TY 2021 Form 990

- TIN:

Form990

Department of the TreasuryInternal Revenue Service

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

Do not enter social security numbers on this form as it may be made public.

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

OMB No. 1545-0047

2021

Open to Public Inspection

A For the 2021 calendar year, or tax year beginning 01-01-2021 , and ending 12-31-2021

BCheck if applicable: Address change Name change Initial return Final return/terminated Amended return Application pending

CName of organization
Dental Service of Massachusetts Inc

Doing business as

Number and street (or P.O. box if mail is not delivered to street address)
465 MEDFORD STREET

Room/suite

City or town, state or province, country, and ZIP or foreign postal code
BOSTON, MA02129

D Employer identification number

04-6143185

E Telephone number

G Gross receipts $ 299,318,172

F Name and address of principal officer:
DENNIS J LEONARD
465 MEDFORD STREET
BOSTON,MA02129

Tax-exempt status: 501(c)(3) 501(c) ( 4 ) LeftBullet

(insert no.) 4947(a)(1) or 527

Website:

WWW.DELTADENTALMA.COM

H(a)

Is this a group return for
subordinates? Yes No

H(b)

Are all subordinates
included?

Yes No

If "No," attach a list. See instructions.

H(c)

Group exemption number MediumBullet

K Form of organization: Corporation Trust Association Other MediumBullet

L Year of formation: 1966

M State of legal domicile: MA

Part I

Summary

1	Briefly describe the organization’s mission or most significant activities: TO IMPROVE THE ORAL HEALTH OF ALL.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2021 (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, Part I, line 11 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	0	0
9	Program service revenue (Part VIII, line 2g) .........	262,356,849	297,448,031
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	1,959,156	1,577,950
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)		0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	264,316,005	299,025,981
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...		0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	142,258,480	168,776,074
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)		0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	95,574,194	97,535,486
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	237,832,674	266,311,560
19	Revenue less expenses. Subtract line 18 from line 12.......	26,483,331	32,714,421
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	128,947,720	126,144,035
21	Total liabilities (Part X, line 26).............	80,422,438	76,930,956
22	Net assets or fund balances. Subtract line 21 from line 20.....	48,525,282	49,213,079

Part II

Signature Block

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

	Signature of officer	Date

	Type or print name and title

Paid Preparer Use Only

Print/Type preparer's name

Preparer's signature

Date

Check if
self-employed

PTIN

Firm's name MediumBullet

Firm's EIN MediumBullet

Firm's address MediumBullet

Phone no.

May the IRS discuss this return with the preparer shown above? (see instructions) ..........YesNo

For Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 11282Y Form 990 (2021)

Form 990 (2021)

Page 2

Part III

Statement of Program Service Accomplishments

Check if Schedule O contains a response or note to any line in this Part III..............

Briefly describe the organization’s mission: TO IMPROVE THE ORAL HEALTH OF ALL.

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ..................... Yes No

If "Yes," describe these new services on Schedule O.

Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ........................... Yes No

If "Yes," describe these changes on Schedule O.

Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.


4a	(Code: ) (Expenses $ 231,800,185 including grants of $ ) (Revenue $ 297,448,031 )
	DENTAL SERVICE OF MASSACHUSETTS, INC. (DSM) D/B/A DELTA DENTAL OF MASSACHUSETTS IS A MASSACHUSETTS NOT-FOR-PROFIT DENTAL SERVICE ORGANIZATION WITH A MISSION TO IMPROVE THE ORAL HEALTH OF ALL AND A VISION TO ACHIEVE PERSON-CENTERED HEALTH BY TRANSFORMING THE SYSTEMS OF POLICY, FINANCE, CARE, AND COMMUNITY. DSM AND ITS SUBSIDIARIES' ACTIVITIES INCLUDE, BUT ARE NOT LIMITED TO, SECURING DENTAL SERVICES FOR EMPLOYEE GROUPS, INDIVIDUALS AND THEIR FAMILIES; INCLUDING THE SAFETY NET POPULATIONS THROUGH MEDICARD, MEDICARE ADVANTAGE AND CHIP PROGRAMS; PROVIDING INNOVATIVE PRODUCTS AND SERVICES; FINANCE AND DEVELP PROFESSIONAL AND SCIENTIFIC STUDY AND RESEARCH; AND EDUCATE THE PUBLIC CONCERNING THE IMPORTANCE OF ORAL HEALTH. DELTA DENTAL OF MASSACHUSETTS IS A MEMBER OF THE DELTA DENTAL PLANS ASSOCIATION. DELTA DENTAL IS AMERICA'S LARGEST AND MOST TRUSTED DENTAL BENEFITS CARRIER, COVERING MORE AMERICANS THAN ANY OTHER DENTAL BENEFITS PROVIDER AND STRIVES DAILY TO MAKE DENTAL COVERAGE MORE ACCESSIBLE AND AFFORDABLE TO A WIDE VARIETY OF EMPLOYERS, GROUPS, AND INDIVIDUALS.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses231,800,185

Form 990 (2021)

Page 3

Part IV

Checklist of Required Schedules

Yes

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A.....................

Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. ...

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............

Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II.........

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III..............

Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............

Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......

If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.

Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment

...................

11a

Yes

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......

11b

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......

11c

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX Click to see attachment

............

11d

Yes

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X Click to see attachment

11e

Yes

Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X Click to see attachment

11f

Yes

12a

Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................

12a

Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment

12b

Yes

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E

14a

Did the organization maintain an office, employees, or agents outside of the United States? .....

14a

Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........

14b

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....

Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................

20a

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....

20a

If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?

20b

Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....

Form 990 (2021)

Page 4

Part IV

Checklist of Required Schedules (continued)

Yes

Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........

Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment

Yes

24a

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............

24a

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...

24b

Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............

24c

Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...

24d

25a

Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....

25a

Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................

25b

Did the organization report any amount on Part X, line 5 or 22 for receivables from or 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? If "Yes," complete Schedule L, Part II...........

Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?

