Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF GEORGIAINC
 
Employer identification number
58-1592076
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC section
(if applicable)
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
noncash assistance
(h) Purpose of grant
or assistance
(1) Achieve Altanta Inc
191 Peachtree St
Atlanta,GA30303
47-2670990 501(c)(3) 400,000       Project Support
(2) Agape Youth & Family Ctr
2353 Bolton Rd Ste 100
Atlanta,GA30318
58-2372950 501(c)(3) 30,000       Project Support
(3) Amer Heart Assn
1101 Nchase Pkwy Ste 1
Marietta,GA30067
13-5613797 501(c)(3) 13,000       Event Support\Annual Fundraiser
(4) Atlanta Community Food Bank
732 Joseph E Blvd NW
Atlanta,GA30318
58-1376648 501(c)(3) 75,000       Project Support
(5) Atlanta Music Project
1280 Peachtree St NE
Atlanta,GA30309
80-0557088 501(c)(3) 30,000       Project Support
(6) Atlanta Volunteer Lawyers Fdn Inc
235 Peachtree St
Atlanta,GA30303
58-1364400 501(c)(3) 85,000       Project Support
(7) Atlanta Women's Fdn
3355 Lenox Rd Ste 850
Atlanta,GA30326
58-2389721 501(c)(3) 123,500       Project Support
(8) Back on My Feet
PO Box 160164
Atlanta,GA30316
26-2109809 501(c)(3) 35,000       Project Support
(9) Bethesda Community Clinic
111 Mountain Brook Drv
Canton,GA30115
27-4923001 501(c)(3) 29,661       Project Support
(10) Big Brothers Big Sisters Of Metro Atlanta
1382 Peachtree St NE
Atlanta,GA30309
58-0861895 501(c)(3) 25,000       Project Support
(11) Camp Kudzu
5885 Glenridge Dr 160
Atlanta,GA30328
58-2449646 501(c)(3) 20,000       Project Support
(12) Care & Counseling Ctr of Georgia Inc
1814 Clairmont Rd
Decatur,GA30033
58-0899552 501(c)(3) 30,000       Project Support
(13) Catholic Charities Of The Archdiocese Of AT
2401 Lake Park Drive SE
Smyrna,GA30080
58-1097003 501(c)(3) 78,500       Event Support\Annual Fundraiser
(14) Chattahoochee Nature Ctr
9135 Willeo Rd
Roswell,GA30075
58-1275604 501(c)(3) 30,000       Project Support
(15) Children's Museum of Atlanta
275 Centennial Drv NW
Atlanta,GA30313
58-1785484 501(c)(3) 60,000       Project Support
(16) CHRIS Kids Inc
1017 Fayetteville Rd
Atlanta,GA30316
58-1430183 501(c)(3) 75,000       Project Support
(17) Clayton State Uni Fdn
2000 Clayton State Blvd
Morrow,GA30260
23-7419285 501(c)(3) 85,000       Scholarship Support
(18) Cobb County Board of Hlth
1650 Cty Services Pkwy
Marietta,GA30008
58-1517015 Government or P 50,000       Project Support
(19) Community Advanced Practice Nurses
173 Blvd NE
Atlanta,GA30312
58-2435328 501(c)(3) 50,000       Project Support
(20) Covenant House Georgia Inc
1559 Johnson Rd NW
Atlanta,GA30318
13-3523561 501(c)(3) 30,000       Project Support
(21) Ctr for Pan Asian Community Svcs
3510 Shallowford Rd NE
Atlanta,GA30341
58-1437980 501(c)(3) 25,000       Project Support
(22) DeKalb County Board of Hlth
445 Winn Way
Decatur,GA30030
58-1417092 Government or P 40,000       Project Support
(23) Diabetes Assn of Atlanta
100 Edgewood Ave
Atlanta,GA30303
58-0973055 501(c)(3) 50,000       Project Support
(24) Families First
80 Lowery Blvd
Atlanta,GA30314
58-1054331 501(c)(3) 74,150       Project Support
(25) Fdn Of Wesley Woods
1817 Clifton Rd NE
Atlanta,GA30329
58-1543164 501(c)(3) 50,000       Project Support
(26) Fernbank Inc
