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," to 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
2014
Open to Public
Inspection
Name of the organization
 
 
Employer identification number
91-0621480
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" to 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
non-cash assistance		 (h) Purpose of grant
or assistance
(1)  
956 South Main Street
Ste A
Colville,WA99114 		91-0793447 501c3 32,196       Third Year ABCD Program
(2)  
909 Georgiana
Port Angeles,WA98362 		01-0590704 501c3 55,000       Second Year ABCD Program in Clallam/Jefferson Counties
(3)  
465 Medford Street
Boston,MA02129 		04-3265080 501c3 100,000       Engagement of primary care physicians in delivery of oral health services
(4)  
111 North Post Street
Ste 301
Spokane,WA99201 		26-3375286 501c3 38,000       Better Health Tomorrow ER Diversion Project
(5)  
111 North Post Street
Ste 301
Spokane,WA99201 		26-3375286 501c3 12,000       Oral Health Leadership Coordinator position
(6)  
1218 Third Avenue
Seattle,WA98101 		91-2041837 501c3 45,000       Yearly Thrive by Five funding
(7)  
1218 Third Avenue
Seattle,WA98101 		91-2041837 501c3 20,000       State Home Visiting Match Fund to expand home visiting programs for Washington's young children
(8)  
955 Powell Ave SW
Renton,WA98057 		91-0884412 501c3 300,000       Dental equipment for Midway Clinic
(9)  
720 8th Ave S
2nd floor
Seattle,WA98104 		91-0947084 501c3 120,000       Equipment InterID dental clinic
(10)  
509 East Main Avenue
Chewelah,WA99109 		91-1053847 501c3 377,888       Equipment upgrade for Colville Clinic
(11)  
509 East Main Avenue
Chewelah,WA99109 		91-1053847 501c3 206,112       Equipment upgrade for three clinics
(12)  
8112 Grand Ave NE
Bainbridge Island,WA98110 		20-0381039 501c3 12,500       Portable dental equipment for mobile program
(13)  
1200 SE 12th St
College Place,WA99324 		20-2958334 501c3 81,500       Capital expenses and start-up costs
(14)  
111 North Post Street
Ste 301
Spokane,WA99201 		26-3375286 501c3 5,250       Oral health project consultant
(15)  
2419 NE Sandy Blvd
Portland,OR97232 		46-1743058   20,000       Additional fluoridation support for Portland
(16)  
2419 NE Sandy Blvd
Portland,OR97232 		46-1743058   50,000       Fluoridation support for Portland
(17)  
901 E Street NW
10th Floor
Washington,DC20004 		56-2307147 501c3 50,000       Campaign for Dental Health
(18)  
510 Plum Street SE
Ste 101
Olympia,WA98501 		91-1323282 501c3 89,341       Funding for the Community Health Center Directors Collaborative
(19)  
800 East Chestnut Street
Ste 2
Bellingham,WA98225 		81-0677295 501c3 164,175       Dental/Medical collaboration referral services
(20)  
800 East Chestnut Street
Ste 2
Bellingham,WA98225 		81-0677295 501c3 30,000       Engaging a health care delivery system in Whatcom County for the purpose of establishing a dental/medical collaboration project.
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
14
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014
Page 2

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to 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
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












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 The grantee is required to sign a grant agreement stating that they will use the funds only for purposes outlined in the grant agreement and application. The grantee is required to file reports on regular intervals outlining use of funds. Grantee is also required to return unused funding if applicable.
Schedule I (Form 990) 2014



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