TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) JEFFREY S RUSSELL...................................................................... PRESIDENT	0.39 ................. 40.00	X	X	0	889,513	38,382
(2) JEFF CHAFFIN DDS...................................................................... DIRECTOR	1.17 ................. 40.00	X		0	397,433	14,083
(3) SHERRY PERKINS...................................................................... SECRETARY-TREASURER	0.67 ................. 40.00		X	0	300,847	14,335
(4) SUZANNE HECKENLAIBLE...................................................................... EXECUTIVE DIRECTOR	10.00 ................. 30.00		X	0	271,476	43,569
(5) ROWENA CROSBIE...................................................................... DIRECTOR, VICE CHAIR	1.00 ................. 1.60	X	X	600	1,200	19,000
(6) MATT MENDENHALL...................................................................... DIRECTOR, CHAIR	1.00 .................	X	X	0	0	0
(7) NOLDEN GENTRY...................................................................... DIRECTOR, THROUGH JUNE	0.50 .................	X		0	0	0
(8) KEN JONES...................................................................... DIRECTOR	0.50 .................	X		0	0	0
(9) JAN REINICKE...................................................................... DIRECTOR	0.50 .................	X		0	0	0
(10) LYNN CURRY DDS...................................................................... DIRECTOR	0.50 .................	X		0	0	0
(11) JOEL WULF...................................................................... DIRECTOR	0.50 .................	X		0	0	0
(12) HOWARD COWEN DDS...................................................................... DIRECTOR	0.50 .................	X		0	0	0
(13) DAN CAPLAN DDS...................................................................... DIRECTOR	0.50 .................	X		0	0	0
(14) TRACY RODGERS...................................................................... DIRECTOR	0.50 .................	X		0	0	0
(15) JENNIFER VERMEER...................................................................... DIRECTOR	0.50 .................	X		0	0	0
(16) SCOTT RAECKER...................................................................... DIRECTOR	0.50 .................	X		0	0	0

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

DELTA DENTAL OF IOWA FOUNDATION

Employer identification number

26-0762771

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................1

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iii) Type of organization (described on lines 1- 10 above (see instructions))	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN		Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(A) DELTA DENTAL OF IOWA	420959302	10	Yes		0	0

Total 1					0	0

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose
3	Gross receipts from activities that are not an unrelated trade or business under section 513 .....
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge
6	Total. Add lines 1 through 5
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Yes

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Yes

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Yes

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Yes

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Yes

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
SCHEDULE A, PART 1, LINE 12G, COLUMN V:	DELTA DENTAL OF IOWA'S MISSION IS TO IMPROVE THE HEALTH AND SMILES OF THE PEOPLE WE SERVE. AN AMOUNT IS SET ASIDE EACH YEAR TO FUND THIS MISSION. THE AMOUNT IS DETERMINED BY THE PERFORMANCE AND FINANCIAL STRENGTH OF DELTA DENTAL. AFTER THE AUDITED FINANCIALS ARE COMPLETE, THE AMOUNT IS PAID TO THE FOUNDATION. THE FOUNDATION IS A SEC. 501(C)(3) ORGANIZATION AND IS A TYPE 1 SUPPORTING ORGANIZATION UNDER SEC. 509(A)(3). IT IS THE RESPONSIBILITY OF THE FOUNDATION TO DISTRIBUTE THE MONIES CONSISTENT WITH ITS MISSION AND FOUNDING DOCUMENTS. THE MISSION OF THE FOUNDATION IS TO SUPPORT AND IMPROVE THE ORAL HEALTH OF IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER SEC. 501(C)(3) ORGANIZATIONS, GOVERNMENTS, OR ACADEMIC INSTITUTIONS THROUGH THEIR GRANTS PROGRAM THAT ALIGN WITH THE PROJECTS OF ACCESS TO CARE, RESEARCH, EDUCATION, AND PREVENTION. THE AMOUNT CONTRIBUTED TO THE FOUNDATION IN 2019 WAS $4,703,950.
SCHEDULE A, PART VI, SECTION A, LINE 3B:	DELTA DENTAL OF IOWA HAS PROVIDED A COPY OF THEIR 501(C)(4) IRS DETERMINATION LETTER AND HAS COMPLETED THE PROFORMA PUBLIC SUPPORT CALCULATIONS ON SCHEDULE A, PART III FOR THE APPLICABLE YEARS. DURING THE CURRENT YEAR, DELTA DENTAL OF IOWA MET THE PUBLIC SUPPORT TEST REQUIREMENTS. DELTA DENTAL OF IOWA FOUNDATION HAS A FORMAL POLICY APPROVED BY THE BOARD TO ANNUALLY CONFIRM THAT DELTA DENTAL OF IOWA HAS MAINTAINED ITS SUPPORTED ORGANIZATION STATUS AS A 501(C)(4) AND HAS SATISFIED THE PUBLIC SUPPORT TESTS UNDER SECTION 509(A)(2) OF THE INTERNAL REVENUE CODE.
SCHEDULE A, PART VI, SECTION A, LINE 3C:	ALL GRANTEES THAT RECEIVE FUNDS FROM THE DELTA DENTAL OF IOWA FOUNDATION ARE REQUIRED TO COMPLETE AN OUTCOMES REPORT WITHIN 30 DAYS OF COMPLETION OF THE PROJECT. FOR GRANTEES UNDER $25,000, THIS INCLUDES INFORMATION SUCH AS THE NUMBER OF INDIVIDUALS SERVICED, CHALLENGES, OPPORTUNITIES AND LESSONS LEARNED. FOR GRANTEES THAT RECEIVE OVER $25,000, AN EVALUATION PLAN IS DEVELOPED IN COORDINATION WITH THE GRANTEE AND THE FOUNDATION SPECIFIC TO THE PROJECT AND TO ALIGN WITH A CORE SET OF INDICATORS OF SUCCESS. IN ADDITION, GRANTEES OVER $50,000 PRESENT TO THE DELTA DENTAL OF IOWA FOUNDATION BOARD AT THE COMPLETION OF THE PROJECT. GRANTEEES MAY REQUEST A ONE-TIME EXTENSION TO SPEND DOWN ANY UNUSED FUNDS, BUT IT MUST BE FOR THE SAME PROJECT, OTHERWISE THE FUNDS ARE REQUIRED TO BE RETURNED. ANY CHANGE FROM THE INITIAL REQUEST FOR FUNDS REQUIRES A WRITTEN REQUEST AND APPROVAL.

Schedule A (Form 990 or 990-EZ) 2019

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Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

DELTA DENTAL OF IOWA FOUNDATION

Employer identification number

26-0762771

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization DELTA DENTAL OF IOWA FOUNDATION

Part I Contributors	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
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization DELTA DENTAL OF IOWA FOUNDATION		Employer identification number 26-0762771

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization DELTA DENTAL OF IOWA FOUNDATION			Employer identification number 26-0762771
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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2019)

Additional Data

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Software Version:

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SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DELTA DENTAL OF IOWA FOUNDATION

Employer identification number

26-0762771

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	14,922,781	14,214,533	11,650,509	8,219,425	7,404,796
b	Contributions ...	2,000,000	1,650,000	1,000,000	3,000,000	1,000,000
c	Net investment earnings, gains, and losses	3,138,857	-914,801	1,590,116	469,972	-142,177
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....	30,760	26,951	26,092	38,888	43,194
g	End of year balance ......	20,030,878	14,922,781	14,214,533	11,650,509	8,219,425

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

100.000 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

Yes

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..		0

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	28,327
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	7,879,589
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	2,656,577
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c	6,735
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	2,663,312
3	Subtract line 2e from line 1..................			3	5,216,277
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	30,760
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c	30,760
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	5,247,037

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	2,392,090
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	5,400
e	Add lines 2a through 2d....................			2e	5,400
3	Subtract line 2e from line 1...................			3	2,386,690
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	30,760
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c	30,760
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	2,417,450

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
PART V, LINE 4:	THE INTENDED USE OF THE ENDOWMENT FUND IS TO PROVIDE A FUTURE STREAM OF INCOME FOR THE FOUNDATION TO BE USED TO FUND THE MISSION OF THE FOUNDATION.
PART X, LINE 2:	AS OF DECEMBER 31, 2019 AND 2018, THE COMPANY'S UNRECOGNIZED TAX BENEFITS WERE NOT SIGNIFICANT. THERE WERE NO SIGNIFICANT PENALTIES OR INTEREST RECOGNIZED OR ACCRUED DURING 2019 AND 2018.
PART XII, LINE 2D - OTHER ADJUSTMENTS:	BOARD MEMBER FEES WAIVED 5,400.