If "Yes," complete

Schedule L, Part III.........................

Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):

A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................

28a

A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....

28b

A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................

28c

Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..

Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............ Click to see attachment

Yes

Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1......................... Click to see attachment

Yes

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?

35a

If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...

35b

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............

Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI

Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............

Yes

Part V

Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........

Yes

Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..

59,654

Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .

Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................

Yes

Form 990 (2021)

Page 5

Part V

Statements Regarding Other IRS Filings and Tax Compliance (continued)

Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................

If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.

Did the organization have unrelated business gross income of $1,000 or more during the year?...

If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...

At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..

If "Yes," enter the name of the foreign country: MediumBullet

See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..

Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?

If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............

Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...

If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................

Organizations that may receive deductible contributions under section 170(c).

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................

If "Yes," did the organization notify the donor of the value of the goods or services provided? .....

Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................

If "Yes," indicate the number of Forms 8282 filed during the year ....

Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?

Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..

If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................

If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................

Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........

Sponsoring organizations maintaining donor advised funds.

Did the sponsoring organization make any taxable distributions under section 4966?........

Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on Part VIII, line 12 ...

10a

Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities

10b

Section 501(c)(12) organizations. Enter:

Gross income from members or shareholders .........

11a

Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........

11b

12a

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?

12a

If "Yes," enter the amount of tax-exempt interest received or accrued during the year.

12b

Section 501(c)(29) qualified nonprofit health insurance issuers.

Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.

13a

Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....

13b

Enter the amount of reserves on hand ............

13c

14a

Did the organization receive any payments for indoor tanning services during the tax year?.....

14a

If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..

14b

Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.

Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.

Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.

Form 990 (2021)

Page 6

Part VI

Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check if Schedule O contains a response or note to any line in this Part VI..............

Section A. Governing Body and Management

Yes

Enter the number of voting members of the governing body at the end of the tax year

If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.

Enter the number of voting members included in line 1a, above, who are independent

Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................

Yes

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .

Yes

Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .

Did the organization become aware during the year of a significant diversion of the organization’s assets? .

Did the organization have members or stockholders? ................

Yes

Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................

Yes

Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................

Yes

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

The governing body? .......................

Yes

Each committee with authority to act on behalf of the governing body? ............

Yes

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)

Yes

10a

Did the organization have local chapters, branches, or affiliates? ............

10a

If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

10b

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................

11a

Yes

Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....

12a

Did the organization have a written conflict of interest policy? If "No," go to line 13.......

12a

Yes

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................

12b

Yes

Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................

12c

Yes

Did the organization have a written whistleblower policy? ...............

Yes

Did the organization have a written document retention and destruction policy? .........

Yes

Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

The organization’s CEO, Executive Director, or top management official ...........

15a

Other officers or key employees of the organization ................

15b

If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.

16a

Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................

16a

If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............

16b

Section C. Disclosure

List the states with which a copy of this Form 990 is required to be filed MediumBullet

Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.

Own website Another's website Upon request Other (explain in Schedule O)

Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBullet

DENISE MARKS465 MEDFORD STREET BOSTON,MA02129 (617) 886-1000

Form 990 (2021)

Page 7

Part VII

Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors

Check if Schedule O contains a response or note to any line in this Part VII..............

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees

1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet

List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."

List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

(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)			(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(1) Andrew C Agwunobi MD Director	1.8 ................. 1.8	X			0	105,000	0
(2) Evelyn H Miller Director	1.8 ................. 1.8	X			0	215,818	0
(3) Jessica A Zeaske Director	1.8 ................. 1.8	X			0	108,318	0
(4) Kathleen V Betts Director	1.8 ................. 1.8	X			0	200,588	0
(5) Pamela DA Reeve Chair/Director	2.5 ................. 2.5	X			0	150,000	0
(6) Robert J Weyant DMD Director	1.8 ................. 1.8	X			0	105,584	0
(7) Roderick K King MD Director	1.8 ................. 1.8	X			0	105,822	0
(8) Todd W Marshall DDS Director	1.8 ................. 1.8	X			0	100,580	0
(9) William C Mills III Director	1.8 ................. 1.8	X			0	108,080	0
(10) Denise Marks Treasurer [3/10/21 - 12/31/21]	4.5 ................. 36.5		X		0	443,061	10,627
(11) Dennis J Leonard President & CEO	35.0 ................. 5.0		X		0	1,109,702	27,916
(12) Gregory P Winn Asst. Treasurer [3/10/21 - 12/31/21] / Treasurer [1/1/21 - 3/10/21]	4.5 ................. 36.5		X		0	450,498	37,977
(13) James P Hawkins Clerk [1/1/21-3/10/21]	4.5 ................. 35.5		X		0	666,018	899,908
(14) Patricia Ma Clerk [3/10/21 - 12/31/21]	4.5 ................. 36.5		X		0	296,715	9,995
(15) Courtney Ransom SVP- Chief Ethics & Compliance Officer-Dentaquest	4.5 ................. 35.5			X	0	511,372	269,946
(16) David Abelman EVP- Chief Legal Officer - DentaQuest	4.5 ................. 35.5			X	0	1,148,335	1,308,573
(17) Myechia Minter-Jordan MD MBA President-Carequest	4.5 ................. 36.5			X	0	1,134,155	33,986

Form 990 (2021)

Page 8

Part VII

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)			(D) Reportable compensation from the organization (W-2/1099-MISC/1099-NEC)	(E) Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) Sheryl L Traylor EVP -HR -Dentaquest - (Retired)	4.5 .......................35.5	X		0	898,538	3,194
(19) Steven J Pollock President-Dentaquest	3.5 .......................36.5	X		0	4,038,183	7,819,645
(20) Jeffrey C Brown Former Treasurer	0.0 .......................0.0		X	0	521,876	1,321

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	12,418,243	10,423,088

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet

Yes

Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............

Yes

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................

Yes

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........

Section B. Independent Contractors

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.

