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        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>419027</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>0</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>63788</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <Form990PartVIISectionAGrp>
        <PersonNm>Myechia Minter-Jordan MD MBA</PersonNm>
        <TitleTxt>President-Carequest</TitleTxt>
        <AverageHoursPerWeekRt>5.0</AverageHoursPerWeekRt>
        <AverageHoursPerWeekRltdOrgRt>35.0</AverageHoursPerWeekRltdOrgRt>
        <HighestCompensatedEmployeeInd>X</HighestCompensatedEmployeeInd>
        <ReportableCompFromOrgAmt>0</ReportableCompFromOrgAmt>
        <ReportableCompFromRltdOrgAmt>2419674</ReportableCompFromRltdOrgAmt>
        <OtherCompensationAmt>39962</OtherCompensationAmt>
      </Form990PartVIISectionAGrp>
      <TotalReportableCompFromOrgAmt>2316750</TotalReportableCompFromOrgAmt>
      <TotReportableCompRltdOrgAmt>5526766</TotReportableCompRltdOrgAmt>
      <TotalOtherCompensationAmt>412697</TotalOtherCompensationAmt>
      <IndivRcvdGreaterThan100KCnt>47</IndivRcvdGreaterThan100KCnt>
      <FormerOfcrEmployeesListedInd>false</FormerOfcrEmployeesListedInd>
      <TotalCompGreaterThan150KInd>true</TotalCompGreaterThan150KInd>
      <CompensationFromOtherSrcsInd>false</CompensationFromOtherSrcsInd>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>42 North Dental Care LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 411381 3RD FLOOR</AddressLine1Txt>
            <CityNm>BOSTON</CityNm>
            <StateAbbreviationCd>MA</StateAbbreviationCd>
            <ZIPCd>02241</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Dental Services</ServicesDesc>
        <CompensationAmt>17892656</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>PREMIER CARE DENISTRY OF MASSACHUSETTS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>105 MAXESS ROAD</AddressLine1Txt>
            <AddressLine2Txt>STE N107</AddressLine2Txt>
            <CityNm>MELVILLE</CityNm>
            <StateAbbreviationCd>NY</StateAbbreviationCd>
            <ZIPCd>11747</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Dental Services</ServicesDesc>
        <CompensationAmt>5322616</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>COMMONWEALTH OF MASSACHUSETTS</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>ONE ASHBURTON PLACE</AddressLine1Txt>
            <AddressLine2Txt>9TH FLOOR</AddressLine2Txt>
            <CityNm>BOSTON</CityNm>
            <StateAbbreviationCd>MA</StateAbbreviationCd>
            <ZIPCd>02108</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Dental Services</ServicesDesc>
        <CompensationAmt>4885902</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Chestnut Dental Associates PC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>38 Pond Street</AddressLine1Txt>
            <AddressLine2Txt>STE 204</AddressLine2Txt>
            <CityNm>Franklin</CityNm>
            <StateAbbreviationCd>MA</StateAbbreviationCd>
            <ZIPCd>02038</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Dental Services</ServicesDesc>
        <CompensationAmt>4649567</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>Great Hill Dental Partners LLC</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 411381</AddressLine1Txt>
            <CityNm>BOSTON</CityNm>
            <StateAbbreviationCd>MA</StateAbbreviationCd>
            <ZIPCd>02241</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>Dental Services</ServicesDesc>
        <CompensationAmt>3596015</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>1722</CntrctRcvdGreaterThan100KCnt>
      <FederatedCampaignsAmt>0</FederatedCampaignsAmt>
      <MembershipDuesAmt>0</MembershipDuesAmt>
      <FundraisingAmt>0</FundraisingAmt>
      <RelatedOrganizationsAmt>0</RelatedOrganizationsAmt>
      <GovernmentGrantsAmt>0</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>0</AllOtherContributionsAmt>
      <NoncashContributionsAmt>0</NoncashContributionsAmt>
      <TotalContributionsAmt>0</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PREMIUMS</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>202374787</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>202374787</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>STATE NON-TAXABLE PREMIUMS</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>71348974</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>71348974</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>Net Administration Service (Net of $755,420,837 claims)</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>61939337</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>61939337</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </ProgramServiceRevenueGrp>
      <TotalOthProgramServiceRevGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </TotalOthProgramServiceRevGrp>
      <TotalProgramServiceRevenueAmt>335663098</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>3515388</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>3515388</ExclusionAmt>
      </InvestmentIncomeGrp>
      <IncmFromInvestBondProceedsGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </IncmFromInvestBondProceedsGrp>
      <RoyaltiesRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </RoyaltiesRevenueGrp>
      <GrossRentsGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>0</RealAmt>
        <PersonalAmt>0</PersonalAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <SecuritiesAmt>77155</SecuritiesAmt>
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      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <SecuritiesAmt>349560</SecuritiesAmt>
        <OtherAmt>-2680</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
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      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>-269725</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>-269725</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <FundraisingGrossIncomeAmt>0</FundraisingGrossIncomeAmt>
      <ContriRptFundraisingEventAmt>0</ContriRptFundraisingEventAmt>
      <FundraisingDirectExpensesAmt>0</FundraisingDirectExpensesAmt>
      <NetIncmFromFundraisingEvtGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetIncmFromFundraisingEvtGrp>
      <GamingGrossIncomeAmt>0</GamingGrossIncomeAmt>
      <GamingDirectExpensesAmt>0</GamingDirectExpensesAmt>
      <NetIncomeFromGamingGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetIncomeFromGamingGrp>
      <GrossSalesOfInventoryAmt>0</GrossSalesOfInventoryAmt>
      <CostOfGoodsSoldAmt>0</CostOfGoodsSoldAmt>
      <NetIncomeOrLossGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </NetIncomeOrLossGrp>
      <MiscellaneousRevenueGrp>
        <TotalRevenueColumnAmt>0</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>0</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>0</ExclusionAmt>
      </MiscellaneousRevenueGrp>
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      <TotalRevenueGrp>
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        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>3245663</ExclusionAmt>
      </TotalRevenueGrp>
      <GrantsToDomesticOrgsGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
      </GrantsToDomesticOrgsGrp>
      <GrantsToDomesticIndividualsGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
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      <ForeignGrantsGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
      </ForeignGrantsGrp>
      <BenefitsToMembersGrp>
        <TotalAmt>217030479</TotalAmt>
        <ProgramServicesAmt>217030479</ProgramServicesAmt>
      </BenefitsToMembersGrp>
      <CompCurrentOfcrDirectorsGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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        <FundraisingAmt>0</FundraisingAmt>
      </CompCurrentOfcrDirectorsGrp>
      <CompDisqualPersonsGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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        <FundraisingAmt>0</FundraisingAmt>
      </CompDisqualPersonsGrp>
      <OtherSalariesAndWagesGrp>
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      <PensionPlanContributionsGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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      <OtherEmployeeBenefitsGrp>
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        <ProgramServicesAmt>12296</ProgramServicesAmt>
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      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
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        <ManagementAndGeneralAmt>1249748</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
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        <ProgramServicesAmt>41368592</ProgramServicesAmt>
        <ManagementAndGeneralAmt>27579060</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>0</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
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        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>5034899</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>5034899</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesLobbyingGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>84000</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesLobbyingGrp>
      <FeesForServicesProfFundraising>
        <TotalAmt>0</TotalAmt>
        <FundraisingAmt>0</FundraisingAmt>
      </FeesForServicesProfFundraising>
      <FeesForSrvcInvstMgmntFeesGrp>
        <TotalAmt>194546</TotalAmt>
        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>194546</ManagementAndGeneralAmt>
        <FundraisingAmt>0</FundraisingAmt>
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      <FeesForServicesOtherGrp>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
        <ManagementAndGeneralAmt>0</ManagementAndGeneralAmt>
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      <AdvertisingGrp>
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        <ProgramServicesAmt>448262</ProgramServicesAmt>
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      </AdvertisingGrp>
      <OfficeExpensesGrp>
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      <InformationTechnologyGrp>
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        <ProgramServicesAmt>33980</ProgramServicesAmt>
        <ManagementAndGeneralAmt>22654</ManagementAndGeneralAmt>
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        <ProgramServicesAmt>0</ProgramServicesAmt>
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      <OccupancyGrp>