Schedule D (Form 990) 2019

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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

2019

Open to Public
Inspection

Name of the organization
DELTA DENTAL OF IOWA FOUNDATION

Employer identification number
26-0762771

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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) ALBIA COMMUNITY SCHOOL DISTRICT 520 SOUTH CLINTON STREET ALBIA,IA52531	42-6038218	STATE OF IOWA	3,500				FUNDING FOR FOOD SUPPLIES FOR A "GRANT'S BEST CHEF CONTEST" FOR 2ND GRADE STUDENTS TO LEARN THE PROS AND CONS OF NATURAL SUGAR VS. PROCESSED SUGAR AND HOW IT AFFECTS TEETH AND BODY.
(2) ALBIA COMMUNITY SCHOOL DISTRICT 520 SOUTH CLINTON STREET ALBIA,IA52531	42-6038218	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR GRANT ELEMENTARY SCHOOL.
(3) ANKENY COMMUNITY SCHOOL DISTRICT 306 SW SCHOOL STREET ANKENY,IA50023	42-6021919	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR ANKENY HIGH SCHOOL.
(4) ANKENY COMMUNITY SCHOOL DISTRICT 306 SW SCHOOL STREET ANKENY,IA50023	42-6021919	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR CROCKER ELEMENTARY SCHOOL.
(5) ANKENY COMMUNITY SCHOOL DISTRICT 306 SW SCHOOL STREET ANKENY,IA50023	42-6021919	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR NORTHEAST ELEMENTARY SCHOOL.
(6) BETTENDORF COMMUNITY SCHOOL DISTRICT 3311 18TH STREET BETTENDORF,IA52722	42-6000825	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR HERBERT HOOVER ELEMENTARY SCHOOL.
(7) BETTENDORF COMMUNITY SCHOOL DISTRICT 3311 18TH STREET BETTENDORF,IA52722	42-6000825	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR NEIL ARMSTRONG ELEMENTARY SCHOOL.
(8) BETTENDORF COMMUNITY SCHOOL DISTRICT 3311 18TH STREET BETTENDORF,IA52722	42-6000825	STATE OF IOWA		527	AMOUNT PAID	PROVIDED 864 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 864 TOOTHBRUSHES, PASTE, AND FLOSS TO BETTENDORF COMMUNITY SCHOOLS.
(9) BURLINGTON COMMUNITY SCHOOL DISTRICT 1429 WEST AVENUE BURLINGTON,IA52601	42-6037437	STATE OF IOWA		3,908	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR BLACK HAWK ELEMENTARY SCHOOL.
(10) BURLINGTON COMMUNITY SCHOOL DISTRICT 1429 WEST AVENUE BURLINGTON,IA52601	42-6037437	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR ALDO LEOPOLD MIDDLE SCHOOL.
(11) BURLINGTON COMMUNITY SCHOOL DISTRICT 1429 WEST AVENUE BURLINGTON,IA52601	42-6037437	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR SUNNYSIDE ELEMENTARY SCHOOL.
(12) BURLINGTON COMMUNITY SCHOOL DISTRICT 1429 WEST AVENUE BURLINGTON,IA52601	42-6037437	STATE OF IOWA		88	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO BURLINGTON COMMUNITY SCHOOL DISTRICT.
(13) CAMANCHE COMMUNITY SCHOOL DISTRICT 702 13TH AVENUE CAMANCHE,IA52730	42-6016657	STATE OF IOWA		4,443	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILING STATION FOR CAMANCHE HIGH SCHOOL.
(14) CAMANCHE COMMUNITY SCHOOL DISTRICT 702 13TH AVENUE CAMANCHE,IA52730	42-6016657	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILING STATION FOR CAMANCHE ELEMENTARY SCHOOL.
(15) CARLISLE COMMUNITY SCHOOL DISTRICT 430 SCHOOL STREET CARLISLE,IA50047	42-0898003	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILING STATION FOR HARTFORD UPPER ELEMENTARY SCHOOL.
(16) CARLISLE COMMUNITY SCHOOL DISTRICT 430 SCHOOL STREET CARLISLE,IA50047	42-0898003	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILING STATION FOR CARLISLE ELEMENTARY SCHOOL.
(17) CARLISLE COMMUNITY SCHOOL DISTRICT 430 SCHOOL STREET CARLISLE,IA50047	42-0898003	STATE OF IOWA		1,916	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILING STATION FOR CARLISLE MIDDLE SCHOOL.
(18) CITY OF CUMMING 694 N 44TH STREET CUMMING,IA50061	42-1124870	CITY OF CUMMING		4,387	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILING STATION FOR THE CITY OF CUMMING.
(19) CITY OF CUMMING 694 N 44TH STREET CUMMING,IA50061	42-1124870	CITY OF CUMMING	3,300				FUNDS USED TO INSTALL WATER LINE TO MAIN WATER SYSTEM IN TOWN FOR WATER BOTTLE FILLING STATION.
(20) CITY OF INDEPENDENCE 331 FIRST STREET EAST INDEPENDENCE,IA50644	42-6004793	CITY OF INDEPENDENCE	25,000				FUNDING PROVIDES FLUORIDATION EQUIPMENT INSTALLATION FOR THE COMMUNITY OF INDEPENDENCE.
(21) CLARINDA COMMUNITY SCHOOL DISTRICT 423 E NODAWAY STREET CLARINDA,IA51632	42-6001136	STATE OF IOWA		3,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR CLARINDA MIDDLE SCHOOL.
(22) CLARINDA COMMUNITY SCHOOL DISTRICT 423 E NODAWAY STREET CLARINDA,IA51632	42-6001136	STATE OF IOWA		3,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR GARFIELD ELEMENTARY SCHOOL.
(23) CLARINDA COMMUNITY SCHOOL DISTRICT 423 E NODAWAY STREET CLARINDA,IA51632	42-6001136	STATE OF IOWA		790	AMOUNT PAID	PROVIDED 720 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 720 TOOTHBRUSHES, PASTE, AND FLOSS TO CLARINDA SCHOOLS.
(24) CLINTON COMMUNITY SCHOOL DISTRICT 1401 12TH AVE N CLINTON,IA52732	42-6049083	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR EAGLE HEIGHTS ELEMENTARY SCHOOL.
(25) CLINTON COMMUNITY SCHOOL DISTRICT 1401 12TH AVE N CLINTON,IA52732	42-6049083	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR WHITTIER ELEMENTARY SCHOOL.
(26) COLLEGE COMMUNITY SCHOOL DISTRICT 401 76TH AVE SW CEDAR RAPIDS,IA52404	42-6020063	STATE OF IOWA		11,451	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR PRAIRIE EDGE HIGH SCHOOL.
(27) COMMUNITY HEALTH CARE INC 500 W RIVER DR DAVENPORT,IA52801	42-1060724	501(C)3	44,197				FUNDING WILL PURCHASE NECESSARY EQUIPMENT AND TOOLS NEEDED TO PROVIDE PEDIATRIC DENTAL CARE TO UNDERSERVED CHILDREN IN THE COMMUNITY.
(28) COMMUNITY HEALTH CARE INC 500 W RIVER DR DAVENPORT,IA52801	42-1060724	501(C)3	3,159				FUNDING WILL BE FOR THE PURCHASE AND DISTRIBUTION OF FINGER COTS AND SILICONE FINGER BRUSHES TO DISTRIBUTE TO CLIENTS AS PART OF THEIR ORAL HEALTH EDUCATION SESSIONS FOR MOTHERS OF INFANTS ENROLLED IN THE SCOTT COUNTY WIC PROGRAM.
(29) COMMUNITY HEALTH CARE INC 500 W RIVER DR DAVENPORT,IA52801	42-1060724	501(C)3		1,844	AMOUNT PAID	PROVIDED 3,024 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 3,024 TOOTHBRUSHES, PASTE, AND FLOSS TO COMMUNITY HEALTH CARE, INC.
