efile Public Visual Render
ObjectId: 202013179349303956 - Submission: 2020-11-12
TIN: 04-6143185
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.
Attach to Form 990.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
19
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)
Advantage Dental Clinics LLC
442 SW Umatilla Ave
Redmond
,
OR
97756
27-0364023
Care Delivery
OR
DQ Group
(2)
Advantage Consulting Services LLC
442 SW Umatilla Ave
Redmond
,
OR
97756
26-3981408
Care Delivery
OR
DQ Group
(3)
Advantage Support Services LLC
442 SW Umatilla Ave
Redmond
,
OR
97756
26-3981367
Care Delivery
OR
DQ Group
(4)
Advantage Clinic Properties LLC
442 SW Umatilla Ave
Redmond
,
OR
97756
27-0357326
Care Delivery
OR
DQ Group
(5)
Advantage Equipment Leasing LLC
442 SW Umatilla Ave
Redmond
,
OR
97556
80-0426323
Care Delivery
OR
DQ Group
(6)
Advantage Dental Service LLC
442 SW Umatilla Ave
Redmond
,
OR
97756
93-1195386
Care Delivery
OR
DQ Group
(7)
Advantage Professional Management LLC
442 SW Umatilla Ave
Redmond
,
OR
97756
26-0207886
Care Delivery
OR
DQ Group
(8)
DentaQuest of Arizona LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
11-3692025
Dental Servic
WI
-13,271,015
DQ GROUP
(9)
DentaQuest of Georgia LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
14-1885493
Dental Servic
WI
357,512
DQ GROUP
(10)
DentaQuest of Illinois Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
42-1529687
Dental Servic
WI
-8,162,885
DQ GROUP
(11)
DentaQuest of Kentucky LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
14-1885490
Dental Servic
WI
3,549,388
DQ GROUP
(12)
DentaQuest of Maryland Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
81-0567214
Dental Servic
WI
-3,740,085
DQ GROUP
(13)
DentaQuest of Minnesota LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
56-2356445
Dental Servic
WI
4,423,493
DQ GROUP
(14)
DentaQuest of New Jersey LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
56-2356433
Dental Servic
WI
474,732
DQ GROUP
(15)
DentaQuest of New Mexico LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
14-1885481
Dental Servic
WI
2,430,065
DQ GROUP
(16)
DentaQuest IPA of New York LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
81-0616910
Dental Servic
WI
29,780,815
DQ GROUP
(17)
DentaQuest of New York LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
14-1885500
Dental Servic
WI
-4,655,251
DQ GROUP
(18)
DentaQuest of Tennessee LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
35-2177954
Dental Servic
WI
8,825,964
DQ GROUP
(19)
DentaQuest Care Group Management LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
32-0487994
Care Delivery
DE
157,486,344
DQ GROUP
(20)
DentaQuest LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
20-0390099
Dental Servic
DE
-17,522,790
202,643,164
DQ GROUP
(21)
Dental Services LLC
14201 NE 20TH AVE 2204
VANCOUVER
,
WA
98686
05-0572255
Care Delivery
WA
DQ Group
(22)
DQ PTR for Oral Healt Advancement LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
82-3649978
Dental Servic
MA
Catalyst
(23)
DentaQuest Foundation LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
82-3645884
Dental Servic
MA
Catalyst
(24)
DQ CGM of Washington LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
84-3407897
Care Delivery
DE
DQ GROUP
(25)
DQCGM of Massachusetts LLC
465 MEDFORD STREET
BOSTON
,
MA
02129
84-1851756
Care Delivery
DE
DQ GROUP
(26)
DENTAQUEST HOLDING CO LLC
465 MEDFORD STREET
Boston
,
DE
02129
82-3782157
Dental SVcS
DE
DSM
(27)
DENTAQUEST OF IOWA LLC
465 MEDFORD STREET
Boston
,
MA
02129
61-1871504
DENTAL SVCS
WI
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?