(A) Name and business address	(B) Description of services	(C) Compensation
42 North Dental Care LLC 200 5TH AVE 3RD FL WALTHAM,MA024518779	Dental Services	16,409,995
Great Hill Dental Partners LLC 1610 TREMONT STREET BOSTON,MA02120	Dental Services	4,324,144
Chestnut Dental Associates PC 38 POND ST SUITE 204 FRANKLIN,MA02038	Dental Services	4,057,167
Mass General Physician Organization 165 CAMBRIDGE ST NO 40 BOSTON,MA02114	Dental Services	2,763,957
BEACON DENTAL HEALTH PC 198 TREMONT ST STE 436 BOSTON,MA02116	Dental Services	2,330,340
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 1,496

Form 990 (2021)

Page 9

Part VIII

Statement of Revenue

Check if Schedule O contains a response or note to any line in this Part VIII.............

(A)
Total revenue

(B)
Related or
exempt
function
revenue

(D)
Revenue
excluded from
tax under sections
512 - 514

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

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

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

h Total. Add lines 1a-1f.......		0

		Business Code
2a	PPO REVENUE	900099	175,767,231	175,767,231
b	PREMIER REVENUE	900099	65,045,931	65,045,931
c	ASO ADMINISTRATIVE SERVICE	900099	56,634,869	56,634,869
d
e
f	All other program service revenue.		0	0	0	0
g	Total. Add lines 2a–2f .....		297,448,031

3 Investment income (including dividends, interest, and othersimilar amounts) ......			1,071,025			1,071,025
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)	0	0	6c
d	Net rental income or (loss).......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		799,116	7a
b	Less: cost or other basis and sales expenses	1,217	290,974	7b
c	Gain or (loss)	-1,217	508,142	7c
d	Net gain or (loss).........			506,925			506,925
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 ....			0	0	0	0
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			299,025,981	297,448,031	0	1,577,950

Form 990 (2021)

Page 10

Part IX

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.		(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
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 .......	168,776,074	168,776,074
5	Compensation of current officers, directors, trustees, and key employees ...........
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 ......	462,783	347,087	115,696
b	Legal .........
c	Accounting ...........	2,126,774		2,126,774
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	170,355		170,355
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	0	0	0	0
12	Advertising and promotion ....
13	Office expenses .......	210	126	84
14	Information technology ......	1,620	972	648
15	Royalties ..
16	Occupancy ...........
17	Travel ............	925	555	370
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	64,781	38,869	25,912
21	Payments to affiliates .......	79,287,033	47,572,220	31,714,813
22	Depreciation, depletion, and amortization ..	143,955	86,373	57,582
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	COMMISSIONS	11,431,720	11,431,720
b	SUBSCRIPTIONS AND DUES	747,852	448,711	299,141
c	ACA FEE & OTHER	3,097,478	3,097,478
d
e	All other expenses	0	0	0	0
25	Total functional expenses. Add lines 1 through 24e	266,311,560	231,800,185	34,511,375	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).

Form 990 (2021)

Page 11

Part X

Balance Sheet

Check if Schedule O contains a response or note to any line in this Part IX..............

				(A) Beginning of year		(B) End of year

1	Cash–non-interest-bearing ........				1
2	Savings and temporary cash investments .........			14,529,122	2	5,844,714
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			375,641	4	3,447,220
5	Loans and other receivables from 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 .......
				0	5	0
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) ...
				0	6	0
7	Notes and loans receivable, net ...........			0	7
8	Inventories for sale or use ............				8
9	Prepaid expenses and deferred charges ......			0	9	4,611
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	14,922,244
b	Less: accumulated depreciation	10b	14,790,285	275,915	10c	131,959
11	Investments—publicly traded securities .			58,076,783	11	55,646,152
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			0	13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			55,690,259	15	61,069,379
16	Total assets. Add lines 1 through 15 (must equal line 33)...			128,947,720	16	126,144,035

17	Accounts payable and accrued expenses .....	2,100,736	17	2,124,654
18	Grants payable ...		18
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 .........
		0	22	0
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	78,321,702	25	74,806,302
26	Total liabilities. Add lines 17 through 25..	80,422,438	26	76,930,956

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	48,525,282	27	49,213,079
28	Net assets with donor restrictions ...........		28
	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 ...........	48,525,282	32	49,213,079
33	Total liabilities and net assets/fund balances ........	128,947,720	33	126,144,035

Form 990 (2021)

Page 12

Part XI

Reconcilliation of Net Assets

Check if Schedule O contains a response or note to any line in this Part XI..............

Total revenue (must equal Part VIII, column (A), line 12) ............

299,025,981

Total expenses (must equal Part IX, column (A), line 25) ............

266,311,560

Revenue less expenses. Subtract line 2 from line 1 ..............

32,714,421

Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..

48,525,282

Net unrealized gains (losses) on investments ...............

-2,322,790

Donated services and use of facilities .................

Investment expenses .....................

Prior period adjustments .....................

Other changes in net assets or fund balances (explain in Schedule O) ........

-29,703,834

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))

49,213,079

Part XII

Financial Statements and Reporting

Check if Schedule O contains a response or note to any line in this Part XII.............

Yes

Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.

Were the organization’s financial statements compiled or reviewed by an independent accountant?

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

Were the organization’s financial statements audited by an independent accountant?

Yes

If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?

Yes

If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?

If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.

