LD-2 Disclosure Form

Clerk of the House of Representatives
Legislative Resource Center
135 Cannon Building
Washington, DC 20515
http://lobbyingdisclosure.house.gov

Secretary of the Senate
Office of Public Records
232 Hart Building
Washington, DC 20510
http://www.senate.gov/lobby

LOBBYING REPORT

Lobbying Disclosure Act of 1995 (Section 5) - All Filers Are Required to Complete This Page

1. Registrant Name Organization/Lobbying Firm Self Employed Individual

KAISER FOUNDATION HEALTH PLAN INC.

2. Address

Address1

ONE KAISER PLAZA, ORDWAY BLDG.

Address2

27th FLOOR

City

OAKLAND

State

Zip Code

94612

Country

USA

3. Principal place of business (if different than line 2)

City

State

Zip Code

Country

4a. Contact Name		b. Telephone Number	c. E-mail
Mr.	Anthony Barrueta	5102716835	anthony.barrueta@kp.org

5. Senate ID#

21027-12

7. Client Name	Self	Check if client is a state or local government or instrumentality
KAISER FOUNDATION HEALTH PLAN INC.

6. House ID#

300780000

TYPE OF REPORT

8. Year

2021

Q1 (1/1 - 3/31)

Q2 (4/1 - 6/30)

Q3 (7/1 - 9/30)

Q4 (10/1 - 12/31)

9. Check if this filing amends a previously filed version of this report

10. Check if this is a Termination Report

Termination Date

11. No Lobbying Issue Activity

INCOME OR EXPENSES - YOU MUST complete either Line 12 or Line 13

12. Lobbying

13. Organizations

INCOME relating to lobbying activities for this reporting period was:

EXPENSE relating to lobbying activities for this reporting period were:

Less than $5,000

$5,000 or more

2,050,000.00

Provide a good faith estimate, rounded to the nearest $10,000, of all lobbying related income for the client (including all payments to the registrant by any other entity for lobbying activities on behalf of the client).

14. REPORTING Check box to indicate expense accounting method. See instructions for description of options.

Method A. Reporting amounts using LDA definitions only

Method B. Reporting amounts under section 6033(b)(8) of the Internal Revenue Code

Method C. Reporting amounts under section 162(e) of the Internal Revenue Code

Signature

Digitally Signed By: Anthony Barrueta

Date

5/19/2021 7:39:31 PM

LOBBYING ACTIVITY. Select as many codes as necessary to reflect the general issue areas in which the registrant engaged in lobbying on behalf of the client during the reporting period. Using a separate page for each code, provide information as requested. Add additional page(s) as needed.

15. General issue area code HCR

16. Specific lobbying issues

17. House(s) of Congress and Federal agencies Check if None

18. Name of each individual who acted as a lobbyist in this issue area

First Name	Last Name	Suffix	Covered Official Position (if applicable)	New
Laird	Burnett
Fish	Brown
Mary Prudence	Fitzpatrick
David	Bennett

19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None

15. General issue area code MMM

16. Specific lobbying issues

17. House(s) of Congress and Federal agencies Check if None

18. Name of each individual who acted as a lobbyist in this issue area

First Name	Last Name	Suffix	Covered Official Position (if applicable)	New
Laird	Burnett
Fish	Brown
Mary Prudence	Fitzpatrick
David	Bennett

19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None

15. General issue area code TAX

16. Specific lobbying issues

17. House(s) of Congress and Federal agencies Check if None

18. Name of each individual who acted as a lobbyist in this issue area

First Name	Last Name	Suffix	Covered Official Position (if applicable)	New
Laird	Burnett
Fish	Brown
Mary Prudence	Fitzpatrick
David	Bennett

19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None

15. General issue area code DEF

16. Specific lobbying issues

17. House(s) of Congress and Federal agencies Check if None

18. Name of each individual who acted as a lobbyist in this issue area

First Name	Last Name	Suffix	Covered Official Position (if applicable)	New
Laird	Burnett
Fish	Brown
Mary Prudence	Fitzpatrick
David	Bennett

19. Interest of each foreign entity in the specific issues listed on line 16 above Check if None

Information Update Page - Complete ONLY where registration information has changed.

20. Client new address

Address
City		State		Zip Code		Country

21. Client new principal place of business (if different than line 20)

City

State

Zip Code

Country

22. New General description of client’s business or activities

LOBBYIST UPDATE

23. Name of each previously reported individual who is no longer expected to act as a lobbyist for the client

First Name

Last Name

Suffix

First Name

Last Name

Suffix

ISSUE UPDATE

24. General lobbying issue that no longer pertains

AFFILIATED ORGANIZATIONS

25. Add the following affiliated organization(s)

Internet Address:

Name

Address

Principal Place of Business
(city and state or country)

Street Address
City	State/Province	Zip	Country

City
State	Country

26. Name of each previously reported organization that is no longer affiliated with the registrant or client

FOREIGN ENTITIES

27. Add the following foreign entities:

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership percentage in client

Street Address
City	State/Province	Country

City
State	Country

28. Name of each previously reported foreign entity that no longer owns, or controls, or is affiliated with the registrant, client or affiliated organization

1	3	5
2	4	6

CONVICTIONS DISCLOSURE

29. Have any of the lobbyists listed on this report been convicted in a Federal or State Court of an offense involving bribery, extortion, embezzlement, an illegal kickback, tax evasion, fraud, a conflict of interest, making a false statement, perjury, or money laundering?
No Yes

Lobbyist Name

Description of Offense(s)