Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2015
Open to Public Inspection
For calendar year 2015, or tax year beginning 01-01-2015 , and ending 12-31-2015
Name of foundation
DELTA DENTAL PLAN OF ARIZONA
CHARITABLE FOUNDATION AND TRUST
Number and street (or P.O. box number if mail is not delivered to street address)5656 WEST TALAVI BLVD
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
GLENDALE, AZ85306
A Employer identification number

86-0842694
B Telephone number (see instructions)

(602) 938-3131
C bullet
G Check all that apply:

D 1. bullet
2. bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$5,518,931J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 816,417
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments 18 18  
4 Dividends and interest from securities... 116,474 116,474  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 -5,502
b Gross sales price for all assets on line 6a 1,191,581
7 Capital gain net income (from Part IV, line 2)... 0
8 Net short-term capital gain.........  
9 Income modifications...........  
10a Gross sales less returns and allowances  
b Less: Cost of goods sold....  
c Gross profit or (loss) (attach schedule).....    
11 Other income (attach schedule)....... Click to see attachment 120,287 0 120,287
12 Total. Add lines 1 through 11........ 1,047,694 116,492 120,287
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0 0 0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 19,200 9,600 0 9,600
c Other professional fees (attach schedule).... Click to see attachment 13,017 6,509 0 6,509
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 813 0 0 0
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings....... 12,036 0 0 1,591
22 Printing and publications.......... 9,295 0 0 5,033
23 Other expenses (attach schedule)....... Click to see attachment 131,281 3,000 77,708 48,083
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 185,642 19,109 77,708 70,816
25 Contributions, gifts, grants paid....... 822,813 713,086
26 Total expenses and disbursements. Add lines 24 and 25 1,008,455 19,109 77,708 783,902
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 39,239
b Net investment income (if negative, enter -0-) 97,383
c Adjusted net income (if negative, enter -0-)... 42,579
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2015)
Form 990-PF (2015)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)		 Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 505,872 550,167 550,167
2 Savings and temporary cash investments......... 240,180 152,900 152,900
3 Accounts receivable bullet3,450
Less: allowance for doubtful accounts bullet   3,750 3,450 3,450
4 Pledges receivable bullet13,686
Less: allowance for doubtful accounts bullet   5,455 13,686 13,686
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use.............. 11,330 8,093 8,093
9 Prepaid expenses and deferred charges.......... 12,974 11,368 11,368
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 3,337,852 Click to see attachment3,125,195 3,125,195
c Investments—corporate bonds (attach schedule)....... 1,111,940 Click to see attachment1,378,771 1,378,771
11 Investments—land, buildings, and equipment: basis bullet14,330
Less: accumulated depreciation (attach schedule) bullet14,330      
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 414,814 Click to see attachment273,487 273,487
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment969 Click to see attachment1,814 Click to see attachment1,814
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 5,645,136 5,518,931 5,518,931
Liabilities 17 Accounts payable and accrued expenses.......... 34,157 161,081
18 Grants payable..................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons 7,790  
21 Mortgages and other notes payable (attach schedule)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)......... 41,947 161,081
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................. 5,599,439 5,357,850
25 Temporarily restricted............... 3,750 0
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see instructions)..... 5,603,189 5,357,850
31 Total liabilities and net assets/fund balances (see instructions). 5,645,136 5,518,931
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 30 (must agree with end-of-year figure reported on prior year’s return) ...............
1
5,603,189
2
Enter amount from Part I, line 27a .....................
2
39,239
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
5,642,428
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
284,578
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
5,357,850
Form 990-PF (2015)
Form 990-PF (2015)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.) 		(b) How acquired
P—Purchase
D—Donation 		(c) Date acquired
(mo., day, yr.) 		(d) Date sold
(mo., day, yr.)
1 a Northern Trust - SEE ATTACHED P    
b
c
d
e
(e) Gross sales price (f) Depreciation allowed
(or allowable) 		(g) Cost or other basis
plus expense of sale 		(h) Gain or (loss)
(e) plus (f) minus (g)
a 1,191,581   1,197,083 -5,502
b
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l) Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i) F.M.V. as of 12/31/69 (j) Adjusted basis
as of 12/31/69 		(k) Excess of col. (i)
over col. (j), if any
a       -5,502
b
c
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 -5,502
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2014 780,638 5,306,192 0.147118
2013 932,661 4,989,694 0.186917
2012 624,245 2,945,326 0.211944
2011 546,652 1,344,691 0.406526
2010 440,497 1,218,291 0.361570
2
Total of line 1, column (d) .....................
21.314075
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years . . .
3
0.262815
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
5,590,274
5
Multiply line 4 by line 3......................
5
1,469,208
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
974
7
Add lines 5 and 6........................
7
1,470,182
8
Enter qualifying distributions from Part XII, line 4.............
8
783,902
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form 990-PF (2015)
Form 990-PF (2015)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 1,948
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 1,948
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 4 0
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5 1,948
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a  
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c 2,400
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 2,400
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8 47
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 405
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet405 RefundedBullet 11 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for definition)?.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletAZ
    b
    If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
    General (or designate) of each state as required by General Instruction G? If "No," attach explanation .
    8b
    Yes
     
    9
    Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
    or 4942(j)(5) for calendar year 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletwww.deltadentalaz.com/foundation
    14
    The books are in care ofbulletTHE ORGANIZATION Telephone no.bullet (602) 938-3131

    Located atbullet5656 WEST TALAVI BLVDGLENDALEAZ ZIP+4bullet85306
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.......bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 2015, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country?
    16   No
    See instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country bullet  
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)? ........
    1b
     
    No
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2015?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2015 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2015.)..................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (Continued)
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? (see instructions)................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    Felix Durazo Chairman
    2.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Keith Gauzza Secretary
    2.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Kathy LaVoy RDH PDHC MEd Vice Chair
    2.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Xavier Ortega Treasurer
    2.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Allan Allford PRESIDENT
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Dutch Baker Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Tali Collins JD Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Alisa Diggs-Gooding PA-c MPH Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Richard Fefer DDS Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Susan Fry MPH Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Rebecca Kenyon Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Alison Lund Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Rob Maple Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Fred Olsen DDS Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Sandi Perez PhD Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Phillip J Santucci DDS MS Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Candace Wiest Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    Tim Wilson DDS Director
    1.00     		0 0 0
    5656 West Talavi Boulevard
    Glendale,AZ85306
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1 PROMOTING ORAL HEALTH BY DISTRIBUTING TOOTHBRUSHES, FLOSS, TOOTHPASTE AND EDUCATIONAL MATERIALS. IMPROVES ORAL HEALTH IN THE STATE OF ARIZONA BY GIVING GRANTS, EQUIPMENT AND SUPPLIES FOR DENTAL CLINICS, SCHOOLS, NONPROFITS USING EVIDENCED-BASED DENTAL PREVENTION STRATEGIES TO HELP CHILDREN, YOUTH AND PREGNANT MOTHERS WITHOUT ACCESS TO DENTAL SERVICES. 62,914
    2  
    3  
    4  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    4,950,670
    b
    Average of monthly cash balances.......................
    1b
    686,324
    c
    Fair market value of all other assets (see instructions)................
    1c
    38,411
    d
    Total (add lines 1a, b, and c).........................
    1d
    5,675,405
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) .............
    1e
    0
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
    0
    3
    Subtract line 2 from line 1d.........................
    3
    5,675,405
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    85,131
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    5,590,274
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    279,514
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    279,514
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    1,948
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    1,948
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    277,566
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    277,566
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    277,566
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    783,902
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
    4
    783,902
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see instructions).................
    5
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    783,902
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2014     		(c)
    2014     		(d)
    2015
    1 Distributable amount for 2015 from Part XI, line 7 277,566
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 379,582
    b From 2011...... 480,515
    c From 2012...... 478,901
    d From 2013...... 684,878
    e From 2014...... 518,072
    fTotal of lines 3a through e........ 2,541,948
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 783,902
    a Applied to 2014, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2015 distributable amount..... 277,566
    e Remaining amount distributed out of corpus 506,336
    5 Excess distributions carryover applied to 2015. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 3,048,284
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2016. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		379,582
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		2,668,702
    10 Analysis of line 9:
    a Excess from 2011.... 480,515
    b Excess from 2012.... 478,901
    c Excess from 2013.... 684,878
    d Excess from 2014.... 518,072
    e Excess from 2015.... 506,336
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2015, enter the date of the ruling.......bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2015 (b) 2014 (c) 2013 (d) 2012
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    DR SANDI PEREZ
    5656 W TALAVI BLVD
    GLENDALE,AZ85306
    (602) 938-3131
    DELTAFOUNDATION@DELTADENTALAZ.COM
    bThe form in which applications should be submitted and information and materials they should include:
    Guidelines are provided on the website at deltadentalaz.com/foundation and the application questions should be answered in a WORD document and accompanied by a 501c3 letter of determination, current organizational budget, list of Board of Directors, current 990, and project budget.
    cAny submission deadlines:
    First Thursday of September no later than 5 PM Arizona time.
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    Applicants must be domiciled in Arizona and serving children, youth and pregnant mothers with programs/projects to improve oral health with preventive dental services, education, screenings, exams, sealants and fluoride treatments.
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    AT Still University
    5850 E Still Circle
    Mesa,AZ85206     		none Public Charity COMMUNITY GRANT 51,000
    AT Still University School of Dentistry
    5850 E Still Circle
    Mesa,AZ85206     		none Public Charity COMMUNITY GRANT 25,000
    AZ Alliance for Community Health Services
    700 E Jefferson St Ste 100
    Phoenix,AZ85004     		none Public Charity COMMUNITY GRANT 24,787
    AZ Community Foundation-Healthier Verde Valley
    2201 E Camelback Rd Ste 405B
    Phoenix,AZ85016     		none Public Charity COMMUNITY GRANT 25,000
    AZ Community Foundation-Hozhoni Foundation
    2201 E Camelback Rd Ste 405B
    Phoenix,AZ85016     		none Public Charity COMMUNITY GRANT 3,000
    AZ Community Foundation-NAU Foundation
    2201 E Camelback Rd Ste 405B
    Phoenix,AZ85016     		none Public Charity COMMUNITY GRANT 12,428
    Boys & Girls Club Metro Phoenix
    4309 E Belleview St Bldg 14
    Phoenix,AZ85008     		none Public Charity COMMUNITY GRANT 15,000
    Boys and Girls Clubs of Colorado River
    2250 Highland Rd
    Bullhead City,AZ86442     		none Public Charity COMMUNITY GRANT 10,140
    Central AZ Shelter Services
    230 S 12th Ave
