulletin November 17, 2008 Disaster Assistance Programs Development In partnership with our unions, Kaiser Permanente Southern California Region is offering several disaster relief programs to assist our employees and physicians affected by the November wildfires that have impacted the communities in which our employees reside. The following is a brief description of each program. Application forms are attached. •

Short Term Emergency Support provides small monetary grants (up to $500.00 net) for urgent and immediate needs such as food, clothing or temporary shelter. These monetary grants are available to any employee who was displaced from his or her primary residence for a minimum of 48 hours under a mandatory evacuation as a result of the severe fires impacting three counties in Southern California. Requests for employees should be faxed to: Jennifer Sangiacomo, Human Resources at Walnut Center 626-405-6247. Requests for physicians should be faxed to Marcia Norgauer, Permanente Benefits Administration at Walnut Center 626-405-6260. Employee checks will be coordinated by Payroll and paid out of the Medical Center Disbursement Accounts. This is reportable income that will be included in the year-end W-2 (or K-1 for partner physicians). Request forms are available in Hospital and Medical Group Administration, Human Resources, union leaders and senior manager offices. Requests for Short Term Emergency Support must be submitted by December 15, 2008.

•

Emergency Assistance Loans are available for employees and physicians who are awaiting other forms of emergency financial aid such as federal programs and insurance claims as a result of full or significant loss of their primary residence. Employees and physicians may apply for an interest-free loan of up to a maximum of $10,000 (the IRS permissible amount). Request forms are available in Hospital and Medical Group Administration, Human Resources, union leaders and senior manager offices. Employees will be required to sign a promissory note of repayment. Repayment will commence after 3 months of loan disbursement and will be handled over an 18-month period using payroll deductions. Requests for Emergency Assistance Loans should be submitted by December 31, 2008. However, under extenuating circumstances, requests may be submitted no later than February 1, 2009.

•

Financial Hardship Cash Outs of Vacation, Life Balance Days, and/or Earned Time Off Account Hours may be available for those who suffer sudden and unexpected loss of property due to these extraordinary and unforeseeable circumstances. Between now and December 31, 2008, requests as a result of the fire disaster will be taxed at the employee’s regular taxation rate, rather than the supplemental tax rate. This is a one-time exception for taxation as a result of this unique situation. The policy and forms for employees can be obtained from Human Resources consultants or through the HR Web site at: http://myhrprd.kp.org/myhr/kp_me/. Click on Find a Form, log on to My HR and select the Financial Hardship Request Form #2140. Employee forms are processed through local HR using existing procedures. Physicians may obtain forms from their Area Payroll coordinator’s office or Permanente Benefits and Retirement Plans.

•

Retirement Plan Withdrawals: Employees who meet eligibility requirements may withdraw a portion of their Kaiser Permanente 401k Plan, Tax Savings Retirement, or Supplemental Retirement Plan - Plan B. Employees should contact Vanguard at 1-800-523-1188 to obtain withdrawal and/or loan information. Hardship withdrawals require documentation. Withdrawals may be subject to taxes and penalties. Employees should consider contacting a financial advisor or a tax professional regarding the tax and retirement implications of distributions from their plans. Physicians, under the age of 59 ½ may be eligible for a hardship withdrawal from the TSR Plan as defined by the IRS. Hardship withdrawals require documentation and are subject to ordinary income tax as well as early withdrawal penalty. Physicians should consider contacting a financial advisor or a tax professional regarding the tax and retirement implications of distributions from their plans. Physicians should contact Permanente Benefits and Retirement Plans at tie line 8-335-2654 or 626-405-2654.

SHORT TERM EMERGENCY SUPPORT Fire Disaster – November 2008

Name: ________________________________________ Date: ____________________ SS#: ________________________ Employee/Physician #: _______________________ Department: ______________________ Work Location: _____________________

Amount Requested: $________________ (Up to $500.00 Net)

This is to certify that I have an immediate need for the following due to the Fire Disasters of November 2008:

† Food † Clothes † Temporary Shelter † Other (please specify): ___________________________________________

I prefer to pick up the check at (check one):

† Local Human Resources Office † Local Business Office † Local Associate Medical Director Office ( Physicians Only) † Other (please specify): ___________________________________________

I prefer to have the check mailed to this address: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ __________________________________________________________ Signature

_____________ Date

Fax Employee Request Forms to: Jennifer Sangiacomo, Human Resources at 626-405-6247 Fax Physician Request Forms to: Marcia Norgauer, Permanente Benefits at 626-405-6260

EMERGENCY LOAN APPLICATION Kaiser Permanente Southern California (Fire Disaster – November 2008) Name: _____________________________________ Date: ___________________ SS#: ______________________ Employee/Physician #: _______________________ Cost Center:____________________ Department: _______________________________ Work Location: ___________________________

Amount of Loss (if known): $________________________ Loan Amount Requested (to a maximum of $10,000): $________________ Nature of Loss: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________________ Pending insurance or emergency assistance claims filed with city, state, federal or insurance agencies. (Please attach copies of application): ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ________________________________________________________ If approved, I prefer to sign loan agreement and pick up check at (check one): ____ Local Human Resource Office ____ Local associate area medical director office (physicians only) ____ Other (please specify):

Signature

Date

Fax Employee Request Forms to: Jennifer Sangiacomo, Human Resources at 626-405-6247 Fax Physician Request Forms to: Marcia Norgauer, Permanente Benefits at 626-405-6260