(30) COMMUNITY HEALTH CARE INC 500 W RIVER DR DAVENPORT,IA52801	42-1060724	501(C)3		86	AMOUNT PAID	PROVIDED 288 TOOTHBRUSHES	PROVIDED 288 TOOTHBRUSHES TO COMMUNITY HEALTH CARE, INC.
(31) COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT 300 W BROADWAY STE 1600 COUNCIL BLUFFS,IA51503	42-6001281	STATE OF IOWA		3,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR CARTER LAKE ELEMENTARY SCHOOL.
(32) COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT 300 W BROADWAY STE 1600 COUNCIL BLUFFS,IA51503	42-6001281	STATE OF IOWA		2,488	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR BLOOMER ELEMENTARY SCHOOL.
(33) COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT 300 W BROADWAY STE 1600 COUNCIL BLUFFS,IA51503	42-6001281	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR ROOSEVELT ELEMENTARY SCHOOL.
(34) COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT 300 W BROADWAY STE 1600 COUNCIL BLUFFS,IA51503	42-6001281	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR EDISON ELEMENTARY SCHOOL.
(35) COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT 300 W BROADWAY STE 1600 COUNCIL BLUFFS,IA51503	42-6001281	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR RUE ELEMENTARY SCHOOL.
(36) COUNCIL BLUFFS COMMUNITY SCHOOL DISTRICT 300 W BROADWAY STE 1600 COUNCIL BLUFFS,IA51503	42-6001281	STATE OF IOWA		88	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO RUE ELEMENTARY SCHOOL.
(37) DAVENPORT COMMUNITY SCHOOL DISTRICT 1702 N MAIN STREET DAVENPORT,IA52803	42-6001350	STATE OF IOWA		6,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR BLUE GRASS ELEMENTARY SCHOOL.
(38) DAVENPORT COMMUNITY SCHOOL DISTRICT 1702 N MAIN STREET DAVENPORT,IA52803	42-6001350	STATE OF IOWA		3,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR JEFFERSON ELEMENTARY SCHOOL.
(39) DAVENPORT COMMUNITY SCHOOL DISTRICT 1702 N MAIN STREET DAVENPORT,IA52803	42-6001350	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR BUCHANAN ELEMENTARY SCHOOL.
(40) DAVENPORT COMMUNITY SCHOOL DISTRICT 1702 N MAIN STREET DAVENPORT,IA52803	42-6001350	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR GARFIELD ELEMENTARY SCHOOL.
(41) DAVENPORT COMMUNITY SCHOOL DISTRICT 1702 N MAIN STREET DAVENPORT,IA52803	42-6001350	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR HARRISON ELEMENTARY SCHOOL.
(42) DAVENPORT COMMUNITY SCHOOL DISTRICT 1702 N MAIN STREET DAVENPORT,IA52803	42-6001350	STATE OF IOWA		220	AMOUNT PAID	PROVIDED 648 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 648 TOOTHBRUSHES, PASTE, AND FLOSS TO DAVENPORT COMMUNITY SCHOOL DISTRICT.
(43) DAVENPORT COMMUNITY SCHOOL DISTRICT 1702 N MAIN STREET DAVENPORT,IA52803	42-6001350	STATE OF IOWA		88	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO FRANK L SMART INTERMEDIATE SCHOOL.
(44) DAVENPORT COMMUNITY SCHOOL DISTRICT 1702 N MAIN STREET DAVENPORT,IA52803	42-6001350	STATE OF IOWA		88	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO WILLIAMS INTERMEDIATE SCHOOL.
(45) DENTAL CONNECTIONS 1111 9TH STREET STE 190 DES MOINES,IA50314	42-0680421	501(C)3	8,193				FUNDING WILL PROVIDE TRANSPORTATION AND CARE COORDINATION TO ELIMINATE BARRIERS TO DENTAL CARE FOR CHILDREN.
(46) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		2,301	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR RIVER WOODS ELEMENTARY SCHOOL.
(47) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		1,325	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR STOWE ELEMENTARY SCHOOL.
(48) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		1,325	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR HANAWALT ELEMENTARY SCHOOL.
(49) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		1,325	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR MERRILL MIDDLE SCHOOL.
(50) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		1,078	AMOUNT PAID	PROVIDED 4,608 TOOTHBRUSHES	PROVIDED 4,608 TOOTHBRUSHES TO DES MOINES PUBLIC SCHOOLS HEADSTART.
(51) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		439	AMOUNT PAID	PROVIDED 720 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 720 TOOTHBRUSHES, PASTE, AND FLOSS TO CAPITOL VIEW ELEMENTARY SCHOOL.
(52) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		307	AMOUNT PAID	PROVIDED 504 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 504 TOOTHBRUSHES, PASTE, AND FLOSS TO OAK PARK ELEMENTARY SCHOOL.
(53) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		263	AMOUNT PAID	PROVIDED 432 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 432 TOOTHBRUSHES, PASTE, AND FLOSS TO CATTELL ELEMENTARY SCHOOL.
(54) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		263	AMOUNT PAID	PROVIDED 432 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 432 TOOTHBRUSHES, PASTE, AND FLOSS TO HILLIS ELEMENTARY SCHOOL.
(55) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		263	AMOUNT PAID	PROVIDED 432 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 432 TOOTHBRUSHES, PASTE, AND FLOSS TO DES MOINES PUBLIC SCHOOLS.
(56) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		220	AMOUNT PAID	PROVIDED 360 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 360 TOOTHBRUSHES, PASTE, AND FLOSS TO GREENWOOD ELEMENTARY SCHOOL.
(57) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO RIVER WOODS ELEMENTARY SCHOOL.
(58) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO HIATT MIDDLE SCHOOL.
(59) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO WILLARD ELEMENTARY SCHOOL.
(60) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO MCCOMBS MIDDLE SCHOOL.
(61) DES MOINES INDEPENDENT COMMUNITY SCHOOL DISTRICT 2323 GRAND AVE DES MOINES,IA50312	42-6001433	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO WALNUT STREET SCHOOL.
(62) DRAKE UNIVERSITY 2507 UNIVERSITY AVENUE DES MOINES,IA50311	42-0680460	501(C)3	11,178				FUNDING TO SUPPORT A CONFERENCE TO FURTHER DEVELOP THE PATH TOWARDS MEDICAL-DENTAL INTEGRATION USING INFORMATION
(63) DRAKE UNIVERSITY 2507 UNIVERSITY AVENUE DES MOINES,IA50311	42-0680460	501(C)3		950	AMOUNT PAID	PROVIDED 3,984 TOOTHBRUSHES	PROVIDED 3,984 TOOTHBRUSHES TO DRAKE UNIVERSITY HEAD START.