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        <ProgramServicesAmt>166516</ProgramServicesAmt>
        <ManagementAndGeneralAmt>111010</ManagementAndGeneralAmt>
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      <TravelGrp>
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        <ProgramServicesAmt>130667</ProgramServicesAmt>
        <ManagementAndGeneralAmt>87111</ManagementAndGeneralAmt>
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      <PymtTravelEntrtnmntPubOfclGrp>
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        <FundraisingAmt>0</FundraisingAmt>
      </PymtTravelEntrtnmntPubOfclGrp>
      <ConferencesMeetingsGrp>
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        <ProgramServicesAmt>106758</ProgramServicesAmt>
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      <PaymentsToAffiliatesGrp>
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      <InsuranceGrp>
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        <ManagementAndGeneralAmt>128250</ManagementAndGeneralAmt>
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        <Desc>COMMISSIONS</Desc>
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        <ProgramServicesAmt>11975550</ProgramServicesAmt>
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      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>PREMIUM TAX &amp; OTHER</Desc>
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      <OtherExpensesGrp>
        <Desc>SUBSCRIPTIONS AND DUES</Desc>
        <TotalAmt>2132530</TotalAmt>
        <ProgramServicesAmt>1279518</ProgramServicesAmt>
        <ManagementAndGeneralAmt>853012</ManagementAndGeneralAmt>
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      <AllOtherExpensesGrp>
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      <TotalFunctionalExpensesGrp>
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        <ProgramServicesAmt>292216501</ProgramServicesAmt>
        <ManagementAndGeneralAmt>40720613</ManagementAndGeneralAmt>
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      </TotalFunctionalExpensesGrp>
      <TotalJointCostsGrp>
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        <EOYAmt>2035841</EOYAmt>
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      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>1007274</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>14922244</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>14922244</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
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        <EOYAmt>0</EOYAmt>
      </LandBldgEquipBasisNetGrp>
      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>76027043</EOYAmt>
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      <InvestmentsProgramRelatedGrp>
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      </InvestmentsProgramRelatedGrp>
      <OtherAssetsTotalGrp>
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        <EOYAmt>62337990</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>141408148</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>6227688</EOYAmt>
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      <LoansFromOfficersDirectorsGrp>
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        <EOYAmt>0</EOYAmt>
      </LoansFromOfficersDirectorsGrp>
      <OtherLiabilitiesGrp>
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        <EOYAmt>78637878</EOYAmt>
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      <TotalLiabilitiesGrp>
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      <InfoInScheduleOPartXIInd>X</InfoInScheduleOPartXIInd>
      <ReconcilationRevenueExpnssAmt>5971647</ReconcilationRevenueExpnssAmt>
      <NetUnrlzdGainsLossesInvstAmt>-264656</NetUnrlzdGainsLossesInvstAmt>
      <OtherChangesInNetAssetsAmt>-9619030</OtherChangesInNetAssetsAmt>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>false</AccountantCompileOrReviewInd>
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      <OtherLiabilitiesOrgGrp>
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      <FootnoteTextInd>X</FootnoteTextInd>
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      <RevenueNotReportedAmt>0</RevenueNotReportedAmt>
      <RevenueSubtotalAmt>0</RevenueSubtotalAmt>
      <OtherRevenuesNotIncludedAmt>0</OtherRevenuesNotIncludedAmt>
      <RevenueNotReportedFinclStmtAmt>0</RevenueNotReportedFinclStmtAmt>
      <TotalRevenuePerForm990Amt>0</TotalRevenuePerForm990Amt>
      <OtherExpensesIncludedAmt>0</OtherExpensesIncludedAmt>
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      <ExpensesSubtotalAmt>0</ExpensesSubtotalAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FASB ISSUED ASU 2019-12, INCOME TAXES (TOPIC 740) - SIMPLIFYING THE ACCOUNTING FOR INCOME TAXES, WHICH ELIMINATED SEVERAL ACCOUNTING EXCEPTIONS RELATED TO INCOME TAXES, AS WELL AS INTRODUCED 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 ORGANIZATIN, SO THE ORGANIZATION HAS DETERMINED THAT ADOPTING THIS NEW STANDARD IS NOT EXPECTED TO HAVE A FINANCIAL IMPACT. THE ORGANIZATION DETERMINES WHETHER A TAX POSITION OF THE ORGANIZATION IS MORE LIKELY 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.</ExplanationTxt>
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        <PersonNm>Pamela DA Reeve</PersonNm>