767 Clifton Rd NE
Atlanta,GA30307
58-6028607 501(c)(3) 54,100       Project Support
(27) First Step Staffing
236 Auburn Ave Ste 203
Atlanta,GA30303
20-8038859 501(c)(3) 85,000       Project Support
(28) GCAPP
1718 Peachtree St
Atlanta,GA30309
31-1520709 501(c)(3) 95,000       Project Support
(29) Georgia Conservancy
230 Peachtree St
Atlanta,GA30303
58-1027246 501(c)(3) 7,250       Event Support\Annual Fundraiser
(30) Georgia Family Connection Ptr
235 Peachtree St Ste 1600
Atlanta,GA30303
58-1888262 501(c)(3) 40,000       Project Support
(31) Georgia Gwinnett College Fdn Inc
1000 Uni Ctr Ln
Lawrenceville,GA30043
20-5107997 501(c)(3) 45,000       Scholarship Support
(32) Georgia Hlth News
2635 Rangewood Court
Atlanta,GA30345
27-3543332 501(c)(3) 19,000       Project Support
(33) Georgia Organics
200 Ottley Drv NE Ste A
Atlanta,GA30324
58-2345310 501(c)(3) 75,000       Project Support
(34) Georgia State Uni Fdn
140 Decatur St
Atlanta,GA30302
58-6033185 501(c)(3) 95,000       Scholarship Support
(35) Georgia Watch
55 Marietta St
Atlanta,GA30303
16-1639971 501(c)(3) 25,000       Project Support
(36) Girl Scouts of Greater Atlanta
5601 N Allen Rd
Mableton,GA30126
58-0566190 501(c)(3) 50,000       Project Support
(37) Good News Clinics
810 Pine St
Gainesville,GA30501
58-2058853 501(c)(3) 50,000       Project Support
(38) Good Samaritan Hlth & Wellness Ctr
175 Samaritan Drv
Jasper,GA30143
58-2576315 501(c)(3) 45,000       Project Support
(39) Good Samaritan Hlth Ctr
1015 Donald Lee Hl Pkwy
Atlanta,GA30318
58-2373395 501(c)(3) 50,000       Project Support
(40) Good Samaritan Hlth Ctr of Cobb
1605 Roberta Drv
Marietta,GA30008
32-0045238 501(c)(3) 50,000       Project Support
(41) Good Shepherd Clinic
6392 Murphy Drv
Morrow,GA30260
58-2578581 501(c)(3) 30,000       Project Support
(42) Gwinnett Tech Fdn
5150 Sugarloaf Pkwy
Lawrenceville,GA30043
58-2106879 501(c)(3) 35,000       Scholarship Support
(43) H&s of Hope Clinic
1010 Hospital Dr
Stockbridge,GA30281
42-1591970 501(c)(3) 50,000       Project Support
(44) HABESHA
477 Windsor St
Atlanta,GA30312
02-0536428 501(c)(3) 30,000       Project Support
(45) Heritage Fund of Atlanta Medical Assn
100 Edgewood Ave
Atlanta,GA30303
58-2372394 501(c)(3) 10,000       Event Support\Awards Ceremony
(46) Hillside
690 Courtenay Dr NE
Atlanta,GA30306
58-0603148 501(c)(3) 40,000       Project Support
(47) Hlth Edu Assessment & Leadership
2600 MLK Jr Blvd
Atlanta,GA30311
26-3990559 501(c)(3) 50,000       Project Support
(48) Hosea Feed the Hungry & Homeless
1035 Donnelly Ave SW
Atlanta,GA30310
58-1340903 501(c)(3) 50,000       Project Support
(49) International Rescue Committee
2305 Parklake Drv NE
Atlanta,GA30345
13-5660870 501(c)(3) 35,000       Project Support
(50) It's The Journey
270 Carpenter Dr Ste 515
Atlanta,GA30328
47-0897591 501(c)(3) 32,500       Event Support\Annual Fundraiser
(51) Jerusalem House
17 Executive Park Drv
Atlanta,GA30329
58-1829807 501(c)(3) 65,000       Project Support
(52) Jewish Family & Career Svcs Inc
4549 Chamblee Dunwoody Rd
Atlanta,GA30338
58-1479212 501(c)(3) 30,000       Project Support
(53) Junior Achievement of Georgia
460 Abernathy Rd NE
Atlanta,GA30328
58-0598050 501(c)(3) 20,000       Project Support
(54) Kennesaw State Uni Fdn
1000 Chastain Rd