(64) DUBUQUE COMMUNITY SCHOOL DISTRICT 2300 CHANEY ROAD DUBUQUE,IA52001	42-6001531	STATE OF IOWA		3,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR AUDUBON ELEMENTARY SCHOOL.
(65) DUBUQUE COMMUNITY SCHOOL DISTRICT 2300 CHANEY ROAD DUBUQUE,IA52001	42-6001531	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR ALTERNATIVE LEARNING CENTER.
(66) DUBUQUE COMMUNITY SCHOOL DISTRICT 2300 CHANEY ROAD DUBUQUE,IA52001	42-6001531	STATE OF IOWA		1,916	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR ELEANOR ROOSEVELT MIDDLE SCHOOL.
(67) DUBUQUE COMMUNITY SCHOOL DISTRICT 2300 CHANEY ROAD DUBUQUE,IA52001	42-6001531	STATE OF IOWA		88	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	POVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO MARSHALL ELEMENTARY SCHOOL.
(68) EDDYVILLE BLAKESBURG FREMONT COMMUNITY SCHOOL DISTRICT 702 VANCE STREET EDDYVILLE,IA52553	42-1415763	STATE OF IOWA		5,943	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR EDDYVILLE ELEMENTARY SCHOOL.
(69) EDDYVILLE BLAKESBURG FREMONT COMMUNITY SCHOOL DISTRICT 702 VANCE STREET EDDYVILLE,IA52553	42-1415763	STATE OF IOWA		176	AMOUNT PAID	PROVIDED 288 TOOTHBRUSHES, PASTE, FLOSS	PROVIDED 288 TOOTHBRUSHES, PASTE, AND FLOSS TO EDDYVILLE BLAKESBURG FREMONT SCHOOLS.
(70) FAMILY INC 3501 HARRY LANGDON BLVD STE 150 COUNCIL BLUFFS,IA51503	51-0657063	501(C)3	25,000				FUNDING TO CONTINUE COLLABORATION FOR CHILDREN'S ORAL HEALTH MOVING TOWARDS SCOPE EXPANSION AS THE "CHILDREN'S ORAL HEALTH COALITION OF SOUTHWEST IOWA" FOCUSING ON REDUCING SUGAR SWEETENED BEVERAGE (SSB) INTAKE AMONG CHILDREN.
(71) FAMILY INC 3501 HARRY LANGDON BLVD STE 150 COUNCIL BLUFFS,IA51503	51-0657063	501(C)3	3,500				FUNDING TO PURCHASE AND/OR DISTRIBUTE PRODUCTS, SUPPLIES, OR EDUCATION MATERIALS FOR THE ANNUAL GIVE KIDS A SMILE DAY, WHICH REACHES OUT TO FAMILIES WITH BARRIERS TO ACCESSING DENTAL CARE AND RURAL UNDERSERVED CHILDREN.
(72) FAMILY INC 3501 HARRY LANGDON BLVD STE 150 COUNCIL BLUFFS,IA51503	51-0657063	501(C)3		3,111	AMOUNT PAID	PROVIDED 12,096 TOOTHBRUSHES	PROVIDED 12,096 TOOTHBRUSHES TO FAMILY, INC.
(73) FORT DODGE COMMUNITY SCHOOL DISTRICT 104 SOUTH 17TH STREET FORT DODGE,IA50501	42-6001767	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR FORT DODGE MIDDLE SCHOOL.
(74) FORT DODGE COMMUNITY SCHOOL DISTRICT 104 SOUTH 17TH STREET FORT DODGE,IA50501	42-6001767	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR FEELHAVER ELEMENTARY SCHOOL.
(75) GENESIS MEDICAL CENTER 1351 W CENTRAL PARK DAVENPORT,IA52742	42-1418847	501(C)3	227,573				FUNDING TO SUPPORT IMPLEMENTATION OF AN EVIDENCE-BASED PRACTICE PREVENTION PROGRAM TO IMPROVE ORAL CARE OF THE NONVENTILATED PATIENT POPULATION IN TWO IOWA GENESIS HOSPITALS.
(76) GLENWOOD COMMUNITY SCHOOL DISTRICT 103 CENTRAL GLENWOOD,IA51534	42-0864701	STATE OF IOWA		5,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR NORTHEAST ELEMENTARY SCHOOL.
(77) GLENWOOD COMMUNITY SCHOOL DISTRICT 103 CENTRAL GLENWOOD,IA51534	42-0864701	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR GLENWOOD MIDDLE SCHOOL.
(78) GRINNELL-NEWBURG COMMUNITY SCHOOL DISTRICT 1333 SUNSET STREET GRINNELL,IA50112	42-6036570	STATE OF IOWA		3,988	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR BAILEY PARK ELEMENTARY SCHOOL.
(79) GRINNELL-NEWBURG COMMUNITY SCHOOL DISTRICT 1333 SUNSET STREET GRINNELL,IA50112	42-6036570	STATE OF IOWA		3,908	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR FAIRVIEW ELEMENTARY SCHOOL.
(80) HAWKEYE AREA COMMUNITY ACTION PROGRAM 1328 2ND AVE SE CEDAR RAPIDS,IA52403	42-0898405	501(C)3		5,118	AMOUNT PAID	PROVIDED 21,024 TOOTHBRUSHES	PROVIDED 21,024 TOOTHBRUSHES TO HAWKEYE AREA COMMUNITY ACTION I-SMILE PROGRAM.
(81) HAWKEYE AREA COMMUNITY ACTION PROGRAM 1328 2ND AVE SE CEDAR RAPIDS,IA52403	42-0898405	501(C)3		875	AMOUNT PAID	PROVIDED 3,024 TOOTHBRUSHES	PROVIDED 3,024 TOOTHBRUSHES TO HAWKEYE AREA COMMUNITY ACTION HEAD START.
(82) HIS HANDS MINISTRIES 400 12TH STREET SE CEDAR RAPIDS,IA52403	39-1878606	501(C)3	5,000				FUNDING WILL BE FOR CARE COORDINATION TO SERVE MORE INDIVIDUALS WHO ARE WITHOUT DENTAL INSURANCE AND DO NOT QUALIFY FOR AID FOR DENTAL CARE.
(83) IOWA CAREGIVERS 939 OFFICE PARK ROAD 332 WEST DES MOINES,IA50265	42-1457592	501(C)3	20,000				FUNDING SUPPORTS MOUTHCARE MATTERS, PHASE 2 FOR ORAL HEALTH EDUCATION AND ACCESS TO CARE FOR UNDERSERVED POPULATIONS.
(84) IOWA DENTAL ASSOCIATION 8797 NW 54TH AVE STE 100 JOHNSTON,IA50131	42-0355455	501(C)3	15,000				FUNDING FOR AN EDUCATIONAL SESSION PRESENTED BY DR. GREG PSALTIS REGARDING PEDIATRIC DENTISTRY.
(85) IOWA DENTAL FOUNDATION 8797 NW 54TH AVE STE 100 JOHNSTON,IA50131	42-1405188	501(C)3	25,000				FUNDING TO PROVIDE EQUIPMENT AND SUPPLIES IN ORDER TO PERFORM SERVICES FOR ORAL HEALTH CARE TO UNDERSERVED CHILDREN AND OLDER ADULTS, MEALS TO OVER 1,000 VOLUNTEERS THROUGHOUT THE DAYS OF THE IOWA MISSION OF MERCY EVENT, MARKETING EFFORTS, AND STAFF TRAVEL/SALARY COSTS.
(86) IOWA DENTAL HYGIENTISTS' ASSOCIATION 136 WILLISTON AVE WATERLOO,IA50702	42-6095419	501(C)6	5,350				FUNDING PROVIDES CONTINUING EDUCATION CLASS PRESENTED TO DENTISTS, DENTAL HYGIENISTS, AND DENTAL ASSISTANTS ON FLUORIDE IN OTC'S, IN-OFFICE VARNISHES, AND SILVER DIAMINE.
(87) IOWA DEPT OF PUBLIC HEALTH-IOWA BOARD OF PHARMACY 400 SW 8TH STREET STE E DES MOINES,IA50309	42-6004523	STATE OF IOWA	167,450				FUNDING CONTINUES TO SUPPORT THE PROGRESS OF THE I-SMILE SILVER PROJECT AND EXPAND THE REACH OF I-SMILE SILVER TO ALL AT-RISK IOWA ADULTS, PARTICULARLY ADULTS ENROLLED IN MEDICAID TO ACCESS ORAL HEALTH SERVICES AND MAINTAIN OVERALL AND ORAL HEALTH.
(88) IOWA DEPT OF PUBLIC HEALTH-ORAL HEALTH BUREAU 321 EAST 12TH STREET DES MOINES,IA50319	42-6004523	STATE OF IOWA	200,000				FUNDING CONTINUES TO SUPPORT I-SMILE@SCHOOL, A STATE WIDE SCHOOL-BASED SEALANT PROGRAM FOR UNDERSERVED CHILDREN.
(89) IOWA DEPT OF PUBLIC HEALTH-ORAL HEALTH BUREAU 321 EAST 12TH STREET DES MOINES,IA50319	42-6004523	STATE OF IOWA	4,000				FUNDING TO ADD TWO ORAL HEALTH QUESTIONS TO THE 2020 IOWA BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM SURVEY ADDRESSING HEALTH BEHAVIORS AND OUTCOMES OF U.S. ADULTS.
(90) IOWA DEPT OF PUBLIC HEALTH-ORAL HEALTH BUREAU 321 EAST 12TH STREET DES MOINES,IA50319	42-6004523	STATE OF IOWA	1,500				FUNDING WILL BE USED BY THE CAVITY FREE IOWA COALITION TO SEND A LETTER TO ALL GENERAL AND PEDIATRIC DENTISTS IN IOWA TO EXPLAIN THE CAVITY FREE IOWA PROGRAM AND WHY TO SUPPORT USE OF FLUORIDE VARNISH.
(91) KEOKUK COMMUNITY SCHOOL DISTRICT 727 WASHINGTON STREET KEOKUK,IA52632	42-6002226	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR KEOKUK HIGH SCHOOL.
(92) KEOKUK COMMUNITY SCHOOL DISTRICT 727 WASHINGTON STREET KEOKUK,IA52632	42-6002226	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR KEOKUK MIDDLE SCHOOL.
(93) LINN MAR COMMUNITY SCHOOL DISTRICT 31111 N 10TH STREET MARION,IA52302	42-1495648	STATE OF IOWA		6,443	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR NOVAK ELEMENTARY SCHOOL.
(94) MARION COUNTY PUBLIC HEALTH 2003 LINCOLN STREET KNOXVILLE,IA50138	42-6004844	501(C)3	12,500				FUNDING CONTRIBUTES TO THE I-SMILE "HEALTHY MOUTHS, HEALTHY MOMS ORAL HEALTH INITIATIVE THAT WILL FOCUS ON THE ORAL HEALTH OF PREGNANT WOMEN WITH A SPECIAL EMPHASIS ON EDUCATING THAT ORAL HEALTH IS AN IMPORTANT PART OF PRENATAL CARE.
(95) MARION COUNTY PUBLIC HEALTH 2003 LINCOLN STREET KNOXVILLE,IA50138	42-6004844	501(C)3		1,972	AMOUNT PAID	PROVIDED 8,064 TOOTHBRUSHES	PROVIDED 8,064 TOOTHBRUSHES TO MARION COUNTY PUBLIC HEALTH.
(96) MATURA ACTION CORPORATION 207 B NORTH ELM STREET CRESTON,IA50801	42-0920388	501(C)3	6,000				FUNDING WILL PROVIDE OUTREACH AND COORDINATION FOR DENTAL SCREENINGS BY COLLABORATING WITH THE CHILD CARE NURSE CONSULTANT TO REACH THOSE CHILDREN WHO FALL BETWEEN THE GAPS OF DENTAL SERVICE, WITH A FOCUS ON THOSE AT IN-HOME CHILDCARE SETTINGS.
(97) MATURA ACTION CORPORATION 207 B NORTH ELM STREET CRESTON,IA50801	42-0920388	501(C)3		604	AMOUNT PAID	PROVIDED 2,304 TOOTHBRUSHES	PROVIDED 2,304 TOOTHBRUSHES TO MATURA SOUTH.
(98) MATURA ACTION CORPORATION 207 B NORTH ELM STREET CRESTON,IA50801	42-0920388	501(C)3		192	AMOUNT PAID	PROVIDED 864 TOOTHBRUSHES	PROVIDED 864 TOOTHBRUSHES TO MATURA HEAD START.
(99) MID-IOWA COMMUNITY ACTION INC 1001 S 18TH AVE MARSHALLTOWN,IA50158	42-0923311	501(C)3	6,060				FUNDING WILL ASSIST WITH STORY COUNTY DENTAL CLINIC EQUIPMENT REPLACEMENT TO CONTINUE TO PROVIDE LONG-TERM IMPACT FOR PATIENTS AND PRACTIONERS, WHO WILL HAVE A HIGHER LEVEL OF DIAGNOSTIC AND THERAPEUTIC EFFECTIVENESS.
(100) MID-IOWA COMMUNITY ACTION INC 1001 S 18TH AVE MARSHALLTOWN,IA50158	42-0923311	501(C)3	3,500				FUNDING WILL PROVIDE A HEALTH CARE INSTITUTE FOR LIMITED-INCOME FAMILIES WITH CHILDREN AGES 0-5.
(101) MID-IOWA COMMUNITY ACTION INC 1001 S 18TH AVE MARSHALLTOWN,IA50158	42-0923311	501(C)3		2,434	AMOUNT PAID	PROVIDED 9,504 TOOTHBRUSHES	PROVIDED 9,504 TOOTHBRUSHES TO I-SMILE AND HEAD START PROGRAMS
(102) NASHUA-PLAINFIELD COMMUNITY SCHOOL DISTRICT 621 PANAMA STREET NASHUA,IA50658	42-6039480	STATE OF IOWA		4,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR NASHUA-PLAINFIELD ELEMENTARY SCHOOL.
(103) NASHUA-PLAINFIELD COMMUNITY SCHOOL DISTRICT 621 PANAMA STREET NASHUA,IA50658	42-6039480	STATE OF IOWA		3,908	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR NASHUA-PLAINFIELD JUNIOR HIGH/HIGH SCHOOL.
(104) SOUTH CENTRAL CALHOUN COMMUNITY SCHOOL DISTRICT 709 WEST MAIN LAKE CITY,IA51449	46-4443300	STATE OF IOWA		3,908	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR SOUTH CENTRAL CALHOUN HIGH SCHOOL.
(105) SOUTH CENTRAL CALHOUN COMMUNITY SCHOOL DISTRICT 709 WEST MAIN LAKE CITY,IA51449	46-4443300	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR SOUTH CENTRAL CALHOUN ELEMENTARY SCHOOL.
(106) SPECIAL OLYMPICS IOWA 551 SE DOVETAIL ROAD GRIMES,IA50111	51-0176029	501(C)3	5,000				FUNDING FOR THE HEALTHY ATHLETES SPECIAL SMILES EDUCATION AND SCREENING PROGRAM.
(107) TRI-COUNTY CHILD AND FAMILY DEVELOPMENT 205 ADAMS STREET STE 2 WATERLOO,IA50703	42-1020922	501(C)3	48,939				FUNDING FOR ORAL HEALTH CARE SERVICES PRIMARILY FOR THE EASTSIDE COMMUNITY OF WATERLOO FOR THE CHILDREN OF TRI-COUNTY HEAD START PROGRAM AND PARTICIPANTS OF GRUNDY AND BUCHANAN COUNTIES.
(108) TRI-COUNTY CHILD AND FAMILY DEVELOPMENT 205 ADAMS STREET STE 2 WATERLOO,IA50703	42-1020922	501(C)3		2,054	AMOUNT PAID	PROVIDED 8,352 TOOTHBRUSHES	PROVIDED 8,352 TOOTHBRUSHES TO TRI-COUNTY CHILD AND FAMILY DEVELOPMENT.
(109) UNIVERSITY OF IOWA COLLEGE OF DENTISTRY 801 NEWTON STREET IOWA CITY,IA52242	42-6004813	STATE OF IOWA	24,890			.	FUNDING TO SUPPORT THE PROJECT TO FOCUS ON INCREASING THE KNOWLEDGE AND SKILL OF AFRICAN REFUGEES/IMMIGRANTS TO FULFILL THE HEALTHY BEHAVIORS REQUIREMENT OF THE DWP ENSURING MORE REFUGEES WILL QUALIFY FOR FULL DENTAL BENEFITS AND INCREASE UTILIZATION OF PREVENTIVE ORAL HEALTH SERVICES.
(110) UNIVERSITY OF IOWA COLLEGE OF DENTISTRY 801 NEWTON STREET IOWA CITY,IA52242	42-6004813	STATE OF IOWA	13,776			.	FUNDING FOR THE UNIVERSITY OF IOWA COLLEGE OF DENTISTRY'S 2019 STUDENTS ORAL HEALTH PROJECTS.
(111) UNIVERSITY OF IOWA COLLEGE OF DENTISTRY 801 NEWTON STREET IOWA CITY,IA52242	42-6004813	STATE OF IOWA	12,700			.	FUNDING FOR THE MIDWEST DENTAL PUBLIC HEALTH CONFERENCE ANNUAL SESSION 2019.
(112) UNIVERSITY OF IOWA COLLEGE OF DENTISTRY 801 NEWTON STREET IOWA CITY,IA52242	42-6004813	STATE OF IOWA	12,500			.	FUNDING WILL CONTRIBUTE TO THE TOTS TO TEENS: MEETING THE CHALLENGE OF TODAY'S PEDIATRIC DENTAL PATIENT CONFERENCE.
(113) UNIVERSITY OF IOWA COLLEGE OF DENTISTRY 801 NEWTON STREET IOWA CITY,IA52242	42-6004813	STATE OF IOWA	3,500			.	FUNDING FOR UNIVESITY OF IOWA COLLEGE OF DENTISTRY PEDIATRIC DENTAL RESIDENT OUTREACH PROJECT.
(114) URBANDALE COMMUNITY SCHOOL DISTRICT 11152 AURORA AVENUE URBANDALE,IA50322	42-6039212	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR WEBSTER ELEMENTARY SCHOOL.
(115) URBANDALE COMMUNITY SCHOOL DISTRICT 11152 AURORA AVENUE URBANDALE,IA50322	42-6039212	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR ROLLING GREEN ELEMENTARY SCHOOL.
(116) URBANDALE COMMUNITY SCHOOL DISTRICT 11152 AURORA AVENUE URBANDALE,IA50322	42-6039212	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO KAREN ACRES ELEMENTARY SCHOOL.
(117) VISITING NURSE SERVICES 1111 9TH ST STE 320 DES MOINES,IA50314	42-0680446	501(C)3	9,025				FUNDING TO EXPAND SERVICES AS PART OF THE CAVITY FREE IOWA PROJECT GAP TO IMPROVE THE OVERALL HEALTH OF IOWA'S CHILDREN.
(118) VISITING NURSE SERVICES 1111 9TH ST STE 320 DES MOINES,IA50314	42-0680446	501(C)3		2,687	AMOUNT PAID	PROVIDED 11,232 TOOTHBRUSHES	PROVIDED 11,232 TOOTHBRUSHES TO VISITING NURSE SERVICES CEDAR RAPIDS I-SMILE PROGRAM.
(119) VISITING NURSE SERVICES 1111 9TH ST STE 320 DES MOINES,IA50314	42-0680446	501(C)3		710	AMOUNT PAID	PROVIDED 2,592 TOOTHBRUSHES	PROVIDED 2,592 TOOTHBRUSHES TO VISITING NURSE SERVICES DES MOINES I-SMILE PROGRAM.
(120) WASHINGTON COUNTY PUBLIC HEALTH 110 N IOWA AVE WASHINGTON,IA52353	42-6005319	STATE OF IOWA		4,387	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR CITY OF WASHINGTON.
(121) WASHINGTON COUNTY PUBLIC HEALTH 110 N IOWA AVE WASHINGTON,IA52353	42-6005319	STATE OF IOWA		2,806	AMOUNT PAID	PROVIDED 10,944 TOOTHBRUSHES	PROVIDED 10,944 TOOTHBRUSHES TO WASHINGTON COUNTY PUBLIC HEALTH.
(122) WATERLOO COMMUNITY SCHOOL DISTRICT 1516 WASHINGTON STREET WATERLOO,IA50702	42-6003910	STATE OF IOWA		1,766	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR HIGHLAND ELEMENTARY SCHOOL.
(123) WATERLOO COMMUNITY SCHOOL DISTRICT 1516 WASHINGTON STREET WATERLOO,IA50702	42-6003910	STATE OF IOWA		1,766	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR LOU HENRY ELEMENTARY SCHOOL.
(124) WATERLOO COMMUNITY SCHOOL DISTRICT 1516 WASHINGTON STREET WATERLOO,IA50702	42-6003910	STATE OF IOWA		1,766	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR ORANGE ELEMENTARY SCHOOL.
(125) WATERLOO COMMUNITY SCHOOL DISTRICT 1516 WASHINGTON STREET WATERLOO,IA50702	42-6003910	STATE OF IOWA		1,338	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR EXPO ALTERNATIVE LEARNING CENTER.
(126) WATERLOO COMMUNITY SCHOOL DISTRICT 1516 WASHINGTON STREET WATERLOO,IA50702	42-6003910	STATE OF IOWA		1,338	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR DR WALTER CUNNINGHAM SCHOOL FOR EXCELLENCE.
(127) WATERLOO COMMUNITY SCHOOL DISTRICT 1516 WASHINGTON STREET WATERLOO,IA50702	42-6003910	STATE OF IOWA		88	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO LOWELL ELEMENTARY SCHOOL.
(128) WAVERLY-SHELL ROCK COMMUNITY SCHOOL DISTRICT 214 CHERRY STREET SHELL ROCK,IA50670	42-6000882	STATE OF IOWA		6,488	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR SOUTHEAST ELEMENTARY SCHOOL.
(129) WAVERLY-SHELL ROCK COMMUNITY SCHOOL DISTRICT 214 CHERRY STREET SHELL ROCK,IA50670	42-6000882	STATE OF IOWA		3,988	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR WEST CEDAR ELEMENTARY SCHOOL.
(130) WAVERLY-SHELL ROCK COMMUNITY SCHOOL DISTRICT 214 CHERRY STREET SHELL ROCK,IA50670	42-6000882	STATE OF IOWA		3,908	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR SHELL ROCK ELEMENTARY SCHOOL.
(131) WAVERLY-SHELL ROCK COMMUNITY SCHOOL DISTRICT 214 CHERRY STREET SHELL ROCK,IA50670	42-6000882	STATE OF IOWA		3,908	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR MARGARETTA CAREY ELEMENTARY SCHOOL.
(132) WEBSTER CITY COMMUNITY SCHOOL DISTRICT 820 DES MOINES STREET WEBSTER CITY,IA50595	42-6021630	STATE OF IOWA		4,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR WEBSTER CITY HIGH SCHOOL.
(133) WEBSTER CITY COMMUNITY SCHOOL DISTRICT 820 DES MOINES STREET WEBSTER CITY,IA50595	42-6021630	STATE OF IOWA		3,908	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR WEBSTER CITY MIDDLE SCHOOL.
(134) WEBSTER CITY COMMUNITY SCHOOL DISTRICT 820 DES MOINES STREET WEBSTER CITY,IA50595	42-6021630	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR SUNSET HEIGHTS ELEMENTARY SCHOOL.
(135) WEST CENTRAL VALLEY COMMUNITY SCHOOL DISTRICT 320 NE 3RD STREET STUART,IA50250	42-1516482	STATE OF IOWA		4,210	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR STUART ELEMENTARY SCHOOL.
(136) WEST CENTRAL VALLEY COMMUNITY SCHOOL DISTRICT 320 NE 3RD STREET STUART,IA50250	42-1516482	STATE OF IOWA		4,210	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR WEST CENTRAL VALLEY HIGH SCHOOL.
(137) WEST CENTRAL VALLEY COMMUNITY SCHOOL DISTRICT 320 NE 3RD STREET STUART,IA50250	42-1516482	STATE OF IOWA		307	AMOUNT PAID	PROVIDED 504 TOOTHBRUSHES, PASTE, AND FLOSS	PROVIDED 504 TOOTHBRUSHES, PASTE, AND FLOSS TO WEST CENTRAL VALLEY COMMUNITY SCHOOLS.
(138) WEST DES MOINES COMMUNITY SCHOOLS 3550 MILLS CIVIC PARKWAY WEST DES MOINES,IA50265	42-6004027	STATE OF IOWA		4,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR WESTRIDGE ELEMENTARY SCHOOL.
(139) WEST DES MOINES COMMUNITY SCHOOLS 3550 MILLS CIVIC PARKWAY WEST DES MOINES,IA50265	42-6004027	STATE OF IOWA		2,836	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR CROSSROADS PARK ELEMENTARY SCHOOL.
(140) WEST DES MOINES COMMUNITY SCHOOLS 3550 MILLS CIVIC PARKWAY WEST DES MOINES,IA50265	42-6004027	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR FAIRMEADOWS ELEMENTARY SCHOOL.
(141) WEST DES MOINES COMMUNITY SCHOOLS 3550 MILLS CIVIC PARKWAY WEST DES MOINES,IA50265	42-6004027	STATE OF IOWA		2,408	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR STILWELL JUNIOR HIGH SCHOOL.
(142) WEST DES MOINES COMMUNITY SCHOOLS 3550 MILLS CIVIC PARKWAY WEST DES MOINES,IA50265	42-6004027	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO HILLSIDE ELEMENTARY SCHOOL.
(143) WEST DES MOINES COMMUNITY SCHOOLS 3550 MILLS CIVIC PARKWAY WEST DES MOINES,IA50265	42-6004027	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO FAIRMEADOWS ELEMENTARY SCHOOL.
(144) WEST DES MOINES COMMUNITY SCHOOLS 3550 MILLS CIVIC PARKWAY WEST DES MOINES,IA50265	42-6004027	STATE OF IOWA		87	AMOUNT PAID	PROVIDED 144 TOOTHBRUSHES, PASTE AND FLOSS	PROVIDED 144 TOOTHBRUSHES, PASTE, AND FLOSS TO CRESTVIEW ELEMENTARY SCHOOL.
(145) WINTERSET COMMUNITY SCHOOL DISTRICT 404 S 2ND STREET WINTERSET,IA50273	42-6036418	STATE OF IOWA		5,943	AMOUNT PAID	WATER BOTTLE FILLING STATION	INSTALLED A WATER BOTTLE FILLING STATION FOR WINTERSET ELEMENTARY SCHOOL.

