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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
2020
Open to Public
Inspection
Name of the organization
MARTIN LUTHER KING JR-LOS ANGELES
HEALTHCARE CORPORATION
Employer identification number
27-4658935
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) MARTIN LUTHER KING JR COMMUNITY HEALTH FOUNDATION
2251 WEST ROSECRANS AVENUE SUITE 18
18
COMPTON,CA90222 		81-2455970 501(C)(3) 2,208,019       FORGIVENESS OF "DUE TO" MLKHC ACCUMULATED FOR OPERATIONS
(2) CALIFORNIA HEALTH FOUNDATION AND TRUST
1215 K STREET SUITE 800
SACRAMENTO,CA95814 		94-1498697 501(C)(3) 105,490       PLEDGE TO HOSPITAL FEE PROGRAM TO AGGREGATE AND DISTRIBUTE FINANCIAL RESOURCES TO SUPPORT CHARITABLE ACTIVITES AT VARIOUS INDEPENDENT HOSPITALS
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
2
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020
Page 2

Schedule I (Form 990) 2020
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
PART I, LINE 2: DURING THE JUNE 30, 2021 FISCAL YEAR, THE ORGANIZATION RELIEVED THE INTERCOMPANY PAYABLE ACCOUNTS OWED TO THE ORGANIZATION OF BOTH MARTIN LUTHER KING JR. COMMUNITY HEALTH FOUNDATION. THIS AMOUNT OF DEBT FORGIVENESS, WHICH HAS BEEN TREATED AS A GRANT FOR PURPOSES OF THIS RETURN, IS BASED OFF ACCRUED EXPENSES IN THE BOOKS AND RECORDS OF BOTH ORGANIZATIONS, AND IS MONITORED BY OVERLAPPING GOVERNANCE OF ALL 3 ORGANIZATIONS. ADDITIONALLY, THE ORGANIZATION PROVIDED THE CALIFORNIA HEALTH FOUNDATION AND TRUST, AN UNRELATED PUBLIC BENEFIT CHARITY ESTABLISHED TO SPONSOR AND SUPPORT HEALTH CARE, WITH AN UNCONDITIONAL GRANT WHICH REQUIRED NO MONITORING OF THE USE OF GRANT FUNDS.
Schedule I (Form 990) 2020



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