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        <TotalAmt>30</TotalAmt>
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          <BusinessNameLine1Txt>DR MICHAEL MANSOURI</BusinessNameLine1Txt>
        </RecipientBusinessName>
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          <StateAbbreviationCd>GA</StateAbbreviationCd>
          <ZIPCd>30068</ZIPCd>
        </USAddress>
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        <NonCashAssistanceAmt>0</NonCashAssistanceAmt>
        <ValuationMethodUsedDesc>N/A</ValuationMethodUsedDesc>
        <NonCashAssistanceDesc>N/A</NonCashAssistanceDesc>
        <PurposeOfGrantTxt>SPONSORSHIP OF OFFICE'S FREE DENTAL CARE DAY</PurposeOfGrantTxt>
      </RecipientTable>
      <RecipientTable>
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          <BusinessNameLine1Txt>CARY FAMILY DENTAL</BusinessNameLine1Txt>
        </RecipientBusinessName>
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          <CityNm>CARY</CityNm>
          <StateAbbreviationCd>NC</StateAbbreviationCd>
          <ZIPCd>27611</ZIPCd>
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        <ValuationMethodUsedDesc>N/A</ValuationMethodUsedDesc>
        <NonCashAssistanceDesc>N/A</NonCashAssistanceDesc>
        <PurposeOfGrantTxt>SPONSORSHIP OF OFFICE'S FREE DENTAL CARE DAY.</PurposeOfGrantTxt>
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      <RecipientTable>
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          <BusinessNameLine1Txt>DR GRANT RINGLER</BusinessNameLine1Txt>
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          <StateAbbreviationCd>KS</StateAbbreviationCd>
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        <ValuationMethodUsedDesc>N/A</ValuationMethodUsedDesc>
        <NonCashAssistanceDesc>N/A</NonCashAssistanceDesc>
        <PurposeOfGrantTxt>SPONSORSHIP OF OFFICE'S FREE DENTAL CARE DAY</PurposeOfGrantTxt>
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      <RecipientTable>
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          <BusinessNameLine1Txt>PREMIER DENTAL</BusinessNameLine1Txt>
        </RecipientBusinessName>
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          <CityNm>OMAHA</CityNm>
          <StateAbbreviationCd>NE</StateAbbreviationCd>
          <ZIPCd>68130</ZIPCd>
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        <ValuationMethodUsedDesc>N/A</ValuationMethodUsedDesc>
        <NonCashAssistanceDesc>N/A</NonCashAssistanceDesc>
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      <TotalOtherOrgCnt>4</TotalOtherOrgCnt>
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        <FormAndLineReferenceDesc>PART I, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>ANY DENTAL PRACTICES WANTING TO HOLD A DENTISTRY FROM THE HEART EVENT MUST FILL OUT PAPERWORK TO DETERMINE ELIGIBILITY. THE PARTICIPATING PRACTICES ARE REQUIRED TO REPORT THEIR RESULTS BACK TO DENTISTRY FROM THE HEART.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>VINCENT MONTICCIOLO, PRESIDENT/TREASURER, AND NATALIE MONTICCIOLO, SECRETARY, ARE HUSBAND AND WIFE.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 8B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION IS RUN BY THE BOARD OF DIRECTORS AND DOES NOT HAVE SEPARATE COMMITTEES AUTHORIZED TO ACT ON THEIR BEHALF.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>FROM 990, AS ULTIMATELY FILED WITH THE IRS, IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS PRIOR TO FILING.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION'S CONFLICT OF INTEREST POLICY REQUIRES THAT ANY ACTUAL AND/OR POTENTIAL CONFLICTS OF INTEREST BE DISCLOSED UPON DISCOVERY. POTENTIAL CONFLICTS ARE MONITORED AND EVALUATED ON AN ONGOING BASIS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION IS MANAGED BY A BOARD OF DIRECTORS COMPRISED OF VOLUNTEERS. AS SUCH, THE COMPENSATION PROCEDURES DESCRIBED IN QUESTION 15A DO NOT APPLY. THE BOARD OF DIRECTORS IS RESPONSIBLE FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND OTHER EMPLOYEES.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.</ExplanationTxt>
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        </RelatedOrganizationName>
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          <AddressLine1Txt>4546 GRAND BLVD</AddressLine1Txt>
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        <EntityTypeTxt>S</EntityTypeTxt>
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      <IdRelatedOrgTxblCorpTrGrp>
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          <BusinessNameLine1Txt>MONTICCIOLO FAMILY AND SEDATION DENTISTRY PA</BusinessNameLine1Txt>
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          <AddressLine1Txt>1214 PLAYMOOR DR</AddressLine1Txt>
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        <EntityTypeTxt>S</EntityTypeTxt>
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      <GiftGrntOrCapContriToOthOrgInd>0</GiftGrntOrCapContriToOthOrgInd>
      <GiftGrntCapContriFromOthOrgInd>1</GiftGrntCapContriFromOthOrgInd>
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      <LoansOrGuaranteesFromOthOrgInd>0</LoansOrGuaranteesFromOthOrgInd>
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      <AssetSaleToOtherOrgInd>0</AssetSaleToOtherOrgInd>
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      <RentalOfFacilitiesToOthOrgInd>0</RentalOfFacilitiesToOthOrgInd>
      <RentalOfFcltsFromOthOrgInd>0</RentalOfFcltsFromOthOrgInd>
      <PerformOfServicesForOthOrgInd>0</PerformOfServicesForOthOrgInd>
      <PerformOfServicesByOtherOrgInd>0</PerformOfServicesByOtherOrgInd>
      <SharingOfFacilitiesInd>1</SharingOfFacilitiesInd>
      <PaidEmployeesSharingInd>1</PaidEmployeesSharingInd>
      <ReimbursementPaidToOtherOrgInd>1</ReimbursementPaidToOtherOrgInd>
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      <TransferToOtherOrgInd>0</TransferToOtherOrgInd>
      <TransferFromOtherOrgInd>0</TransferFromOtherOrgInd>
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</Return>