Kaiser Permanente Southern California Region

[Pages:4]Kaiser Permanente Southern California Region

2018 Wildfire Disaster Assistance Program

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 recent 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 wildfires impacting Southern California. Requests for employees should be emailed to deborah.silverman@, H.R. Compliance at Walnut Center. Requests for physicians should be emailed to mary.j.vergara@, Permanente Total Compensation at Walnut Center. Employee and physician 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 November 30, 2018.

? 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 November 30, 2018. However, under extenuating circumstances, requests may be submitted no later than December 31, 2018.

? 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 November 30, 2018, 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 Financial Hardship Request Form (#2140) can be obtained by visiting: Employee forms are processed through local HR using existing procedures. Physicians may obtain forms from Permanente Total Compensation by calling 1-877-608-0044.

? 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 ? 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 Total Compensation at 1-877-608-0044.

SHORT TERM EMERGENCY SUPPORT Wildfire Assistance ? 2018 Holy Fire

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 Holy Fire of August 2018:

Food Clothes Temporary Shelter Other (please specify): ___________________________________________

Please attach applicable receipts if available.

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

Scan and Email Employee Request Forms to: deborah.silverman@, HR Compliance. Physicians may contact Permanente Human Resources Shared Services at 1-877-608-0044 to initiate a Short-

Term Emergency Support request.

EMERGENCY LOAN APPLICATION Kaiser Permanente Southern California

Wildfire Assistance ? 2018 Holy Fire

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

Scan and Email Employee Request Forms to: deborah.silverman@, HR Compliance. Physicians may contact Permanente Human Resources Shared Services at 1-877-608-0044 to initiate a Short-

Term Emergency Support request.

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