Form 990 (2021)

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

Form 990, Special Condition Description:

Special Condition Description

- TIN:

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

2021

Open to Public Inspection

Name of the organization

Dental Service of Massachusetts Inc

Employer identification number

04-6143185

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) 2021

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 ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

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

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)

(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	9,054	9,054	0
d	Equipment ....	6,458,405	6,458,405	0
e	Other .....	8,454,785	8,322,826	131,959
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				131,959

Schedule D (Form 990) 2021

Page 3

Part VII

Investments - Other 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
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

Investments - Program 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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
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
(1)INVESTMENT IN SUBSIDIARY				11,236,162
(2)COST REIMBURSEMENT				49,833,217
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				61,069,379

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
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	74,806,302
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) 2021

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
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1..................		3
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
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................		4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

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	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
e	Add lines 2a through 2d....................		2e
3	Subtract line 2e from line 1...................		3
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
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

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
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	THE FASB ISSUE ASU 2019-12, INCOME TAXES (TOPIC 740) - SIMPLIFYING THE ACCOUNTING FOR INCOME TAXES, WHICH WILL ELIMINATE SEVERAL ACCOUNTING EXCEPTIONS RELATED TO INCOME TAXES, AS WELL AS INTRODUCE ADDITIONAL REQUIREMENTS WITHIN TOPIC 740. ASU 2019-12 IS EFFECTIVE FOR NONPUBLIC BUSINESS ENTITIES FOR FISCAL YEARS BEGINNING AFTER DECEMBER 15, 2021, WITH EARLY ADOPTION PERMITTED. THE ELIMINATED EXCEPTIONS AND ADDITIONAL REQUIREMENTS DO NOT CURRENTLY RELATE TO ACTIVITIES UNDERTAKEN BY THE COMPANY, SO THE COMPANY HAS DETERMINED THAT ADOPTING THIS NEW STANDARD IS NOT EXPECTED TO HAVE A FINANCIAL IMPACT. THE COMPANY DETERMINES WHETHER A TAX POSITION OF THE COMPANY IS MORE LIKLEY THAN NOT TO BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTION OF ANY RELATED APPEALS OF LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS OF THE POSITION. FOR TAX POSITIONS MEETING THE MORE LIKLEY THAN NOT THRESHOLD, THE TAX AMOUNT RECOGNIZED IN THE FINANCIAL STATEMENTS IS REDUCED BY THE LARGEST BENEFIT THAT HAS A GREATER THAN FIFTY PERCENT LIKELIHOOD OF BEING REALIZED UPON THE ULTIMATE SETTLEMENT WITH THE RELEVANT TAXING AUTHORITY.

Return Reference

Explanation

Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote

THE FASB ISSUE ASU 2019-12, INCOME TAXES (TOPIC 740) - SIMPLIFYING THE ACCOUNTING FOR INCOME TAXES, WHICH WILL ELIMINATE SEVERAL ACCOUNTING EXCEPTIONS RELATED TO INCOME TAXES, AS WELL AS INTRODUCE ADDITIONAL REQUIREMENTS WITHIN TOPIC 740. ASU 2019-12 IS EFFECTIVE FOR NONPUBLIC BUSINESS ENTITIES FOR FISCAL YEARS BEGINNING AFTER DECEMBER 15, 2021, WITH EARLY ADOPTION PERMITTED. THE ELIMINATED EXCEPTIONS AND ADDITIONAL REQUIREMENTS DO NOT CURRENTLY RELATE TO ACTIVITIES UNDERTAKEN BY THE COMPANY, SO THE COMPANY HAS DETERMINED THAT ADOPTING THIS NEW STANDARD IS NOT EXPECTED TO HAVE A FINANCIAL IMPACT. THE COMPANY DETERMINES WHETHER A TAX POSITION OF THE COMPANY IS MORE LIKLEY THAN NOT TO BE SUSTAINED UPON EXAMINATION, INCLUDING RESOLUTION OF ANY RELATED APPEALS OF LITIGATION PROCESSES, BASED ON THE TECHNICAL MERITS OF THE POSITION. FOR TAX POSITIONS MEETING THE MORE LIKLEY THAN NOT THRESHOLD, THE TAX AMOUNT RECOGNIZED IN THE FINANCIAL STATEMENTS IS REDUCED BY THE LARGEST BENEFIT THAT HAS A GREATER THAN FIFTY PERCENT LIKELIHOOD OF BEING REALIZED UPON THE ULTIMATE SETTLEMENT WITH THE RELEVANT TAXING AUTHORITY.

Schedule D (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- 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

2021

Open to Public Inspection

Name of the organization

Dental Service of Massachusetts Inc

Employer identification number

04-6143185

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

Yes

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

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) 2021

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, 1099-MISC compensation, and/or 1099-NEC			(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)
1Evelyn H Miller Director	(i) (ii)	0 ------------- 215,818	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 215,818	0 ------------- 0
2Kathleen V Betts Director	(i) (ii)	0 ------------- 200,588	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 200,588	0 ------------- 0
3Jeffrey C Brown Former Treasurer	(i) (ii)	0 ------------- 10,736	0 ------------- 15,052	0 ------------- 496,088	0 ------------- 739	0 ------------- 582	0 ------------- 523,197	0 ------------- 496,088
4James P Hawkins Clerk [1/1/21-3/10/21]	(i) (ii)	0 ------------- 279,662	0 ------------- 259,156	0 ------------- 127,200	0 ------------- 898,837	0 ------------- 1,071	0 ------------- 1,565,926	0 ------------- 127,200
5Dennis J Leonard President & CEO	(i) (ii)	0 ------------- 445,054	0 ------------- 314,648	0 ------------- 350,000	0 ------------- 26,876	0 ------------- 1,040	0 ------------- 1,137,618	0 ------------- 350,000
6Gregory P Winn Asst. Treasurer [3/10/21 - 12/31/21] / Treasurer [1/1/21 - 3/10/21]	(i) (ii)	0 ------------- 243,894	0 ------------- 98,604	0 ------------- 108,000	0 ------------- 36,696	0 ------------- 1,281	0 ------------- 488,475	0 ------------- 108,000
7Denise Marks Treasurer [3/10/21 - 12/31/21]	(i) (ii)	0 ------------- 392,508	0 ------------- 50,553	0 ------------- 0	0 ------------- 9,216	0 ------------- 1,411	0 ------------- 453,688	0 ------------- 0
8Patricia Ma Clerk [3/10/21 - 12/31/21]	(i) (ii)	0 ------------- 296,548	0 ------------- 167	0 ------------- 0	0 ------------- 9,500	0 ------------- 495	0 ------------- 306,710	0 ------------- 0
9Steven J Pollock President-Dentaquest	(i) (ii)	0 ------------- 895,805	0 ------------- 1,402,378	0 ------------- 1,740,000	0 ------------- 7,818,234	0 ------------- 1,411	0 ------------- 11,857,828	0 ------------- 1,740,000
10David Abelman EVP- Chief Legal Officer - DentaQuest	(i) (ii)	0 ------------- 408,398	0 ------------- 289,937	0 ------------- 450,000	0 ------------- 1,307,400	0 ------------- 1,173	0 ------------- 2,456,908	0 ------------- 450,000
11Myechia Minter-Jordan MD MBA President-Carequest	(i) (ii)	0 ------------- 563,527	0 ------------- 570,628	0 ------------- 0	0 ------------- 33,397	0 ------------- 589	0 ------------- 1,168,141	0 ------------- 0
12Sheryl L Traylor EVP -HR -Dentaquest - (Retired)	(i) (ii)	0 ------------- 0	0 ------------- 0	0 ------------- 898,538	0 ------------- 3,058	0 ------------- 136	0 ------------- 901,732	0 ------------- 898,538
13Courtney Ransom SVP- Chief Ethics & Compliance Officer-Dentaquest	(i) (ii)	0 ------------- 299,770	0 ------------- 151,602	0 ------------- 60,000	0 ------------- 268,603	0 ------------- 1,343	0 ------------- 781,318	0 ------------- 60,000