Kennesaw,GA30066
23-7034345 501(c)(3) 80,000       Scholarship Support
(55) Life Tools Community Dvlmpt Corporation
5357 Chapel Hill Rd
Douglasville,GA30135
27-0070164 501(c)(3) 15,000       Project Support
(56) Lutheran Svcs Of Georgia Inc
230 Peachtree St
Atlanta,GA30303
58-1535692 501(c)(3) 20,000       Project Support
(57) MACVC-Metro Atlanta Corporate Vlt Council
1100 Peachtree St
Atlanta,GA30309
58-2054790 501(c)(3) 9,800       Event Support\Awards Ceremony
(58) Mary Hall Freedom House Inc
200 Hannover Park
Sandy Springs,GA30350
58-2238354 501(c)(3) 30,000       Project Support
(59) McIntosh Trail Community Svc Board
1435 N Expressway
Griffin,GA30224
58-2098758 Government or P 40,000       Project Support
(60) Mercy Hlth Ctr Inc
700 Oglethorpe Ave C7
Athens,GA30606
58-2603523 501(c)(3) 25,000       Project Support
(61) MLK Jr Ctr for Nonviolent Social Change
449 Auburn Ave
Atlanta,GA30212
58-1030989 501(c)(3) 27,000       Event Support\Awards Ceremony
(62) Moving in the Spirit
750 Glenwood Ave SE
Atlanta,GA30316
58-2207431 501(c)(3) 30,000       Project Support
(63) MUST Ministries
1407 Cobb Pkwy N
Marietta,GA30061
58-2034725 501(c)(3) 30,000       Project Support
(64) National Black Arts Festival
235 Peachtree St
Atlanta,GA30303
58-1736780 501(c)(3) 50,000       Project Support
(65) Oakhurst Medical Ctrs
5582 Memorial Dr
Stone Mountain,GA30083
58-1413957 501(c)(3) 50,000       Project Support
(66) Odyssey Family Counseling Ctr Corporation
1919 John Wesley Ave
College Park,GA30337
58-1295404 501(c)(3) 30,000       Project Support
(67) Palmetto Hlth Council
643 Main St
Palmetto,GA30268
58-1307597 501(c)(3) 50,000       Project Support
(68) Park Pride Atlanta
233 Peachtree St
Atlanta,GA30303
58-1883895 501(c)(3) 48,300       Project Support
(69) Pedestrians Educating Drivers on Safety
1389 Peachtree St
Atlanta,GA30309
58-2267503 501(c)(3) 30,000       Project Support
(70) Piedmont Park Conservancy
400 Park Drv
Atlanta,GA30306
58-1551369 501(c)(3) 94,300       Project Support
(71) Playworks Edu Energized Georgia
PO Box 7040
Atlanta,GA30357
94-3251867 501(c)(3) 60,000       Project Support
(72) Positive Impact Hlth Ctrs
3075 Breckinridge Blvd
Duluth,GA30096
58-1763324 501(c)(3) 75,000       Project Support
(73) Project Interconnections
2198 Dresden Drv
Chamblee,GA30341
58-1899845 501(c)(3) 70,000       Project Support
(74) Project Open H&-Atlanta
181 Armour Drv NE
Atlanta,GA30324
58-1816778 501(c)(3) 85,000       Project Support
(75) Ptr Against Domestic Violence
PO Box 170225
Atlanta,GA30317
58-1314556 501(c)(3) 50,000       Project Support
(76) Robert W Woodruff Arts Ctr
1280 Peachtree St NE
Atlanta,GA30309
58-0633971 501(c)(3) 99,000       Project Support
(77) Saint Joseph's Mercy Care Svcs
424 Decatur St SE
Atlanta,GA30312
58-1752700 501(c)(3) 50,000       Project Support
(78) Senior Citizen Svcs of Metropolitan AT
1705 Commerce Drv NW
Atlanta,GA30318
58-0960309 501(c)(3) 50,000       Project Support
(79) Spelman College
350 Spelman Ln
Atlanta,GA30314
58-0566243 501(c)(3) 10,000       Project Support
(80) The Clayton Cty Juvenille Justice Fund
1408 Slake Plaza Drv
Morrow,GA30260
26-3202598 501(c)(3) 40,000       Project Support
(81) The Community Fdn for Greater Atlanta
50 Hurt Plaza SE Ste 449
Atlanta,GA30303