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        <TotalCompensationRltdOrgsAmt>163855</TotalCompensationRltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>Patricia Ma</PersonNm>
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        <PersonNm>Denise Marks</PersonNm>
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        <TotalCompensationRltdOrgsAmt>687786</TotalCompensationRltdOrgsAmt>
        <CompReportPrior990FilingOrgAmt>0</CompReportPrior990FilingOrgAmt>
        <CompReportPrior990RltdOrgsAmt>0</CompReportPrior990RltdOrgsAmt>
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      <RltdOrgOfficerTrstKeyEmplGrp>
        <PersonNm>ERIK MONTLACK</PersonNm>
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        <PersonNm>Gregory P Winn</PersonNm>
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        <FormAndLineReferenceDesc>Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation</FormAndLineReferenceDesc>
        <ExplanationTxt>THE OFFICER'S COMPENSATION IS ESTABLISHED BY A RELATED ORGANIZATION, CAREQUEST INSTIUTE FOR ORAL HEALTH, INC. [FORMERLY CATALUST 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.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part I, Line 4a Severance or change-of-control payment</FormAndLineReferenceDesc>
        <ExplanationTxt>MYECHIA MINTER-JORDAN RECEIVED SEVERANCE IN THE AMOUNT OF $960,000.</ExplanationTxt>
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        <FormAndLineReferenceDesc>Schedule J, Part II</FormAndLineReferenceDesc>
        <ExplanationTxt>COMPENSATION PAID BY RELATED ORGANIZATION: SCHEDULE J PART II INCLUDES INDIVIDUALS THAT ARE PAID BY CAREQUEST INSTITUTE FOR ORAL HEALTH, INC., A RELATED ORGANIZATION, BUT PERFORMED SERVICES FOR BOTH CAREQUEST INSTITUTE FOR ORAL HEALTH, INC. AND DENTAL SERVICE OF MASSACHUSETTS, INC. AS REPORTED IN PART VI, SECTION A, COLUMN (B), NONE OF THESE INDIVIDUALS DEVOTES MORE THAN 5.0 HOURS PER WEEK TO DENTAL SERVICE OF MASSACHUSETTS, INC. ADDITIONALLY, ALL THE BONUS COMPENSATION REPORTED IN PART II IS PAID BY EACH OF THE RESPECTIVE ORGANIZATIONS MENTIONED ABOVE.</ExplanationTxt>
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      <SupplementalInformationDetail>
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        <ExplanationTxt>COLUMN B (II) ON SCHEDULE J PART II INCLUDES BONUSES EARNED AND ACCRUED DURING 2023 BUT PAID IN 2024.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Schedule J, Part II, Column (C) DEFERRED COMPENSATION</FormAndLineReferenceDesc>
        <ExplanationTxt>COLUMN C ON SCHEDULE J PART II INCLUDES 401K MATCH DOLLAR AMOUNTS AS PAID BY DELTA DENTAL OF MASSACHUSETTS, INC., AND ITS RELATED ORGANIZATION CAREQUEST INSTITUTE FOR ORAL HEALTH, INC.</ExplanationTxt>
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        <ExplanationTxt>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.</ExplanationTxt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 2 Family/business relationships amongst interested persons</FormAndLineReferenceDesc>
        <ExplanationTxt>DENISE MARKS - Business relationship, GREGORY P. WINN - Business relationship, PATRICIA MA - 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, ERIK MONTLACK - Business relationship</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 6 Classes of members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>CAREQUEST INSTITUTE FOR ORAL HEALTH, INC. (FORMERLY CATALYST INSTITUTE, INC.) IS THE SOLE MEMBER OF DENTAL SERVICES OF MASSACHUSETTS, INC.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7a Members or stockholders electing members of governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>The members of the organization elect the directors at the annual meeting of the organization.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders</FormAndLineReferenceDesc>
        <ExplanationTxt>A QUORUM OF THE ORGANIZATION'S MEMBERS MAY VOTE TO AMEND OR REPEAL THE BY-LAWS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 11b Review of form 990 by governing body</FormAndLineReferenceDesc>
        <ExplanationTxt>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 &amp; 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 12c Conflict of interest policy</FormAndLineReferenceDesc>
        <ExplanationTxt>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 MEMBER 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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VI, Line 19 Required documents available to the public</FormAndLineReferenceDesc>
        <ExplanationTxt>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.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part VIII, Line 2c Net Administration Service (Net of $755,420,837 claims)</FormAndLineReferenceDesc>
        <ExplanationTxt>Net Administrative Services include ASO Revenue and fees of $817,360,174 net of claims of $755,420,837.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>Form 990, Part XI, Line 9 Other changes in net assets or fund balances</FormAndLineReferenceDesc>
        <ExplanationTxt>EQUITY IN SUBSIDIARIES - 380970; DISTRIBUTIONS TO CAREQUEST FOUNDATION, INC. - -10000000; Total - -9619030;</ExplanationTxt>
      </SupplementalInformationDetail>
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