Schedule J (Form 990) 2021

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
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	THE OFFICER'S COMPENSATION IS ESTABLISHED BY A RELATED ORGANIZATION, CAREQUEST INSTITUTE FOR ORAL HEALTH, INC. (FORMERLY CATALYST INSTITUTE, INC.) THROUGH THE USE OF A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, FORMS 990 OF OTHER ORGANIZATIONS, COMPENSATION SURVEYS OR STUDIES AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
Schedule J, Part I, Line 4a Severance or change-of-control payment	SHERYL L. TRAYLOR RECEIVED SEVERANCE IN THE AMOUNT OF $298,538 AND JEFFREY C. BROWN RECEIVED SEVERANCE IN THE AMOUNT OF $322,088. THIS AMOUNT IS INCLUDED IN BOTH INDIVIDUALS' COMPENSATION ON SCHEDULE J, PART II.
Schedule J, Part II	COMPENSATION PAID BY RELATED ORGANIZATION: SCHEDULE J, PART II INCLUDES INDIVIDUALS THAT ARE PAID BY DENTAQUEST, LLC, A RELATED ORGANIZATION, BUTPERFORM SERVICES FOR BOTH DENTAQUEST, LLC AND DENTAL SERVICE OF MASSACHUSETTS, INC., THE FILING ORGANIZATION. AS REPORTED IN PART VII, SECTION A, COLUMN (B), NONE OF THESE INDIVIDUALS DEVOTES MORE THAN 4.5 HOURS PER WEEK TO DENTAL SERVICE OF MASSACHUSETTS. ADDITIONALLY, ALL OF THE BONUS AND INCENTIVE COMPENSATION REPORTED IN PART II IS SOLELY RELATED TO WORK PERFORMED FOR, AND PAID BY, DENTAQUEST, LLC
Schedule J, Part II, Column (B)(ii) BONUS PAYMENTS	COLUMN B (II) ON SCHEDULE J PART II INCLUDES BONUSES EARNED AND ACCRUED DURING 2020 BUT PAID IN 2021.
Schedule J, Part II, Column (B)(iii) OTHER REPORTABLE COMPENSATION	OTHER REPORTABLE COMPENSATION REPRESENTS LONG-TERM INCENTIVE COMPENSATION EXPENSE EARNED PRIOR TO 2021 BUT PAID DURING 2021
Schedule J, Part II, Column (C) DEFERRED COMPENSATION	COLUMN C ON SCHEDULE J PART II INCLUDES LONG-TERM INCENTIVE COMPENSATION AND PENSION AMOUNTS EARNED DURING 2021 BUT PAID IN FUTURE YEARS.

Schedule J (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- TIN:

SCHEDULE O
(Form 990)

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

2021

Open to Public
Inspection

Name of the organization

Dental Service of Massachusetts Inc

Employer identification number

04-6143185

Return Reference	Explanation
Form 990, Part VI, Line 15 COMPENSATION POLICY	CAREQUEST INSTITUTE FOR ORAL HEALTH, INC. (FORMERLY CATALYST INSTITUTE, INC.), THE SOLE MEMBER OF DENTAL SERVICE OF MASSACHUSETTS, INC., HANDLES THE RESPONSIBILITY OF DETERMINING COMPENSATION FOR DENTAL SERVICE OF MASSACHUSETTS' OFFICERS.
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons	DR. MYECHIA MINTER-JORDAN - Business relationship, DENISE MARKS - Business relationship, GREGORY P. WINN - Business relationship, PATRICIA MA - Business relationship, JAMES P. HAWKINS - Business relationship, PAMELA D.A. REEVE - Business relationship, EVELYN H. MILLER - Business relationship, JESSICA A. ZEASKE - Business relationship, WILLIAM C. MILLS III - Business relationship, RODERICK K. KING - Business relationship, KATHLEEN V. BETTS - Business relationship, ROBERT J. WEYANT - Business relationship, DR. ANDREW C. AGWUNOBI - Business relationship, TODD W. MARSHALL - Business relationship
Form 990, Part VI, Line 3 Delegation of management duties	THE COMPANY HIRES DENTAQUEST, LLC (A RELATED PARTY) TO PROVIDE MANAGEMENT SERVICES.
Form 990, Part VI, Line 6 Classes of members or stockholders	CAREQUEST INSTITUTE FOR ORAL HEALTH, INC. (FORMERLY CATALYST INSTITUTE, INC.) IS THE SOLE MEMBER OF DENTAL SERVICES OF MASSACHUSETTS, INC.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	THE MEMBERS OF THE ORGANIZATION ELECT THE DIRECTORS AT THE ANNUAL MEETING OF THE ORGANIZATION.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	A QUORUM OF THE ORGANIZATION'S MEMBERS MAY VOTE TO AMEND OR REPEAL THE BY-LAWS.
Form 990, Part VI, Line 11b Review of form 990 by governing body	THE AUDIT COMMITTEE, A COMMITTEE OF THE DSM BOARD OF DIRECTORS, REVIEWS A FINAL FORM OF THE FORM 990 PRIOR TO ACTUAL FILING. MEMBERS OF THE EXTERNAL TAX FIRM (CURRENTLY ERNST & YOUNG U.S., LLP) INITIALLY DISCUSS, PREPARE AND REVIEW THE RETURN WITH MANAGEMENT. MANAGEMENT AND STAFF REVIEW THE 990 FOR ACCURACY AND COMPLETENESS AND PROVIDE COMMENTS TO THE PREPARER. ONCE THE RETURN IS FULLY ANALYZED AND PREPARED, A PAPER COPY IS DISTRIBUTED TO THE AUDIT COMMITTEE MEMBERS IN ADVANCE OF A SPECIFIC MEETING. AUDIT COMMITTEE MEMBERS REVIEW THE DRAFT FORM 990 AND THEN SEND TO THE FULL BOARD. A COPY OF THE FINAL FORM 990 IS SENT TO THE FULL BOARD AND OFFICERS BEFORE IT IS FILED.
Form 990, Part VI, Line 12c Conflict of interest policy	MONITORING THE ORGANIZATION'S CONFLICT OF INTEREST POLICY PROVIDES THAT ANNUALLY, EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS SHALL SIGN A QUESTIONNAIRE AFFIRMING THAT SUCH PERSON RECEIVED A COPY OF THE CONFLICT-OF-INTEREST POLICY, READ, AND UNDERSTANDS THE POLICY AND AGREES TO COMPLY WITH THE POLICY. ADDITIONALLY, THE SIGNED QUESTIONNAIRE AFFIRMS THAT THE PERSON UNDERSTANDS DENTAL SERVICE OF MASSACHUSETTS, INC. IS A CHARITABLE ORGANIZATION AND THAT IN ORDER TO MAINTAIN ITS TAX-EXEMPT STATUS, DENTAL SERVICE OF MASSACHUSETTS MUST ENGAGE IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. ENFORCEMENT IF THE GOVERNING BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A BOARD OR COMMITTEE MEMBER ("MEMBER") HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE MEMBER'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE GOVERNING BOARD OR COMMITTEE DETERMINES THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. WHO IS COVERED? THE ORGANIZATION'S CONFLICT OF INTEREST POLICY COVERS EACH DIRECTOR, PRINCIPAL OFFICER AND MEMBERS OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS. LEVEL OF DETERMINATION AND REVIEW OF CONFLICTS IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER PRESENTATION OF A POTENTIAL TRANSACTION OR ARRANGEMENT IS MADE BY AN INTERESTED PERSON, THE REMAINING DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE TRANSACTION OR ARRANGEMENT IN QUESTION. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE IF DENTAL SERVICE OF MASSACHUSETTS, INC. CAN OBTAIN, WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, THE GOVERNING BOARD OR COMMITTEE SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. RESTRICTIONS PLACED ON CONFLICTED PERSONS IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS.
Form 990, Part VI, Line 19 Required documents available to the public	WE FILE A MASSACHUSETTS FORM PC WITH AN ATTACHED FORM 990. THE FORM PC IS FILED WITH THE ATTORNEY GENERAL'S OFFICE AND IS AVAILABLE FOR INSPECTION BY ANY OF THE INTERESTED PUBLIC. THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, ARTICLES OF INCORPORATION AND BYLAWS ARE MADE AVAILABLE UPON REQUEST.
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	EQUITY IN SUBSIDIARIES - 296166; DISTRIBUTIONS TO CAREQUEST INSTITUTE FOR ORAL HEALTH, INC. - -30000000;

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

Cat. No. 51056K

Schedule O (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2

- 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

2021

Open to Public Inspection

Name of the organization

Dental Service of Massachusetts Inc

Employer identification number

04-6143185

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
(1) DQCGM OF OREGON LLC 442 SW UMATILLA AVE STE 200 REDMOND,OR97756 27-0364023	CARE DELIVERY	OR	0	0	DQ GROUP
(2) ADVANTAGE CONSULTING SERVICES LLC 442 SW UMATILLA AVE STE 200 REDMOND,OR97756 26-3981408	CARE DELIVERY	OR	0	0	DQ GROUP
(3) ADVANTAGE SUPPORT SERVICES LLC 442 SW UMATILLA AVE STE 200 REDMOND,OR97756 26-3981367	CARE DELIVERY	OR	0	0	DQ GROUP
(4) ADVANTAGE DENTAL SVCS LLC 442 SW UMATILLA AVE STE 200 REDMOND,OR97756 93-1195386	CARE DELIVERY	OR	0	0	DQ GROUP
(5) ADVANTAGE COMMUNITY HOLDING COMPANY LLC 442 SW UMATILLA AVE STE 200 REDMOND,OR97756 20-8939962	CARE DELIVERY	OR	0	0	DQ GROUP
(6) DENTAQUEST OF ARIZONA LLC 465 MEDFORD STREET BOSTON,MA02129 11-3692025	DENTAL SVCS	WI	0	8,976,956	DQ GROUP
(7) DENTAQUEST ADMINISTRATIVE SERVICES LLC 465 MEDFORD STREET BOSTON,MA02129 39-2041298	DENTAL SVCS	WI	0	271,167	DQ GROUP
(8) DENTAQUEST OF GEORGIA LLC 465 MEDFORD STREET BOSTON,MA02129 14-1885493	DENTAL SVCS	WI	0	-222,992	DQ GROUP
(9) DENTAQUEST OF ILLINOIS INC 465 MEDFORD STREET BOSTON,MA02129 42-1529687	DENTAL SVCS	WI	0	14,858,952	DQ GROUP
(10) DENTAQUEST OF KENTUCKY LLC 465 MEDFORD STREET BOSTON,MA02129 14-1885490	DENTAL SVCS	WI	0	3,330,017	DQ GROUP
(11) DENTAQUEST OF MARYLAND INC 465 MEDFORD STREET BOSTON,MA02129 81-0567214	DENTAL SVCS	WI	0	51,144	DQ GROUP
(12) DENTAQUEST OF MINNESOTA LLC 465 MEDFORD STREET BOSTON,MA02129 56-2356445	DENTAL SVCS	WI	0	4,396,173	DQ GROUP
(13) DENTAQUEST OF NEW JERSEY LLC 465 MEDFORD STREET BOSTON,MA02129 56-2356433	DENTAL SVCS	WI	0	1,221,016	DQ GROUP
(14) DENTAQUEST OF NEW MEXICO LLC 465 MEDFORD STREET BOSTON,MA02129 14-1885481	DENTAL SVCS	WI	0	1,967,974	DQ GROUP
(15) DENTAQUEST IPA OF NEW YORK LLC 465 MEDFORD STREET BOSTON,MA02129 81-0616910	DENTAL SVCS	WI	0	44,667,484	DQ GROUP
(16) DENTAQUEST OF NEW YORK LLC 465 MEDFORD STREET BOSTON,MA02129 14-1885500	DENTAL SVCS	WI	0	-6,120,692	DQ GROUP
(17) DENTAQUEST OF TENNESSEE LLC 465 MEDFORD STREET BOSTON,MA02129 35-2177954	DENTAL SVCS	WI	0	11,226,254	DQ GROUP
(18) DENTAQUEST CARE GROUP MANAGEMENT LLC 465 MEDFORD STREET BOSTON,MA02129 32-0487994	CARE DELIVERY	DE	0	154,200,484	DQ GROUP
(19) DENTAQUEST LLC 465 MEDFORD STREET BOSTON,MA02129 20-0390099	DENTAL SVCS	DE	22,113,471	297,507,586	DQ GROUP
(20) DQCGM OF WASHINGTON LLC 465 MEDFORD STREET BOSTON,MA02129 84-3407897	CARE DELIVERY	DE	0	0	DQ GROUP
(21) DQCGM OF MASSACHUSETTS LLC 465 MEDFORD STREET BOSTON,MA02129 84-1851756	CARE DELIVERY	DE	0	0	DQ GROUP
(22) DENTAQUEST OF IOWA LLC 465 MEDFORD STREET BOSTON,MA02129 61-1871504	DENTAL SVCS	WI	0	134,447	DQ GROUP
(23) DQCHM OF ALABAMA LLC 465 Medford Street Boston,MA02129 87-2778161	CARE DELIVERY	AL	0	0	DQ GROUP
(24) DQCGM OF FLORIDA LLC 465 Medford Street Boston,MA02129 87-3142270	CARE DELIVERY	FL	0	0	DQ GROUP

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)CAREQUEST FOUNDATION INC 465 MEDFORD STREET BOSTON,MA02129 04-3265080	ORAL HTH IMPR	MA	501(c)(3)	PF	CAREQUEST		No
(2)DENTAQUEST CARE GROUP INC 465 MEDFORD STREET BOSTON,MA02129 46-3674034	ORAL HTH IMPR	MA	501(c)(3)	Type I	CAREQUEST		No
(3)DENTAL HEALTH PROGRAMS INC DBA COMMU 465 MEDFORD STREET BOSTON,MA02129 75-1823660	ORAL HTH IMPR	TX	501(c)(3)	7	DQ CAREGROUP		No
(4)COMMUNITY CARE OF KENTUCKY INC 101 S FIFTH STREET 3500 NATION LOUISVILLE,KY40202 46-5159094	ORAL HTH IMPR	KY	501(c)(3)	7	DQ CAREGROUP		No
(5)CAREQUEST INST FOR ORAL HLTH INC 465 MEDFORD STREET BOSTON,MA02129 38-4016550	ORAL HTH IMPR	MA	501(c)(4)		NA		No
(6)COMMUNITY CARE OF NEW MEXICO INC 465 MEDFORD STREET BOSTON,MA02129 47-1711799	ORAL HTH IMPR	NM	501(c)(3)	7	DQ CAREGROUP		No
(7)THE OHIO RETIREE DENTAL BENEFITS ASSOCIA 100 CROWNE POINT PLACE CINCINNATI,OH45241 27-1693969	ORAL HTH IMPR	OH	501(c)(3)	7	DCP HOLD COR		No
(8)DENTAQUEST INSTITUTE INC 465 MEDFORD STREET Boston,MA02129 20-5312990	ORAL HTH IMPR	MA	501(c)(3)	Type I	CAREQUEST		No
(9)Sarrell Regional Dental Center for Public Health Inc 230 E 10th Street No 106 Anniston,AL36207 20-0232609	ORAL HTH IMPR	AL	501(c)(3)	10	DQ Care Group		No

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

Cat. No. 50135Y

Schedule R (Form 990) 2021

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	(e) Predominant income(related, unrelated, excluded from tax under sections 512-514)	(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?		(k) Percentage ownership
(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	(k) Percentage ownership
(1) ADVANTAGE HARBOR QALICB OWNERS- QALICB-1 442 SW UMATILLA AVE STE 200 Redmond,OR97756	CARE DELIVERY	OR	DQ GROUP	Excluded	0	0		No	0			0 %
(2) ADVANTAGE HARBOR QALICB OWNERS - Advantage Harbor 442 SW UMATILLA AVE STE 200 Redmond,OR97756	CARE DELIVERY	OR	DQ GROUP	Excluded	0	0		No	0			0 %
(3) ADVANTAGE HARBOR QALICB OWNERS - Advantage LaPine 442 SW UMATILLA AVE STE 200 Redmond,OR97756	CARE DELIVERY	OR	DQ GROUP	Excluded	0	0		No	0			0 %

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	(h) Percentage ownership	(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	(h) Percentage ownership	Yes	No
(1) DENTAQUEST GROUP INC 465 MEDFORD STREET BOSTON,MA02129 20-4056199	DENTAL SVCS	DE	CAREQUEST	C Corporation	0	0	100 %		No
(2) DSM MASSACHUSETTS INSURANCE COMPANY INC 465 MEDFORD STREET BOSTON,MA02129 46-5661073	INSURANCE	MA	DSM INVESTMENTS	C Corporation	196,501	313,000	100 %	Yes
(3) DENTAQUEST USA INSURANCE COMPANY INC 465 MEDFORD STREET BOSTON,MA02129 20-2970185	INSURANCE	TX	DQ GROUP	C Corporation	76,156,662	134,214,709	100 %		No
(4) DSM INVESTMENTS INC 465 MEDFORD STREET BOSTON,MA02129 04-3428012	DENTAL SVCS	MA	DSM	C Corporation	296,161	161,919	100 %	Yes
(5) DENTAQUEST OF FLORIDA INC 465 MEDFORD STREET BOSTON,MA02129 65-0743731	INSURANCE	FL	DQ GROUP	C Corporation	11,767,210	11,323,618	100 %		No
(6) DSM USA INSURANCE COMPANY INC 465 MEDFORD STREET BOSTON,MA02129 59-0397210	INSURANCE	TX	DQ GROUP	C Corporation	33,843,336	69,273,848	100 %		No
(7) CALIFORNIA DENTAL NETWORK INC 465 MEDFORD STREET BOSTON,MA02129 93-0954061	INSURANCE	CA	DQ GROUP	C Corporation	125,648	3,391,913	100 %		No
(8) PACIFIC DENTAL NETWORK INC 465 MEDFORD STREET BOSTON,MA02129 33-0672992	DENTAL SVCS	CA	GQ GROUP	C Corporation	116,338	-1,012	100 %		No
(9) DSM INSURANCE SERVICES INC 465 MEDFORD STREET BOSTON,MA02129 04-3172335	INSURANCE	MA	DSM INVESTMENTS	C Corporation	95,174	1,813,932	100 %		No
(10) DentaQuest Oral Health Center of Massachusetts PC 465 MEDFORD STREET BOSTON,MA02129 84-1891345	ORAL HTH CTR	MA	DQ GROUP	C Corporation	0	0	100 %		No
(11) GARY W ALLEN DMD PC 465 Medford Street Boston,MA02129 20-2758287	ORAL HEALTH CENTER	MA	DQ GROUP	C Corporation	0	0	100 %		No
(12) ADVANTAGE DENTAL ORAL HEALTH & VISION CENTER OF ALABAMA PC 465 Medford Street Boston,MA02129 20-0232609	ORAL HEALTH CENTER	AL	DQ GROUP	C Corporation	0	0	100 %		No
(13) ADVANTAGE DENTAL ORAL HEALTH CENTER OF FLORIDA PA 465 Medford Street Boston,MA02129 87-3780957	ORAL HEALTH CENTER	FL	DQ GROUP	C Corporation	0	0	100 %		No
(14) ADVANTAGE DENTAL GROUP PC 465 Medford Street Boston,MA02129 80-0437099	ORAL HEALTH CENTER	OR	DQ GROUP	C Corporation	0	0	100 %		No
(15) ADVANTAGE LEVERAGED LENDERS INC 442 SW UMATILLA AVE STE 200 REDMOND,OR97756 57-1140840	CARE DELIVERY	OR	DQ GROUP	C Corporation	0	0	100 %		No
(16) CAREQUEST INNOVATION PARTNERS INC 465 MEDFORD STREET BOSTON,MA02129 83-2714016	ORAL HTH CTR	DE	CAREQUEST	C Corporation	0	0	100 %		No
(17) ADVANTAGE DENTAL PLAN INC 442 SW UMATILLA AVE STE 200 REDMOND,OR97756 93-1156986	CARE DELIVERY	OR	DQ GROUP	C Corporation	0	0	100 %		No
(18) OREGON COMMUNITY DENTAL CARE 442 SW UMATILLA AVE STE 200 REDMOND,OR97756 45-4129709	CARE DELIVERY	OR	DQ GROUP	C Corporation	0	0	100 %		No
(19) DCP HOLDING COMPANY INC 100 CROWNE POINT PLACE CINCINNATI,OH45241 20-1291244	INSURANCE	OH	DQ GROUP	C Corporation	7,096,440	7,661,225	100 %		No
(20) DENTAL CARE PLUS INC 100 CROWNE POINT PLACE CINCINNATI,OH45241 31-1185262	INSURANCE	OH	DCP HOLDINGS CO	C Corporation	6,250,400	18,198,405	100 %		No
(21) INSURANCE ASSOCIATES PLUS INC 100 CROWNE POINT PLACE CINCINNATI,OH45241 20-1455615	INSURANCE	OH	DCP HOLDINGS CO	C Corporation	99,914	206,132	100 %		No
(22) ADENTA INC 100 CROWNE POINT PLACE CINCINNATI,OH45241 61-1301274	INSURANCE	KY	DCP HOLDINGS CO	C Corporation	137,011	275,545	100 %		No

Schedule R (Form 990) 2021

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) ............................

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) .................

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

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

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) DENTAQUEST GROUP INC & SUBSIDIARIES	P	13,049,245	FMV

Schedule R (Form 990) 2021

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?		(k) Percentage ownership
(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	(k) Percentage ownership

Schedule R (Form 990) 2021

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. See instructions.

Return Reference	Explanation

Schedule R (Form 990) 2021

Additional Data

Software ID:	21014044
Software Version:	2021v4.2