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 California
 
Employer identification number
94-1461312
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) AMERICAN CANCER SOCIETY
1710 WEBSTER STREET
OAKLAND,CA94612
94-1170350 501(c)(3) 12,000       SPONSORSHIP FROM SF OFFICE, RANCHO CORDOVA, HARRISBURG & ALPHARETTA
(2) BAY AREA COUNCIL
353 SACRAMENTO ST 10TH FLR
SAN FRANCISCO,CA94111
23-7325853 501(c)(3) 10,000       SPONSORSHIP OF THE BAC 2016 OUTLOOK CONFERENCE
(3) CADP
12700 PARK CENTERAL DR STE 400
DALLAS,TX752511529
33-0385553 501(C)(6) 10,700       2016 ANNUAL CONFERENCE SPONSORSHIP
(4) CALIFORNIA ACADEMY OF GENERAL DENTISTRY
PO BOX 22417
SACRAMENTO,CA95822
94-2557207 501(c)(3) 20,000       CE COURSE SPONSORED FOR CAGD FALL MTG
(5) CALIFORNIA STATE UNIVERSITY NORTHRIDGE FOUNDATION
18111 NORDHOFF ST
NORTHRIDGE,CA91330
95-6196006 501(c)(3) 10,000       SPONSORSHIP EVENT:09/22/16
(6) CAMBRA COALITION
5050 LAGUNA BLVD STE 112 448
ELK GROVE,CA95758
46-0633229 501(c)(3) 5,000       SPONSOR CAMBRA CONFERENCE, AUG 21 - 23, 2016
(7) CHALLENGED ATHLETES FOUNDATION
9591 WAPLES ST
SAN DIEGO,CA92121
33-0739596 501(c)(3) 5,000       SPOT IN THE BACK CENTURY IN THE BACK TO BACK CENT NOR CA
(8) CHILDREN'S DENTAL HEALTH ASSOC OF SAN DIEGO
1270 24th STREET
SAN DIEGO,CA92102
95-2545484 501(c)(3) 5,000       SPONSORSHIP FOR DAY AT THE RACES ON 8/26/16
(9) DELTA DENTAL COMMUNITY CARE FOUNDATION
100 FIRST ST
SAN FRANCISCO,CA94105
37-1570764 501(c)(3) 672,053       CONTRIBUTION TO THE FOUNDATION FOR DDC
(10) DENTAL COLLEGE OF GEORGIA AT AUGUSTA
DIVISION OF CONTINUING EDUCATION
1120 15TH STREET-FI-1085
AUGUSTA,GA30904
58-6002053   10,000       "GENERAL DENTISTRY PROBLEM SOLVING" - 8/21/15
(11) FINE ARTS MUSEUM
GOLDEN GATE PARK 50 HAGIWARA TEA
GARDEN DR
SAN FRANCISCO,CA94118
94-3045948 501(c)(3) 5,000       CONTRIBUTION
(12) INTERAGENCY INSTITUTE FOR FEDERAL HEALTH CARE EXECUTIVES
5325 MACARTHUR BLVD NW
WASHINGTON,DC20016
61-1478726   17,000       CONTRIBUTION
(13) LA CLINICA DE LA RAZA
PO BOX 17054
OAKLAND,CA94601
94-1744108 501(c)(3) 5,000       SPONSORSHIP "ALL THAT JAZZ" EVENT
(14) NATIONAL CHILDREN'S ORAL
HEALTH FOUNDATION 4108 PARK RD STE
300
CHARLOTTE,NC28209
20-3921574 501(c)(3) 100,000       AMERICA'S TOOTHFAIRY PROGRAM - LOS ANGELES AND TEXAS
(15) NATIONAL GUARD YOUTH FOUNDATION
415 NORTH LEE ST
ALEXANDRIA,VA22314
54-1940978 501(c)(3) 10,000       CONTRIBUTION PROGRAM AND CONTRIBUTORS SPONSORSHIP LEVEL
(16) NATIONAL MILITARY FAMILY ASSOCIATION
3601 EISENHOWER AVE STE 425
ALEXANDRIA,VA22304
52-0899384 501(c)(3) 6,250       CONTRIBUTION FOR LEADERSHIP LUNCHEON IN SEPT.
(17) PENFED FOUNDATION INC
2930 EISENHOWER AVENUE
ALEXANDRIA,VA22314
54-2062271 501(c)(3) 5,000       SPONSOR 12TH ANNUAL NIGHT OF HEROES GALA - 5/11/16
(18) PENNSYLVANIA COALITION FOR ORAL HEALTH
PO BOX 50
WYMEWOOD,PA19096
01-0564355 501(c)(3) 10,000       ADVANCING ORAL HEALTH POLICY & PREVENTIVE ED
(19) RESERVE OFFICERS ASSOCIATION
1 CONSTITUTION AVE NE
WASHINGTON,DC20002
53-0132450 501(C)(19) 5,000       INDUSTRY STARs CONTRIBUTION
(20) SAN FRANCISCO BALLET
455 FRANKLIN STREET
SAN FRANCISCO,CA94102
94-1415298 501(c)(3) 5,000       CONTRIBUTION
(21) SONOMA COUNTY DEPARTMENT OF HEALTH
490 MENDOCINO AVE
SANTA ROSA,CA95401
94-6000539   7,000       PERINATAL & INFANT ORAL HEALTH PILOT PROJECT
(22) TEAMSMILE
2000 SWIFT AVE
NORTH KANSAS CITY,MO64116
75-3250075 501(c)(3) 50,000       SPONSORSHIP FOR TEAMSMILE EVENT
(23) THE L A TRUST
333 S BEAUDRY AVE 29TH FL
LOS ANGELES,CA90017
95-4262448 501(c)(3) 10,000       TOOTHFAIRY CONVENTION SPONSORSHIP ON 2/11/17
(24) UC REGENTS
513 PARNASSUS AVE
SAN FRANCISCO,CA94143
95-2226406   26,000       SPONSORSHIP FOR SUMMER FELLOWSHIP; CE COURSE and 2016 RESEARCH & CLINICAL EX
(25) UNITED WAY CALIFORNIA CAPITAL REGION
10389 OLD PLACERVILLE RD
SACRAMENTO,CA958272506
23-7079003 501(c)(3) 43,185       UNITED WAY MATCHING
(26) UNITED WAY OF THE BAY AREA
550 KEARNY STREET 1000
SAN FRANCISCO,CA94108
94-1312348 501(c)(3) 188,204       UNITED WAY MATCHING AND SAN FRANCISCO CONTRIBUTION FOR NOV 2016
(27) MISCELLANEOUS ITEMS LESS THAN 5000

 
 
  62,568       MISCELLANEOUS CONTRIBUTION
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
20
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
6
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) STUDENT LEADERSHIP AWARDS 60 255,000   N/A  
(2) HISPANIC SCHOLARSHIP 21 210,000   N/A  
(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: The organization awards grants for programs that foster dental health and education. Through these grants the organization helps finance health, education, and research projects in dentistry, health and human services, and civic and community affairs. The two grants are: (1) the dental health and education contribution, which supports dental health and awareness programs and (2) the standard dental research grant, which supports professional research related to dental health. Grants are awarded to groups that: (1) provide dentistry for economically disadvantaged persons; (2) provide dentistry for groups that are dentally underserved; (3) provide education to advance the awareness or the science of dentistry; (4) promote public dental health; and (5) are involved in community activities related to dental care. Grant Guidelines: Priority will go to projects that focus on issues related to the delivery of oral health care, including those with significant potential for improving oral health and reducing treatment costs. Priority consideration will go to researchers from the dental schools in the enterprise states, but will not be limited to these institutions. Priority will go to two types of studies: (1) pilot or feasibility studies likely to enhance the investigator's chance for long-term funding from other sources; and (2) complete projects considered to be of interest to the health, education, and research fund, for which other sources of funds are traditionally unavailable or insufficient. Priority will go to studies that evaluate the outcome of preventative and treatment procedures. Retrospective studies or those involving analysis of existing data should be considered, rather than long-term follow-up studies, in order to reduce the years required to obtain data. Overhead charges within each eligible grant will be limited to eight percent. The fund will normally make one to two standard research grants per year. Individual grants will generally not exceed $40,000. Grants will be limited to one-year projects, subject to renewal. Except in special cases, an organization/entity will not be eligible for more than one grant during any year. A screening committee reviews all applications, with final grant decisions made by the fund's administrative committee.
Schedule I (Form 990) 2016



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