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

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:	THE DELTA DENTAL OF IOWA FOUNDATION HAS ACCESS TO GUIDESTAR.COM TO REVIEW ANY ORGANIZATION'S FORM 990. ONCE AWARDED FUNDS, DELTA DENTAL OF IOWA FOUNDATION NOTIFIES GRANTEES OF AN OUTCOMES REPORTING FORM THAT MUST BE COMPLETED WITHIN A YEAR OF THE GRANT PERIOD END DATE BASED ON THE ALLOCATED FUNDS PROVIDED UNLESS ANOTHER DATE HAS BEEN AGREED UPON.

Schedule I (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DELTA DENTAL OF IOWA FOUNDATION

Employer identification number

26-0762771

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JEFFREY S RUSSELL PRESIDENT	(i) (ii)	0 ------------- 539,129	0 ------------- 215,668	0 ------------- 134,716	0 ------------- 8,001	0 ------------- 30,381	0 ------------- 927,895	0 ------------- 118,975
2JEFF CHAFFIN DDS DIRECTOR	(i) (ii)	0 ------------- 250,094	0 ------------- 68,502	0 ------------- 78,837	0 ------------- 12,461	0 ------------- 1,622	0 ------------- 411,516	0 ------------- 75,295
3SHERRY PERKINS SECRETARY-TREASURER	(i) (ii)	0 ------------- 202,736	0 ------------- 60,759	0 ------------- 37,352	0 ------------- 12,761	0 ------------- 1,574	0 ------------- 315,182	0 ------------- 35,456
4SUZANNE HECKENLAIBLE EXECUTIVE DIRECTOR	(i) (ii)	0 ------------- 184,524	0 ------------- 57,510	0 ------------- 29,442	0 ------------- 13,188	0 ------------- 30,381	0 ------------- 315,045	0 ------------- 27,516

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

PART I, LINE 4B

EFFECTIVE JANUARY 1, 2016, THE OFFICERS OF DELTA DENTAL OF IOWA, A RELATED ORGANIZATION, PARTICIPATE IN A SEC. 457(F) PLAN. DELTA DENTAL OF IOWA MAKES A CONTRIBUTION TO THE PLAN ANNUALLY ON BEHALF OF THE OFFICERS. THIS CONTRIBUTION IS A PERCENTAGE OF SALARY AND IS SET AND APPROVED BY THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF DELTA DENTAL OF IOWA. THE PORTION OF A PARTICIPANT'S ACCOUNT BALANCE ALLOCATED TO A PARTICULAR PLAN YEAR'S AWARD BECOMES VESTED ON JANUARY 1ST OF THE FOURTH YEAR FOLLOWING THE PLAN YEAR FOR WHICH THE AWARD IS GRANTED. THAT AMOUNT IS THEN PAID TO THE OFFICER. OTHER THAN THE VESTING CRITERIA, THE OFFICERS CANNOT ACCESS THE FUNDS UNTIL RETIREMENT, LEAVING THE COMPANY, OR DEATH. OFFICERS WHO RECEIVED DEPOSITS IN 2019 FROM DELTA DENTAL OF IOWA AND THE AMOUNTS ARE: JEFFREY S. RUSSELL $ 54,727 SHERRY PERKINS $ 8,162 SUZANNE HECKENLAIBLE $ 6,792 JEFF CHAFFIN $ 29,254 OFFICERS THAT RECEIVED PAYMENTS OF VESTED AMOUNTS IN 2019 AND THE AMOUNTS ARE: JEFFREY S. RUSSELL $ 118,975 SHERRY PERKINS $ 35,456 SUZANNE HECKENLAIBLE $ 27,516 JEFF CHAFFIN $ 75,295 THE OFFICERS OF DELTA DENTAL OF IOWA, A RELATED ORGANIZATION, PARTICIPATE IN A LONG-TERM INCENTIVE PLAN. THE PLAN IS INTENDED AND AT ALL TIMES SHALL BE AN UNFUNDED AND UNSECURED PLAN THAT IS LIMITED TO KEY MANAGEMENT EMPLOYEES OF THE ORGANIZATION DESIGNED TO ENHANCE THE BOARD'S EFFORT AT RETENTION OF ITS EXECUTIVE STAFF. NO PAYMENTS WERE MADE IN 2019.

SCHEDULE J, PART I, LINE 3

THE EXECUTIVE DIRECTOR AND OFFICERS EXCLUDING THE CHAIR AND VICE CHAIR OF THE BOARD OF THE FOUNDATION ARE EMPLOYEES OF DELTA DENTAL OF IOWA. DELTA DENTAL OF IOWA CHARGES THE FOUNDATION A MANAGEMENT FEE FOR THE TIME SPENT BY THE PRESIDENT, SECRETARY AND TREASURER, AND EXECUTIVE DIRECTOR.

Schedule J (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

DELTA DENTAL OF IOWA FOUNDATION

Employer identification number

26-0762771

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 2	J. CHAFFIN HAD A PROVIDER-RELATED BUSINESS RELATIONSHIP WITH "DELTA DENTAL OF IOWA" BOARD MEMBER D. GRANT IN 2019. T. RODGERS HAD A BUSINESS RELATIONSHIP WITH L. CURRY AND H. COWEN IN 2019. D. CAPLAN HAD A BUSINESS RELATIONSHIP WITH H. COWEN, K. JONES, AND T. RODGERS IN 2019. R. CROSBIE HAD A BUSINESS RELATIONSHIP WITH "DELTA DENTAL OF IOWA" BOARD MEMBER E. BROWN IN 2019.
FORM 990, PART VI, SECTION A, LINE 4	THE FOUNDATION BOARD APPROVED A NEW MISSION IN NOVEMBER AND THE MEMBER ("DELTA DENTAL OF IOWA") APPROVED IN DECEMBER 2019. ARTICLES OF AMENDMENT WAS FILED IN JANUARY 2020 WITH THEIR NEW MISSION "THE CORPORATION IS ORGANIZED TO STRENGTHEN AND TRANSFORM THE HEALTH AND SMILES OF ALL IOWANS. NOTWITHSTANDING THE FOREGOING, HOWEVER, THE CORPORATION IS ORGANIZED EXCLUSIVELY FOR CHARITABLE, EDUCATIONAL, AND SCIENTIFIC PURPOSES, INCLUDING, FOR SUCH PURPOSES, THE MAKING OF DISTRIBUTIONS TO ORGANIZATIONS THAT QUALIFY AS EXEMPT ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED (OR THE CORRESPONDING PROVISION OF ANY FUTURE UNITED STATES INTERNAL REVENUE LAW)".
FORM 990, PART VI, SECTION A, LINE 6	THE FOUNDATION SHALL HAVE ONE MEMBER, WHICH SHALL BE DELTA DENTAL OF IOWA ("DELTA DENTAL"), A SECTION 501(C)(4) ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A	EACH DIRECTOR SHALL BE ELECTED BY THE MEMBER. IN ELECTING DIRECTORS, THE MEMBER MAY SEEK RECOMMENDATIONS FROM THE FOUNDATION'S BOARD OR A COMMITTEE OF THE BOARD.
FORM 990, PART VI, SECTION B, LINE 11B	THE FORM 990 AND ALL RELATED SCHEDULES WERE REVIEWED BY BOTH THE MANAGEMENT OF THE FOUNDATION AND THE BOARD OF DIRECTORS PRIOR TO FILING. THE FORM 990 WAS REVIEWED BY MANAGEMENT OF THE FOUNDATION PRIOR TO PRESENTATION TO THE BOARD OF DIRECTORS. THE MEMBERS OF THE MANAGEMENT TEAM WHO REVIEWED THE FORM 990 WERE THE PRESIDENT, SECRETARY/TREASURER, AND EXECUTIVE DIRECTOR. A COPY OF THE FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C	CONSISTENT WITH ITS CONFLICT OF INTEREST POLICY, ANNUALLY THE FOUNDATION CONDUCTS A CONFLICT OF INTEREST REVIEW FOR COMPLIANCE WITH FEDERAL AND STATE LAW AND COMPANY POLICY. THE REVIEW INCLUDES ALL OFFICERS AND DIRECTORS. COMPLETED CONFLICT OF INTEREST QUESTIONNAIRES AND DISCLOSURES ARE COMPARED TO THE GROUP FOR POTENTIALLY CONFLICTING TRANSACTIONS, BUSINESS AND FAMILY RELATIONSHIPS AND AFFILIATIONS. A WRITTEN REPORT OF THE FINDINGS IS GIVEN TO THE BOARD OF DIRECTORS AND OFFICERS. THE CONFLICT OF INTEREST POLICY PROVIDES GUIDANCE ON ACTIONS AND SPECIFIC SOLUTIONS TO ADDRESS CONFLICTS WHEN THEY OCCUR. THE SOLUTIONS PROVIDED BY THE GUIDANCE ARE DISCUSSED AND DOCUMENTED IN THE BOARD OF DIRECTOR'S MEETING MINUTES.
FORM 990, PART VI, SECTION B, LINE 15	THE EXECUTIVE DIRECTOR AND OFFICERS EXCLUDING THE CHAIR AND VICE CHAIR OF THE BOARD ARE EMPLOYEES OF DELTA DENTAL. DELTA DENTAL OF IOWA CHARGES THE FOUNDATION A MANAGEMENT FEE FOR THE TIME SPENT BY THE PRESIDENT, SECRETARY AND TREASURER, AND EXECUTIVE DIRECTOR.
FORM 990, PART VI, SECTION C, LINE 19	THE FOUNDATION'S ARTICLES OF INCORPORATION BECOME A MATTER OF PUBLIC RECORD WHEN THEY ARE FILED WITH THE IOWA SECRETARY OF STATE. THE FINANCIAL STATEMENTS BECOME A MATTER OF PUBLIC RECORD WHEN THEY ARE FILED AS PART OF THE FORM 990 WITH THE IRS. THE CONFLICT OF INTEREST POLICY IS NOT FILED WITH ANY AGENCY; HOWEVER, IT WOULD BE MADE AVAILABLE UPON REQUEST. ALL GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS WOULD BE MADE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9:	RECOVERIES OF PRIOR YEAR GRANTS 6,735. BOARD MEMBER FEES WAIVED -5,400.
FORM 990, PART VI, SECTION B, LINE 13:	THE FOUNDATION DOES NOT HAVE A WHISTELEBLOWER POLICY AS IT HAS NO EMPLOYEES. THE FOUNDATION PURCHASES MANAGEMENT SERVICES FROM DELTA DENTAL. DELTA DENTAL OF IOWA HAS A WRITTEN WHISTLEBLOWER POLICY THAT ALL EMPLOYEES ARE SUBJECT TO.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