Yes
No
(1)
DQ Ptship for Oral Health Advt INC
465 Medford Street
BOSTON
,
MA
02129
04-3265080
ORAL HTH IMPR
MA
501(c)(3)
n/a
Catalyst Ins
No
(2)
DentaQuest Institute Inc
465 Medford Street
BOSTON
,
MA
02129
20-5312990
ORAL HTH IMPR
MA
501(c)(3)
12A
Catalyst Ins
No
(3)
DentaQuest Care Group Inc
465 Medford Street
BOSTON
,
MA
02129
46-3674034
ORAL HTH IMPR
MA
501(c)(3)
12A
Catalyst Ins
No
(4)
Dental Hth Progr Inc dba Community DC
465 Medford Street
BOSTON
,
MA
02129
75-1823660
ORAL HTH IMPR
TX
501(C)(3)
7
DQ Care Grou
No
(5)
Sarrell Regional Dental Center for Publi
230 E 10th Street No 106
ANNISTON
,
AL
36207
20-0232609
ORAL HTH IMPR
AL
501(C)(3)
10
DQ Care Grou
No
(6)
Community Care of Kentucky Inc
101 S Fifth Street 3500 Nation
LOUISVILLE
,
KY
40202
46-5159094
ORAL HTH IMPR
KY
501(C)(3)
7
DQ Care Grou
No
(7)
Catalyst Institute Inc
465 Medford Street
BOSTON
,
MA
02129
38-4016550
ORAL HTH IMPR
MA
501(c)(4)
n/a
NA
No
(8)
COMMUNITY CARE OF NEW MEXICO INC
465 MEDFORD STREET
BOSTON
,
MA
02129
47-1711799
ORAL HTH IMPR
NM
501(c)(3)
7
DQ CAREGROUP
No
(9)
THE OHIO RETIREE DENTAL BENEFITS ASSOC
100 CROWNE POINT PLACE
CINCINNATI
,
OH
45241
27-1693969
ORAL HTH IMPR
OH
501(c)(3)
7
DCP HOLDCO
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2019
Page 2
Schedule R (Form 990) 2019
Page
2
Part III
Identification of Related Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(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
Yes
No
Yes
No
(1)
ACH Company LLC
442 SW Umatilla Av
Redmond
,
OR
97756
20-8939962
CARE DELIVERY
OR
DQ Group
No
0
(2)
AHQ Owners - QALICB-1
442 SW Umatilla Av
Redmond
,
OR
97756
27-4218188
CARE DELIVERY
OR
DQ Group
No
0
(3)
AHQ Owners - Advt Harbor
442 SW Umatilla Av
Redmond
,
OR
97756
46-3260263
CARE DELIVERY
OR
DQ Group
No
0
(4)
AHQ Owners - Advt LaPine
442 SW Umatilla Av
Redmond
,
OR
97756
CARE DELIVERY
OR
DQ Group
No
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?
