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
2016
Open to Public
Inspection
Name of the organization
DELTA DENTAL OF OKLAHOMA ORAL
HEALTH FOUNDATION
Employer identification number
27-4417052
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) CATHOLIC CHARITIES DIOCESE OF TULSA
2450 N HARVARD AVE
TULSA,OK73115 		73-1171950 501C3 140,000       HEALTH, GENERAL
(2) CITY RESCUE MISSION
800 W CALIFORNIA AVE
OKLAHOMA CITY,OK73106 		73-0713883 501C3 60,000       HUMAN SERVICE
(3) CROSSINGS COMMUNITY CLINIC
2208 W HEFNER RD STE B
OKLAHOMA CITY,OK73120 		86-1115863 501C3 25,000       HEALTH, GENERAL
(4) D-DENT
11212 N MAY AVENUE SUITE 110
OKLAHOMA CITY,OK73120 		73-1325324 501C3 135,000       HEALTH, GENERAL
(5) EASTERN OKLAHOMA DONATED DENTAL SER
3741 S PEORIA
TULSA,OK74105 		41-2103655 501C3 157,500       HEALTH, GENERAL
(6) GOOD SHEPHERD MEDICAL AND DENTAL FO
20 12TH AVE NW
ARDMORE,OK73401 		73-1509801 501C3 20,000       HEALTH, GENERAL
(7) GOOD SHEPHERD MINISTRIES OF OKLAHOM
222 NW 12TH
OKLAHOMA CITY,OK73103 		20-0526892 501C3 189,497       HUMAN SERVICE
(8) MINISTRIES OF JESUS INC
1100 E I-35 FRONTAGE RD
EDMOND,OK73034 		73-1622804 501C3 32,000       HUMAN SERVICE
(9) MORTON COMPREHENSIVE HEALTH SERVICE
1334 N LANSING AVENUE
TULSA,OK74106 		73-1177858 501C3 20,000       HEALTH, GENERAL
(10) NEIGHBOR FOR NEIGHBOR RESTORATIVE P
505 E 36TH ST N
TULSA,OK74106 		73-0776404 501C3 50,000       HUMAN SERVICE
(11) NEIGHBORHOOD SERVICES ORGANIZATION
8101 S WALKER STE C
OKLAHOMA CITY,OK73139 		73-0785944 501C3 85,000       HUMAN SERVICE
(12) OKLAHOMA DENTAL FOUNDATION FOR RESE
317 NE 13TH ST
OKLAHOMA CITY,OK73104 		73-0678114 501C3 406,103       HEALTH, GENERAL
(13) SOUTHERN OKLAHOMA TECHNOLOGY CENTER
2610 SAM NOBLE PARKWAY
ARDMORE,OK73401 		73-1019541 501C3 6,000       EDUCATIONAL
(14) TRI COUNTY TECH CENTER FREE CLINIC
6101 SE NOWATA
BARTLESVILLE,OK74006 		73-1188682 501C3 6,000       HEALTH, GENERAL
(15) UNIVERSITY OF OKLAHOMA FOUNDATION
1201 N STONEWALL AVE
OKLAHOMA CITY,OK73117 		73-6091755 501C3 50,000       HEALTH, GENERAL
(16) UNIVERSITY OF OKLAHOMA FOUNDATION
1201 N STONEWALL AVE
OKLAHOMA CITY,OK73117 		73-6091755 501C3 205,000       HUMAN SERVICE
(17) WESTERN OKLAHOMA FAMILY CARE CENTER
PO BOX 1727
ELK CITY,OK73648 		26-1284785 501C3 18,000       HEALTH, GENERAL
(18) GREEN COUNTRY FREE CLINIC
500 SE FRANK PHILLIPS BLVD
BARTLESVILLE,OK74003 		73-1363792 501C3 15,000       HEALTH, GENERAL
(19) WESTERN TECHNOLOGY CENTER
2605 E MAIN ST
WEATHERFORD,OK73096 		73-1105189 501C3 6,000       EDUCATIONAL
(20) OKLAHOMA COMMUNITY HEALTH CENTERS INC
6501 BROADWAY EXTENSION SUITE 200
OKLAHOMA CITY,OK73116 		73-1365933 501C3 20,000       HEALTH, GENERAL
(21) DENTOVATIVE SERVICE FOUNDATION
602 S UTICA AVE
TULSA,OK74104 		20-0520512 501C3 5,000       EDUCATIONAL, DENTAL
(22) HOMELESS ALLIANCE
1724 NW 4TH STREET
OKLAHOMA CITY,OK73106 		11-3718005 501C3 7,200       HUMAN SERVICE
(23) NATIONAL CHILDREN'S ORAL HEALTH FOUNDATION
4108 PARK RD STE 300
CHARLOTTE,NC28209 		20-3921574 501C3 45,000       EDUCATIONAL, DENTAL
(24) OMHC RED ROCK BEHAVIORAL HEALTH SERVICES
4400 N LINCOLN BLVD
OKLAHOMA CITY,OK73105 		73-6111618 501C3 10,000       DENTAL CARE PROGRAM
(25) REMERGE OF OK COUNTY INC
PO BOX 2845
OKLAHOMA CITY,OK73101 		46-4504748 501C3 20,000       DENTAL CARE PROGRAM
(26) UNIVERSITY OF CENTRAL OKLAHOMA FOUNDATION
100 N UNIVERSITY DR
EDMOND,OK73034 		73-6108032 501C3 15,000       EDUCATIONAL, UNDERGRAD SCHOLARSHIPS
(27) UNIVERSITY OF OKLAHOMA FOUNDATION
100 TIMBERDELL RD
NORMAN,OK73019 		73-6091755 501C3 15,000       EDUCATIONAL, UNDERGRAD SCHOLARSHIPS
(28) EAST CENTRAL UNIVERSITY FOUNDATION
1100 E 14TH PMB Y-8
ADA,OK74820 		23-7058908 501C3 15,000       EDUCATIONAL, UNDERGRAD SCHOLARSHIPS
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
28
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) 2016
Page 2

Schedule I (Form 990) 2016
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 (Form 990) 2016



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