DELTA DENTAL OF IOWA FOUNDATION

Employer identification number

26-0762771

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)DELTA DENTAL OF IOWA 9000 NORTHPARK DRIVE JOHNSTON,IA50131 42-0959302	NON-PROFIT ORGANIZATION TO IMPROVE THE ORAL HEALTH OF THE PEOPLE IT SERVES	IA	501(C)(4)				No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) DELTA DENTAL OF IOWA	C	4,703,950	SEE PART VII - SUPPLEMENTAL INFO.
(2) DELTA DENTAL OF IOWA	O	352,940	HOURS WORKED

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation
FORM 990, SCHEDULE R, PART V, LINE 2(1), COLUMN D:	CASH RECEIVED BASED ON A PERCENTAGE OF DELTA DENTAL OF IOWA'S REVENUE APPROVED BY THEIR BOARD. THE AMOUNT REPORTED INCLUDES A CONTRIBUTION OF $4,703,950 WHICH IS A PROMISE TO GIVE.
FORM 990, SCHEDULE R, PART V, LINE 2(2), COLUMN B:	MANAGEMENT FEES OF $352,940 WERE PAID TO DELTA DENTAL OF IOWA WHICH COULD ALSO BE CLASSIFIED UNDER CODE M.

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE CORPORATION IS ORGANIZED TO SUPPORT AND IMPROVE THE ORAL HEALTH OF IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER SEC. 501(C)(3) ORGANIZATIONS, GOVERNMENTS, OR ACADEMIC INSTITUTIONS THAT ARE UNDERTAKING PROJECTS THAT SUPPORT AND IMPROVE THE ORAL HEALTH OF IOWANS. THE FOUNDATION WILL PROVIDE FUNDS TO OTHER TAX-EXEMPT ORGANIZATIONS THROUGH THEIR GRANT PROGRAM THAT ALIGN WITH THE PROJECTS OF ACCESS TO CARE, RESEARCH, EDUCATION AND PREVENTION.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	10
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	0
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,009,354	4,710,796
9	Program service revenue (Part VIII, line 2g) .........	0	0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	640,674	536,241
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	5,650,028	5,247,037
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	2,200,812	1,551,994
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	400	600
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	654,801	864,856
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	2,856,013	2,417,450
19	Revenue less expenses. Subtract line 18 from line 12.......	2,794,015	2,829,587
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	20,145,967	25,351,147
21	Total liabilities (Part X, line 26).............	324,008	41,689
22	Net assets or fund balances. Subtract line 21 from line 20.....	19,821,959	25,309,458

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 1,089,122 including grants of $ 773,985 ) (Revenue $ )
	PREVENTIVE PROJECT - ACTIVITIES THAT ARE AIMED TO DECREASE THE INCIDENCE, PREVALENCE, AND SEVERITY OF DENTAL DISEASE.

4b	(Code: ) (Expenses $ 691,625 including grants of $ 460,788 ) (Revenue $ )
	EDUCATIONAL PROJECT - ACTIVITIES TO ENHANCE THE AWARENESS OF GOOD ORAL HEALTH WITH A FOCUS ON CHILDREN, THE ELDERLY, THE INDIGENT, AND AT-RISK POPULATIONS.

4c	(Code: ) (Expenses $ 305,610 including grants of $ 237,364 ) (Revenue $ )
	ACCESS/UNDERSERVED PROJECT - ACTIVITIES THAT PROVIDE ASSISTANCE TO UNDERSERVED AREAS AND POPULATIONS OF IOWA.

	(Code: ) (Expenses $ 93,312 including grants of $ 79,857 ) (Revenue $ )
	CLINICAL RESEARCH PROJECT - RESEARCH EFFORTS TO IMPROVE DENTAL HEALTH, SPECIFICALLY THOSE THAT ENHANCE THE ART AND SCIENCE OF DENTISTRY AND/OR ADDRESS A PREVALENT DENTAL DISEASE OR ISSUE OF SIGNIFICANT IMPACT TO IOWANS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 93,312 including grants of $ 79,857 ) (Revenue $ )
4e	Total program service expenses2,179,669

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	600	1,860,469	129,369

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d	4,703,950
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	6,846

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		4,710,796

		Business Code
2a
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....

3 Investment income (including dividends, interest, and othersimilar amounts) ......			535,026			535,026
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)			6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		23,000	7a
b	Less: cost or other basis and sales expenses		21,785	7b
c	Gain or (loss)		1,215	7c
d	Net gain or (loss).........			1,215			1,215
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See instructions.....			5,247,037	0	0	536,241

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	1,551,994	1,551,994
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	600		600
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......	352,940	228,744	124,196
b	Legal .........	405		405
c	Accounting ...........	9,900		9,900
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	32,160		32,160
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)
12	Advertising and promotion ....	7,280	5,327	1,953
13	Office expenses .......	251,047	244,717	6,330
14	Information technology ......	5,666	538	5,128
15	Royalties ..
16	Occupancy ...........
17	Travel ............	37,574	23,073	14,501
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	16,352	10,670	5,682
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..
23	Insurance ...
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	CONSULTING	85,955	54,469	31,486
b	OUTSIDE SERVICES	43,049	43,049
c	OUTREACH AND EDUCATION	12,873	12,873
d	MEMBERSHIP FEES	5,350	4,215	1,135
e	All other expenses	4,305		4,305
25	Total functional expenses. Add lines 1 through 24e	2,417,450	2,179,669	237,781	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........		163,815	1	95,287
2	Savings and temporary cash investments .........		1,693,833	2	2,536,674
3	Pledges and grants receivable, net ......		5,001,088	3	4,703,950
4	Accounts receivable, net .............			4
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				6
7	Notes and loans receivable, net ...........			7
8	Inventories for sale or use ............			8
9	Prepaid expenses and deferred charges ......		10,053	9	5,449
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b		10c
11	Investments—publicly traded securities .		13,275,520	11	18,008,810
12	Investments—other securities. See Part IV, line 11 .....			12
13	Investments—program-related. See Part IV, line 11 ..			13
14	Intangible assets ...............			14
15	Other assets. See Part IV, line 11 ...........		1,658	15	977
16	Total assets. Add lines 1 through 15 (must equal line 33)...		20,145,967	16	25,351,147

17	Accounts payable and accrued expenses .....	30,638	17	12,223
18	Grants payable ...	260,000	18	1,139
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	33,370	25	28,327
26	Total liabilities. Add lines 17 through 25..	324,008	26	41,689

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	1,548,090	27	2,574,630
28	Net assets with donor restrictions ...........	18,273,869	28	22,734,828
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	19,821,959	32	25,309,458
33	Total liabilities and net assets/fund balances ........	20,145,967	33	25,351,147