Yes
No
(1)
DentaQuest Group Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
20-4056199
Dental Service
DE
NA
C CORP
0
0
0 %
No
(2)
DSM Massachusetts Insurance Company Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
46-5661073
Insurance
MA
DSM Investments
C CORP
-384,994
10,167,478
100.000 %
Yes
(3)
DentaQuest USA Insurance Company Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
20-2970185
Insurance
TX
NA
C CORP
0
0
0 %
No
(4)
DSM Investments Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
04-3428012
Dental Service
MA
DSM
C CORP
0
10
100.000 %
Yes
(5)
DentaQuest of Florida Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
65-0743731
Insurance
FL
NA
c corp
0
0
0 %
No
(6)
DSM USA Insurance Company Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
59-0397210
Insurance
TX
NA
c corp
0
0
0 %
No
(7)
California Dental Network Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
93-0954061
Insurance
CA
NA
c corp
0
0
0 %
No
(8)
Pacific Dental Network Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
33-0672992
Dental Service
CA
NA
c corp
0
0
0 %
No
(9)
DSM Insurance Services Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
04-3172335
Insurance
MA
DSM Investments
C CORP
-98,878
-547,801
100.000 %
Yes
(10)
DentaQuest Oral Health Center Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
04-3434787
Oral Health Cente
MA
DSM Investments
C CORP
-209,706
392,199
100.000 %
Yes
(11)
MYSTIC RIVER INSURANCE COMPANY
171 elgin ave
george town
,
grand cayman
ky1-1002
CJ
insurance
CJ
NA
C Corp
0
0
0 %
No
(12)
Advantage Dental Plan Inc
442 SW Umatilla Ave
Redmond
,
OR
97756
93-1156986
Care Delivery
OR
NA
C Corp
0
0
0 %
No
(13)
DentaQuest Impact Inc
465 MEDFORD STREET
BOSTON
,
MA
02129
83-2714016
Oral Health Impro
DE
NA
C CORP
0
0
0 %
No
(14)
advantage leveraged lenders inc
442 SW UMATILLA AVE
redmond
,
OR
97756
46-2124368
care delivery
OR
NA
C CORP
0
0
0 %
No
(15)
Dental Care Plus Inc
100 Crowne Point
Cincinnati
,
OH
45241
31-1185262
Insurance
OH
NA
C CORP
0
0
0 %
No
(16)
Insurance Associates Plus Inc
100 Crowne Point
Cincinnati
,
OH
45241
20-1455615
Insurance
OH
NA
C CORP
0
0
0 %
No
(17)
Adenta Inc
100 Crowne Point
Cincinnati
,
OH
45241
61-1301274
Insurance
KY
NA
C CORP
0
0
0 %
No
(18)
DCP Holding Company Inc
100 crowne point
cincinnati
,
OH
45241
20-1291244
insurance
OH
NA
c Corp
0
0
No
Schedule R (Form 990) 2019
Page 3
Schedule R (Form 990) 2019
Page
3
Part V
Transactions With Related Organizations.
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note.
Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
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
.....................
1a
No
b
Gift, grant, or capital contribution to related organization(s)
............................
1b
Yes
c
Gift, grant, or capital contribution from related organization(s)
............................
1c
No
d
Loans or loan guarantees to or for related organization(s)
............................
1d
No
e
Loans or loan guarantees by related organization(s)
............................
1e
No
f
Dividends from related organization(s)
............................
1f
No
g
Sale of assets to related organization(s)
............................
1g
Yes
h
Purchase of assets from related organization(s)
............................
1h
No
i
Exchange of assets with related organization(s)
............................
1i
No
j
Lease of facilities, equipment, or other assets to related organization(s)
.......................
1j
No
k
Lease of facilities, equipment, or other assets from related organization(s)
......................
1k
No
l
Performance of services or membership or fundraising solicitations for related organization(s)
.....................
1l
No
m
Performance of services or membership or fundraising solicitations by related organization(s)
.................
1m
No
n
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
...................
1n
No
o
Sharing of paid employees with related organization(s)
............................
1o
Yes
p
Reimbursement paid to related organization(s) for expenses
............................
1p
Yes
q
Reimbursement paid by related organization(s) for expenses
............................
1q
No
r
Other transfer of cash or property to related organization(s)
............................
1r
No
s
Other transfer of cash or property from related organization(s)
............................
1s
No
2
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
11,527,208
FMV
Schedule R (Form 990) 2019
Page 4
Schedule R (Form 990) 2019
Page
4
Part VI
Unrelated Organizations Taxable as a Partnership.
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)
(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
Yes
No
Yes
No
Yes
No
Schedule R (Form 990) 2019
Page 5
Schedule R (Form 990) 2019
Page
5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. (see instructions).
Return Reference
Explanation
Schedule R (Form 990) 2019
Additional Data
Software ID:
Software Version: