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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
2023
Open to Public
Inspection
Name of the organization
KAISER FOUNDATION HEALTH PLAN OF THE
MID-ATLANTIC STATES INC
Employer identification number
52-0954463
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) Acts
Po Box 74
Dumfries,VA22026 		54-0897679 501(c)(3) 20,000       Social Health Practices
(2) Alliance For A Healthier Generation Inc
1028 Se Water Ave215
Portland,OR97214 		27-2028308 501(c)(3) 100,000       Thriving Schools. Building Healthier Communities T
(3) Baileys Crossroads Health Access
Po Box 8332
Falls Church,VA22041 		30-0765570 501(c)(3) 46,683       Kp Enterprise Strategies
(4) Baltimore Healthy Start Inc
610 N Chester St
Baltimore,MD21205 		52-1694523 501(c)(3) 9,150       Operating Support
(5) Baltimore Office Of Promotion & The Arts
7 Saint Paul St 100
Baltimore,MD21202 		90-0091850 501(c)(3) 25,000       Nonprofit Organization That Cultivates The City's
(6) Bridgetower Media
222 S 9th St 900
Minneapolis,MN55402 		85-3333083 501(c)(3) 8,800       Empowering Communities With Data, Insights And Con
(7) Capital Pride Alliance Inc
2000 14th St Nw
Washington,DC20009 		26-1763254 501(c)(3) 31,530       Serving The Needs Of The Lgbtq+ Community All Year
(8) Celebrate Annapolis Juneteenth
3036 Rock Dr
Riva,MD21140 		92-1132568 501(c)(3) 7,500       To Commemorate The Emancipation Of The Last Enslav
(9) Coalition For Nonprofit Housing
727 15th St Nw 600
Washington,DC20005 		52-1750323 501(c)(3) 75,000       Economic Opportunity
(10) Community Clinic Inc
8630 Fenton St1204
Silver Spring,MD20910 		52-0988386 501(c)(3) 7,500       Social Health Practices
(11) Dar Al-hijrah Islamic Center
3159 Row St
Falls Church,VA22044 		31-1256417 501(c)(3) 50,000       Economic Opportunity
(12) Ebenezer Cog Community Outreach
7550 Buchanan St
Hyattsville,MD20784 		88-4035121 501(c)(3) 7,500       Social Health Practices
(13) Edu-futuro
2110 Washington Blvd 3fl
Arlington,VA22204 		54-1914671 501(c)(3) 50,000       Economic Opportunity
(14) Greater Washington Community Foundation
1325 G St Nw 480
Washington,DC20005 		23-7343119 501(c)(3) 86,000       Housing For Health
(15) Healthworks For Northern Virginia
163 Fort Evans Rd Ne
Leesburg,VA20176 		20-2379419 501(c)(3) 50,000       Kp Enterprise Strategies
(16) Homes For Hope
3009 G St Se
Washington,DC20019 		27-0034814 501(c)(3) 50,000       Economic Opportunity
(17) Hospice Of The Chesapeake Foundation
90 Ritchie Hwy
Pasadena,MD21122 		52-1457419 501(c)(3) 7,800       Caring For Life Throughout The Journey With Illnes
(18) Kings Deliverance Hope Helping Others
248 W Chestnut Hill Rd
Newark,DE19713 		85-2588031 501(c)(3) 6,250       Economic Opportunity
(19) La Clinica Del Pueblo Inc
2831 15th St Nw
Washington,DC20009 		52-1942551 501(c)(3) 50,000       Kp Enterprise Strategies
(20) Legal Aid Bureau Inc
500 E Lexington St
Baltimore,MD21202 		52-0591621 501(c)(3) 100,000       Housing For Health
(21) Make A Wish Of The Mid Atlantic
6555 Rock Spring Dr280
Bethesda,MD20817 		52-1306075 501(c)(3) 14,500       Granted Over 10,000 Wishes Of Children Fighting Cr
(22) Maryland African American Museum
830 E Pratt St
Baltimore,MD21202 		52-2107879 501(c)(3) 125,000       Maryland African American Museum
(23) Maryland Citizens Health Initiative
2600 Saint Paul St
Baltimore,MD21218 		52-2173223 501(c)(3) 10,000       Social Health Practices
(24) Micah Ecumenical Ministries
Po Box 3277
Fredericksburg,VA22402 		20-4044884 501(c)(3) 75,000       Housing For Health
(25) Montgomery Housing Partnership Inc
12200 Tech Rd 250
Silver Spring,MD20904 		52-1631939 501(c)(3) 200,000       Housing For Health
(26) Mosaic Theater Company Of Dc
1333 H St Ne
Washington,DC20002 		47-2641919 501(c)(3) 9,250       Make Powerful, Transformational, Socially-relevant
(27) National Coalition For The Homeless
2201 P St Nw
Washington,DC20037 		52-1517415 501(c)(3) 30,000       Housing For Health
(28) National Korean American Svc & Education Consortiu
13890 Braddock Rd309
Centreville,VA20121 		11-3303986 501(c)(3) 75,000       Economic Opportunity
(29) New Futures
609 H St Ne 500
Washington,DC20002 		52-2180378 501(c)(3) 35,000       Economic Opportunity
(30) Novella Ctr For Entrepreneurship (NEC)
250 W Dickman St
Baltimore,MD21231 		83-4583974 501(c)(3) 50,000       Thriving Schools
(31) Npower Inc
55 Washington St 560
Brooklyn,NY11201 		13-4145441 501(c)(3) 50,000       Economic Opportunity
(32) Pathforward Inc
Po Box 100731
Arlington,VA22210 		54-1615993 501(c)(3) 8,749       Housing For Health
(33) Pauls Place Inc
1118 Ward St
Baltimore,MD21230 		52-1372359 501(c)(3) 20,000       Social Health Practices
(34) Pickett Fences Senior Services Inc
9701 Apollo Dr 301
Largo,MD20774 		46-1572005 501(c)(3) 20,000       Social Health Practices
(35) Prince Georges County Fire Ems
9201 Basil Ct 452
Largo,MD20774 		52-6000998 Government 75,000       Promote Safety And Provide The Highest Quality Of
(36) Prince Georges Healthcare Alliance Inc
9475 Lottsford Rd270
Largo,MD20774 		81-1002853 501(c)(3) 10,000       Safety Net Program That Subsidizes Health Care Ser
(37) Sheperds Table Inc
8106 Georgia Ave
Silver Spring,MD20910 		52-1381738 501(c)(3) 10,000       Housing For Health
(38) South Baltimore Learning Corporation
28 E Ostend St
Baltimore,MD21230 		52-1745263 501(c)(3) 50,000       Economic Opportunity
(39) Suitup Incorporated
25 Broadway Fl 12
New York,NY10004 		46-3381399 501(c)(3) 7,000       Economic Opportunity
(40) University Of Maryland Medical System Fdn
110 S Paca St Fl 9
Baltimore,MD21201 		52-2238893 501(c)(3) 10,000       Serving The Health Care Needs Of Maryland
(41) Virginia Hospital Center Fdn
Arlington Health System
Arlington,VA22205 		20-4129901 501(c)(3) 10,000       To Honor Veterans, Their Families, And Caregivers
(42) WETATI Academy Inc
6304 Somerset Rd
Riverdale,MD20737 		37-1704890 501(c)(3) 5,160       Operating Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
42
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) 2023
Page 2

Schedule I (Form 990) 2023
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. Larger grants (typically over $100k) may require quarterly progress reports.
Schedule I (Form 990) 2023



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