58-1344646 501(c)(3) 900,000       Project Support
(82) The Corporation of Mercer Uni
3001 Mercer Uni Drv
Atlanta,GA30341
58-0566167 501(c)(3) 45,000       Scholarship Support
(83) The Ctr for Black Women's Wellness CBWW
477 Windsor St SW
Atlanta,GA30312
58-2212203 501(c)(3) 50,000       Project Support
(84) The Ctr for Working Families
477 Windsor St Ste 101
Atlanta,GA30312
27-0230104 501(c)(3) 30,000       Project Support
(85) The Environmental Fund for Georgia
100 Peachtree St NW
Atlanta,GA30303
58-2022001 501(c)(3) 87,000       Project Support
(86) The Henry W Grady Hlth System Fdn
191 Peachtree St Ste 820
Atlanta,GA30303
58-2130437 501(c)(3) 13,500       Event Support\Annual Fundraiser
(87) The Hlth Initiative
1530 DeKalb Ave NE
Atlanta,GA30307
58-2271500 501(c)(3) 35,000       Project Support
(88) The Morehouse School Of Medicine
720 Wview Drv SW
Atlanta,GA30310
58-1438873 501(c)(3) 500,000       Project Support;Scholarship Support
(89) The Sheltering Arms
385 Centennial Park Drv
Atlanta,GA30313
58-0566236 501(c)(3) 85,000       Project Support
(90) Trees Atlanta
225 Chester Ave
Atlanta,GA30316
58-1584758 501(c)(3) 49,650       Project Support
(91) Uni of Georgia Fdn
394 S Milledge Ave
Athens,GA30602
58-6033837 501(c)(3) 45,000       Scholarship Support
(92) Uni of West Georgia Fdn
1601 Maple St
Carrollton,GA30118
58-6056464 501(c)(3) 80,000       Scholarship Support
(93) United Negro College Fund
229 Peachtree St
Atlanta,GA30303
13-1624241 501(c)(3) 5,750       Event Support\Annual Fundraiser
(94) United Way of Greater Atlanta
100 Edgewood Ave NE
Atlanta,GA30303
58-0566194 501(c)(3) 400,000       Project Support
(95) View Point Hlth
175 Gwinnett Drv
Lawrenceville,GA30046
58-2103187 Government or P 40,000       Project Support
(96) Voices for Georgia's Children
100 Edgewood Ave NE
Atlanta,GA30303
02-0678823 501(c)(3) 40,000       Project Support
(97) Wellspring Living
860 Johnson Ferry Rd
Atlanta,GA30342
58-2614182 501(c)(3) 30,000       Project Support
(98) Wholesome Wave Georgia Incorporated
1070 Colquitt Ave
Atlanta,GA30307
45-4816906 501(c)(3) 25,000       Project Support
(99) Year Up
730 Peachtree St
Atlanta,GA30308
04-3534407 501(c)(3) 65,000       Project Support
(100) YMCA of Metropolitan Atlanta
100 Edgewood Ave NE
Atlanta,GA30303
58-0566253 501(c)(3) 350,000       Capital Fund Support;Project Support
(101) Young Women Christian Assn of Greater AT
957 N Highland Ave
Atlanta,GA30306
58-0593442 501(c)(3) 89,550       Event Support\Annual Fundraiser
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
101
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2017
Page 2

Schedule I (Form 990) 2017
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients
(c) Amount of
cash grant
(d) Amount of
noncash assistance
(e) Method of valuation (book,
FMV, appraisal, other)
(f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
SCHEDULE I, PART I, LINE 2 PROCEDURES FOR MONITORING THE USE OF GRANTS Y At the end of their funding cycle, grantees are required to submit a final report which delineates accomplishments related to stated objectives. Large grants (typically over $100K) may require quarterly progress reports.
Schedule I (Form 990) 2017



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