    Phoenix,AZ85007     		none Public Charity COMMUNITY GRANT 15,000
    Desert Mission
    9229 N 4th St
    Phoenix,AZ85020     		none Public Charity COMMUNITY GRANT 15,000
    Dignity Health Foundation
    1727 W Fry Rd Ste 230
    Chandler,AZ85224     		none Public Charity COMMUNITY GRANT 6,100
    El Rio Health Center Foundation
    839 W Congress St
    Tucson,AZ85745     		none Public Charity COMMUNITY GRANT 30,000
    Esperanca
    1911 W Earll Dr
    Phoenix,AZ85015     		none Public Charity COMMUNITY GRANT 15,000
    Flagstaff Medical Center
    1200 N Beaver St
    Flagstaff,AZ86001     		none Public Charity COMMUNITY GRANT 10,000
    Golden Gate Community Center
    1625 N 39th Ave
    Phoenix,AZ85009     		none Government COMMUNITY GRANT 20,000
    Homeless Outreach Programs
    PO Box 363
    Nutrioso,AZ85932     		none Public Charity COMMUNITY GRANT 7,650
    Legacy Foundation Christown YMCA
    5517 N 17th Ave
    Phoenix,AZ85015     		none Public Charity COMMUNITY GRANT 15,000
    Maggie's Place Inc
    PO Box 1102
    Phoenix,AZ85001     		none Public Charity COMMUNITY GRANT 10,000
    Marana Health Center
    13395 N Marana Main St
    Marana,AZ85658     		none Public Charity COMMUNITY GRANT 15,000
    Mountain Park Health Center
    2702 N 3rd St Ste 4020
    Phoenix,AZ85004     		none government COMMUNITY GRANT 32,000
    Native American Community Health
    4041 N Central Ave Bldg C
    Phoenix,AZ85012     		none Public Charity COMMUNITY GRANT 20,000
    Navajo County Public Health Services
    117 E Buffalo St
    Holbrook,AZ86025     		none government COMMUNITY GRANT 43,560
    Overgaard Ponderosa Lions
    PO Box 402
    Overgaard,AZ85933     		none Public Charity COMMUNITY GRANT 11,000
    River Cities United Way
    145 N Havasu Ave
    Lake Havasu City,AZ86405     		none Public Charity COMMUNITY GRANT 6,000
    Society of St Vincent de Paul
    PO Box 13600
    Phoenix,AZ85002     		none Public Charity COMMUNITY GRANT 15,000
    Southwest Behavioral Helath Services
    2580 Highway 95 Ste 120
    Riviera,AZ86442     		none Public Charity COMMUNITY GRANT 4,250
    Southwest Human Development
    2850 N 24th St
    Phoenix,AZ85008     		none Public Charity COMMUNITY GRANT 15,000
    St Elizabeth's Health Center
    140 W Speedway Blvd Ste 100
    Tucson,AZ85705     		none Public Charity COMMUNITY GRANT 20,000
    Sun Life Family Health Center
    865 N Arizola Rd
    Casa Grande,AZ85122     		none Public Charity COMMUNITY GRANT 15,000
    The Poore Free Medical Clinic
    608 N Humphreys
    Flagstaff,AZ86001     		none Public Charity COMMUNITY GRANT 25,000
    The University of Arizona Foundation
    1450 N Cherry Ave
    Tucson,AZ85719     		none Public Charity COMMUNITY GRANT 50,000
    Verde Valley Medical Center
    269 S Candy Ln
    Cottonwood,AZ86326     		none Public Charity COMMUNITY GRANT 13,407
    Other Miscellaneous Organizations
    Various Locations
    VARIOUS,AZ85306     		none Public Charity COMMUNITY GRANT 164,241
    Other Miscellaneous Organizations
    Various Locations
    VARIOUS,AZ85306     		none Public Charity SPONSORSHIPS 63,250
    Total .................................bullet 3a 822,813
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3
    Interest on savings and temporary cash investments ...........     		    14 18  
    4 Dividends and interest from securities....     14 116,474  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6
    Net rental income or (loss) from personal property     		         
    7 Other investment income.....          
    8
    Gain or (loss) from sales of assets other than inventory ............     		    18 -5,502  
    9 Net income or (loss) from special events:     01 120,287  
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. 0 231,277 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13231,277
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
    Yes
     
