Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

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 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2019
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) ATLANTA BELTLINE PARTNERSHIP INC
112 KROG ST NE STE 14
ATLANTA,GA30307 		56-2464486 501(c)(3) 52,500       Sponsorships
(2) ATLANTA COMMUNITY FOOD BANK INC
732 JOSEPH E LOWERY BLVD NW
ATLANTA,GA30318 		58-1376658 501(c)(3) 200,000       PROJECT SUPPORT
(3) Atlanta Neighborhood Dev't Partnership
229 Peachtree St 706
Atlanta,GA30303 		58-1946632 501(c)(3) 250,000       PROJECT SUPPORT
(4) ATLANTA VOLUNTEER LAWYERS FOUNDATION
235 PEACHTREE ST NE 1750
ATLANTA,GA30303 		58-1364400 501(c)(3) 72,250       PROJECT SUPPORT
(5) CHRIS 180 INC
1017 FAYETTEVILLE ROAD SE
ATLANTA,GA30316 		58-1430183 501(c)(3) 250,000       PROJECT SUPPORT
(6) CRISTO REY ATLANTA JESUIT HIGH SCHOOL
680 W PEACHTREE ST NW
ATLANTA,GA30308 		45-5550340 501(c)(3) 35,000       PROJECT SUPPORT
(7) EARTHSHARE OF GEORGIA
100 PEACHTREE ST NW 1960
ATLANTA,GA30303 		58-2022001 501(c)(3) 27,000       Sponsorships
(8) FERNBANK MUSEUM OF NATURAL HISTORY
767 CLIFTON RD NE
ATLANTA,GA30307 		58-6028607 501(c)(3) 9,000       Sponsorships
(9) FIRST STEP STAFFING
236 AUBURN AVE NE 203
ATLANTA,GA30303 		20-8038859 501(c)(3) 45,000       PROJECT SUPPORT
(10) GEORGIA CAMPAIGN FOR ADOLESCENT POWER
1718 PEACHTREE ST NW 465
ATLANTA,GA30309 		31-1520709 501(c)(3) 80,750       PROJECT SUPPORT
(11) GEORGIA HEALTH NEWS
2635 RANGEWOOD CT
ATLANTA,GA30345 		27-3543332 501(c)(3) 17,100       PROJECT SUPPORT
(12) GEORGIA ORGANICS INC
200 OTTLEY DR NE STE A
ATLANTA,GA30324 		58-2345310 501(c)(3) 63,750       PROJECT SUPPORT
(13) GEORGIA STATE UNIVERSITY
PO Box 3999
Atlanta,GA30302 		58-6002050 Government 26,106       Research
(14) GEORGIA WATCH
55 MARIETTA ST NW 903
ATLANTA,GA30303 		16-1639971 501(c)(3) 22,500       PROJECT SUPPORT
(15) GROVE PARK FOUNDATION INC
1562 DONALD LEE HOLLOWELL PKWY NW
ATLANTA,GA30318 		82-1913260 501(c)(3) 350,000       PROJECT SUPPORT
(16) HERITAGE FUND OF ATLANTA MEDICAL ASSOC
PO BOX 4421
ATLANTA,GA30302 		58-2372394 501(c)(3) 10,000       Sponsorships
(17) INITIATIVE FOR AFFORDABLE HOUSING INC
PO BOX 885
SCOTTDALE,GA30079 		58-1932474 501(c)(3) 20,000       PROJECT SUPPORT
(18) ITS THE JOURNEY INC
270 CARPENTER DR 515
ATLANTA,GA30328 		47-0897591 501(c)(3) 40,000       Sponsorships
(19) JDRF INTERNATIONAL
1333 HOWE AVE ST 133
SACRAMENTO,CA95825 		23-1907729 501(c)(3) 7,500       Sponsorships
(20) LATIN AMERICAN ASSOCIATION INC
2750 BUFORD HIGHWAY
ATLANTA,GA30324 		58-1237316 501(c)(3) 7,750       Sponsorships
(21) LEADERSHIP DEKALB INC
315 W PONCE DE LEON AVE 550
DECATUR,GA30030 		58-2131661 501(c)(3) 7,500       Sponsorships
(22) LEUKEMIA & LYMPHOMA SOCIETY INC
3 INTERNATIONAL DR 200
RYE BROOK,NY10573 		13-5644916 501(c)(3) 15,000       Sponsorships
(23) PIEDMONT PARK CONSERVANCY INC
PO BOX 7795
ATLANTA,GA30357 		58-1551369 501(c)(3) 75,000       Sponsorships
(24) ROBERT W WOODRUFF ART CENTER INC
1280 PEACHTREE ST NE
ATLANTA,GA30309 		58-0633971 501(c)(3) 99,000       PROJECT SUPPORT
(25) SENIOR CITIZEN SERVICES
1705 COMMERCE DR NW
ATLANTA,GA30318 		58-0960309 501(c)(3) 36,000       PROJECT SUPPORT
(26) SHELTERING ARMS
385 CENTENNIAL OLYMPIC PARK DR
ATLANTA,GA30313 		58-0566236 501(c)(3) 63,750       PROJECT SUPPORT
(27) THE CHILDREN'S MUSEUM OF ATLANTA
275 CENTENNIAL OLYMPIC PK DR NW
ATLANTA,GA30313 		58-1785484 501(c)(3) 72,250       PROJECT SUPPORT
(28) THE KING CENTER
449 AUBURN AVE NE
ATLANTA,GA30312 		58-1030989 501(c)(3) 14,950       Sponsorships
(29) TREES ATLANTA INC
225 CHESTER AVE
ATLANTA,GA30316 		58-1584758 501(c)(3) 45,000       PROJECT SUPPORT
(30) UNITED WAY OF GREATER ATLANTA
40 COURTLAND ST NE 300
ATLANTA,GA30303 		58-0566194 501(c)(3) 255,000       PROJECT SUPPORT
(31) YEAR UP INC
730 PEACHTREE ST STE 900
ATLANTA,GA30308 		04-3534407 501(c)(3) 45,000       PROJECT SUPPORT
(32) YMCA OF METROPOLITAN ATLANTA
569 MLK JR DRIVE
ATLANTA,GA30314 		58-0666253 501(c)(3) 255,000       PROJECT SUPPORT
(33) YWCA OF GREATER ATLANTA
957 N HIGHLAND AVE NE
ATLANTA,GA30306 		58-0593442 501(c)(3) 75,000       Sponsorships
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
33
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) 2019
Page 2

Schedule I (Form 990) 2019
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 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) 2019



Additional Data


Software ID:  
Software Version: