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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
DELTA DENTAL OF OKLAHOMA 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,OK74115 		73-1171950 501C3 110,000       HEALTH, GENERAL
(2) CITY RESCUE MISSION
800 W CALIFORNIA AVE
OKLAHOMA CITY,OK73106 		73-0713883 501C3 38,000       HUMAN SERVICE
(3) CROSSINGS COMMUNITY CLINIC
10255 N PENNSYLVANIA AVE
OKLAHOMA CITY,OK73120 		86-1115863 501C3 15,000       HEALTH, GENERAL
(4) COMMUNITY HEALTH CONNECTION
2321 E 3RD ST
TULSA,OK74104 		04-3766364 501C3 20,000       HEALTH, GENERAL
(5) D-DENT
3000 UNITED FOUNDERS BLVD STE 122
OKLAHOMA CITY,OK73112 		73-1325324 501C3 110,000       HEALTH, GENERAL
(6) EASTERN OKLAHOMA DONATED DENTAL SERVICES
9810 E 42ND ST STE 210
TULSA,OK74146 		41-2103655 501C3 110,000       HEALTH, GENERAL
(7) GOOD SHEPHERD MINISTRIES OF OKLAHOMA
222 NW 12TH
OKLAHOMA CITY,OK73103 		20-0526892 501C3 90,000       HUMAN SERVICE
(8) HEARTS THAT CARE VOLUNTEER HEALTH CLINIC
304 SW A AVE
LAWTON,OK73501 		20-8373475 501C3 50,000       HEALTH, GENERAL
(9) NEIGHBORHOOD SERVICES ORGANIZATION
431 SW 11TH ST
OKLAHOMA CITY,OK73109 		73-0785944 501C3 72,000       HUMAN SERVICE
(10) OKLAHOMA DENTAL FOUNDATION
317 NE 13TH ST
OKLAHOMA CITY,OK73104 		73-0678114 501C3 520,000       HEALTH, GENERAL
(11) WESTERN OKLAHOMA FAMILY CARE CENTER
609 W E AVE
ELK CITY,OK73648 		26-1284785 501C3 5,000       HEALTH, GENERAL
(12) GREEN COUNTRY FREE CLINIC
500 SE FRANK PHILLIPS BLVD
BARTLESVILLE,OK74003 		73-1363792 501C3 10,000       HEALTH, GENERAL
(13) RED ROCK BEHAVIORAL HEALTH SERVICES
4400 N LINCOLN BLVD
OKLAHOMA CITY,OK73105 		73-6111618 501C3 8,000       DENTAL CARE PROGRAM
(14) REMERGE OF OK COUNTY INC
PO BOX 2845
OKLAHOMA CITY,OK73101 		46-4504748 501C3 8,000       DENTAL CARE PROGRAM
(15) RURAL HEALTH NETWORK OF OKLAHOMA
1405 E KIRK ST
HUGO,OK74743 		46-2917154 501C3 13,250       DENTAL CARE PROGRAM
(16) VARIETY CARE FOUNDATION
3000 N GRAND BLVD
OKLAHOMA CITY,OK73107 		73-1088577 501C3 33,000       EDUCATIONAL
(17) WATER ROCK MINISTRIES
PO BOX 22741
OKLAHOMA CITY,OK73123 		45-1165200 501C3 8,000       EDUCATIONAL
(18) MORTON COMPREHENSIVE HEALTH SERVICE
1334 N LANSING AVE
TULSA,OK74106 		73-1177858 501C3 36,000       DENTAL CARE PROGRAM
(19) GOOD SHEPHERD COMMUNITY CLINIC INC
20 12TH AVE NW
ARDMORE,OK73401 		73-1509801 501C3 10,000       HUMAN SERVICE
(20) MINISTRIES OF JESUS INC
1100 E I-35 SERVICE ROAD
EDMOND,OK73034 		73-1622804 501C3 22,000       HUMAN SERVICE
(21) UNIVERSITY OF OKLAHOMA FOUNDATION INC
100 TIMBERDELL ROAD
NORMAN,OK730190685 		73-6091755 501C3 140,000       EDUCATIONAL
(22) STERLING ANGEL OF SMILES NONPROFIT ORGANIZATION
PO BOX 891330
OKLAHOMA CITY,OK73189 		47-1915858 501C3 10,000       HUMAN SERVICE
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
22
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) 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: GRANTEES MUST MEET FOUR ELIGIBILITY REQUIREMENTS IN ORDER TO BE AWARDED A GRANT. FIRST, THE ORGANIZATION SEEKING THE GRANT MUST BE A 501(C)(3) NONPROFIT ORGANIZATION WITH PUBLIC CHARITY STATUS, AN EDUCATIONAL INSTITUTION, A GOVERNMENT AGENCY, OR A FAITH-BASED ORGANIZATION THAT SERVES ALL MEMBERS OF THE COMMUNITY REGARDLESS OF RELIGIOUS BELIEF. WE DO NOT AWARD GRANTS TO INDIVIDUALS. SECOND, THE PROGRAM, PROJECT OR INITIATIVE BEING FUNDED MUST BE DENTAL HEALTH OR EDUCATION RELATED. THIRD, THE PROGRAM CANNOT DISCRIMINATE ON THE BASIS OF RACE, ETHNICITY, NATIONAL ORIGIN, OR RELIGION. FOURTH, THE PROGRAM MUST SERVE OKLAHOMANS. THE ORGANIZATION MONITORS TO ENSURE THAT THE CHARITABLE PURPOSES ARE SATISFIED AND REQUIRES DETAILED SUPPORTING DOCUMENTATION FROM THE RECIPIENT ORGANIZATION TO CONFIRM USE AND VALUE OF SERVICES RENDERED.
Schedule I (Form 990) 2020



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