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.

    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    1c 245,258 Arizona Dental Insurance Service Inc ARIZONA DENTAL INSURANCE SERVICE, INC. PROVIDES THE ORGANIZATION FREE USE OF FACILITIES, OFFICE EQUIPMENT AND STAFF.
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527?...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    ARIZONA DENTAL INSURANCE SERVICE INC 501(C)(4) UP TO 4 COMMON BOARD MEMBERS AND PRESIDENT/CEO
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below
    (see instr.)?
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2015)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
    OMB No. 1545-0047
    2015
    Name of the organization
    DELTA DENTAL PLAN OF ARIZONA
    CHARITABLE FOUNDATION AND TRUST
    Employer identification number

    86-0842694
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ





    Form 990-PF




    Check if your organization is covered by the General Rule or a Special Rule.  
    Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
    General Rule
    Special Rules
    ......... Arrow Bullet $  
    Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
    990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
    Form 990-EZ or on its Form 990PF, Part I, line 2, to certify that it does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
    Name of organization
    DELTA DENTAL PLAN OF ARIZONA
    CHARITABLE FOUNDATION AND TRUST         		Employer identification number
    86-0842694
    Part I
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
     
     

    ARIZONA DENTAL INSURANCE SERVICE IN  
    5656 W Talavi Blvd
     
    glendale, AZ85306

    		$ 707,713


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
     
     

    Thunderbirds Charities  
    7226 N 16th St Ste 100
     
    phoenix, AZ85020

    		$ 14,816


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    3
     
     

    Carrington College  
    4742 N 24th St 360
     
    phoenix, AZ85016

    		$ 15,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    4
     
     

    Delta Dental of Arizona  
    5656 W Talavi Blvd
     
    glendale, AZ85306

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    5
     
     

    Arizona Diamondbacks  
    401 E Jefferson St
     
    phoenix, AZ85004

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    6
     
     

    Henry Schein  
    8409 Worthshire Dr
     
    North Richland Hills, TX76182

    		$ 7,500


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 3
    Name of organization
    DELTA DENTAL PLAN OF ARIZONA
    CHARITABLE FOUNDATION AND TRUST         		Employer identification number

    86-0842694
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 4
    Name of organization
    DELTA DENTAL PLAN OF ARIZONA
    CHARITABLE FOUNDATION AND TRUST         		Employer identification number

    86-0842694
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2015 AccountingFeesSchedule
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Accounting 19,200 9,600 0 9,600

    TY 2015 InvestmentsCorpBondsSchedule
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Name of Bond End of Year Book Value End of Year Fair Market Value
    Corporate Bonds 1,378,771 1,378,771

    TY 2015 InvestmentsCorpStockSchedule
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Name of Stock End of Year Book Value End of Year Fair Market Value
    CORPORATE STOCK 3,125,195 3,125,195

    TY 2015 InvestmentsOtherSchedule2
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    Other AT COST 273,487 273,487

    TY 2015 OtherAssetsSchedule
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    Interest Receivable 969 1,814 1,814


    TY 2015 OtherDecreasesSchedule
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Description Amount
    Unrealized Loss 284,578


    TY 2015 OtherExpensesSchedule
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    DUES AND SUBSCRIPTIONS 8,539 0 0 8,539
    PROMOTION 7,947 0 0 7,947
    POSTAGE 4,539 0 0 2,599
    BANK CHARGES 3,000 3,000 0 0
    MEALS AND ENTERTIANMENT 6,172 0 0 6,172
    TRAINING AND SEMINARS 1,561 0 0 1,561
    TELEPHONE 1,047 0 0 1,047
    SUPPLIES 6,067 0 0 5,595
    MISC EXP 7,228 0 0 7,150
    BOARD EXPENSES 7,473 0 0 7,473
    GOLF TOURNAMENT COURSE FEES 20,886 0 20,886 0
    GOLF TOURNAMENT FOOD 17,241 0 17,241 0
    GOLF TOURNAMENT SUPPLIES 8,324 0 8,324 0
    GOLF TOURNAMENT VOLUNTEER 3,458 0 3,458 0
    GOLF TOURNAMENT PRINT & ADS 3,731 0 3,731 0
    GOLF TOURNAMENT RAFFLE 1,580 0 1,580 0
    GOLF TOURNAMENT MISC 2,393 0 2,393 0
    GOLF TOURNAMENT TEE PRIZES 20,095 0 20,095 0


    TY 2015 OtherIncomeSchedule2
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    Gross Income from Special Fundraising Events 120,287   120,287


    TY 2015 OtherProfessionalFeesSchedule
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Other PROFESSIONAL FEES 13,017 6,509 0 6,509


    TY 2015 TaxesSchedule
    Name:
    DELTA DENTAL PLAN OF ARIZONA
     
    CHARITABLE FOUNDATION AND TRUST
    EIN:
    86-0842694
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Taxes 813 0 0 0