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Schedule I
(Form 990)
(Rev. January 2025)
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 instructions and the latest information.
OMB No. 1545-0047
Open to Public
Inspection
Name of the organization
ARIZONA DENTAL INSURANCE SERVICE INC
 
Employer identification number
86-0274899
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) American Red Cross
431 18th Street NW
Washington,DC20006 		53-0196605 501(C)(3) 20,000       Donation
(2) Delta Dental Plan of Arizona Charitable Foundation and Trust
14850 North Scottsdale Rd
Suite 400
Scottsdale,AZ85254 		86-0842694 501(C)(3) 1,740,318 326,662 FMV Donated Services Annual Contribution Based on Board Directive to Promote Oral Health
(3) Diversity in Dentistry Mentorships Inc
4729 East Sunrise Drive
Suite 147
Tucson,AZ85718 		85-2395210 501(C)(3) 12,771       Donation
(4) Knight-Swift Charitable Foundation
2002 W Wahalla Lane
Phoenix,AZ85027 		84-4034572 501(C)(3) 10,500       Donation
(5) Save the Family Foundation
125 E University Dr
Mesa,AZ85201 		86-0665712 501(C)(3) 5,000       Donation
(6) Southwest Human Development
2850 N 24th Street
Phoenix,AZ85008 		86-0407179 501(C)(3) 10,000       Donation
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
6
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) Rev. 1-2025

Schedule I (Form 990) Rev. 1-2025
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds THE ORGANIZATION'S BOARD RECEIVES REGULAR REPORTS ON THE ORGANIZATION'S ACTIVITIES AND EXPENDITURES OF GRANT FUNDS DONATIONS ARE MADE TO ESTABLISHED, WELL-RESPECTED, LOCAL PUBLIC CHARITY ORGANIZATIONS. AS A RESULT, ONGOING MONITORING OF THE USE OF GRANT FUNDS IS NOT CONSIDERED NECESSARY.
Schedule I (Form 990) Rev. 1-2025



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