﻿<?xml version="1.0" encoding="utf-8"?>
<Return xmlns="http://www.irs.gov/efile" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.irs.gov/efile" returnVersion="2017v2.3">
  <ReturnHeader binaryAttachmentCnt="0">
    <ReturnTs>2018-11-02T09:26:05-00:00</ReturnTs>
    <TaxPeriodEndDt>2018-06-30</TaxPeriodEndDt>
    <PreparerFirmGrp>
      <PreparerFirmName>
        <BusinessNameLine1Txt>Ronald B Bosack PC</BusinessNameLine1Txt>
      </PreparerFirmName>
      <PreparerUSAddress>
        <AddressLine1Txt>405 N Oak St</AddressLine1Txt>
        <CityNm>Mt Prospect</CityNm>
        <StateAbbreviationCd>IL</StateAbbreviationCd>
        <ZIPCd>60056</ZIPCd>
      </PreparerUSAddress>
    </PreparerFirmGrp>
    <ReturnTypeCd>990PF</ReturnTypeCd>
    <TaxPeriodBeginDt>2017-07-01</TaxPeriodBeginDt>
    <Filer>
      <EIN>822245000</EIN>
      <BusinessName>
        <BusinessNameLine1Txt>DENTAL PATIENT SAFETY FOUNDATION</BusinessNameLine1Txt>
      </BusinessName>
      <BusinessNameControlTxt>DENT</BusinessNameControlTxt>
      <PhoneNum>8332167931</PhoneNum>
      <USAddress>
        <AddressLine1Txt>16011 SOUTH 108TH AVENUE</AddressLine1Txt>
        <CityNm>ORLAND PARK</CityNm>
        <StateAbbreviationCd>IL</StateAbbreviationCd>
        <ZIPCd>60467</ZIPCd>
      </USAddress>
    </Filer>
    <BusinessOfficerGrp>
      <PersonNm>ROBERT C BOSACK</PersonNm>
      <PersonTitleTxt>CHAIRMAN</PersonTitleTxt>
      <PhoneNum>8332167931</PhoneNum>
      <SignatureDt>2018-11-02</SignatureDt>
      <DiscussWithPaidPreparerInd>true</DiscussWithPaidPreparerInd>
    </BusinessOfficerGrp>
    <PreparerPersonGrp>
      <PreparerPersonNm>Ronald B Bosack</PreparerPersonNm>
      <PhoneNum>8476449300</PhoneNum>
      <PreparationDt>2018-11-02</PreparationDt>
    </PreparerPersonGrp>
    <FilingSecurityInformation>
      <IPAddress>
        <IPv4AddressTxt>173.15.56.28</IPv4AddressTxt>
      </IPAddress>
      <IPDt>2018-11-02</IPDt>
      <IPTm>15:57:05</IPTm>
      <IPTimezoneCd>CD</IPTimezoneCd>
      <FilingLicenseTypeCd>P</FilingLicenseTypeCd>
      <AtSubmissionCreationDeviceId>0648105AC80FA720C8EFBBCD849DD960B8B60668</AtSubmissionCreationDeviceId>
      <AtSubmissionFilingDeviceId>0648105AC80FA720C8EFBBCD849DD960B8B60668</AtSubmissionFilingDeviceId>
    </FilingSecurityInformation>
    <TaxYr>2017</TaxYr>
    <BuildTS>2019-02-21 02:37:17Z</BuildTS>
  </ReturnHeader>
  <ReturnData documentCnt="5">
    <IRS990PF documentId="990PF" softwareId="17005317" softwareVersionNum="18.2.0.0">
      <InitialReturnInd>X</InitialReturnInd>
      <Organization501c3ExemptPFInd>X</Organization501c3ExemptPFInd>
      <FMVAssetsEOYAmt>28230</FMVAssetsEOYAmt>
      <MethodOfAccountingCashInd>X</MethodOfAccountingCashInd>
      <AnalysisOfRevenueAndExpenses>
        <ContriRcvdRevAndExpnssAmt>34200</ContriRcvdRevAndExpnssAmt>
        <CapGainNetIncmNetInvstIncmAmt>0</CapGainNetIncmNetInvstIncmAmt>
        <TotalRevAndExpnssAmt>34200</TotalRevAndExpnssAmt>
        <TotalNetInvstIncmAmt>0</TotalNetInvstIncmAmt>
        <PrintingAndPubRevAndExpnssAmt>600</PrintingAndPubRevAndExpnssAmt>
        <OtherExpensesRevAndExpnssAmt referenceDocumentId="990PF:131">5370</OtherExpensesRevAndExpnssAmt>
        <OtherExpensesDsbrsChrtblAmt>4641</OtherExpensesDsbrsChrtblAmt>
        <TotOprExpensesRevAndExpnssAmt>5970</TotOprExpensesRevAndExpnssAmt>
        <TotOprExpensesNetInvstIncmAmt>0</TotOprExpensesNetInvstIncmAmt>
        <TotOprExpensesDsbrsChrtblAmt>4641</TotOprExpensesDsbrsChrtblAmt>
        <ContriPaidRevAndExpnssAmt>0</ContriPaidRevAndExpnssAmt>
        <ContriPaidDsbrsChrtblAmt>0</ContriPaidDsbrsChrtblAmt>
        <TotalExpensesRevAndExpnssAmt>5970</TotalExpensesRevAndExpnssAmt>
        <TotalExpensesNetInvstIncmAmt>0</TotalExpensesNetInvstIncmAmt>
        <TotalExpensesDsbrsChrtblAmt>4641</TotalExpensesDsbrsChrtblAmt>
        <ExcessRevenueOverExpensesAmt>28230</ExcessRevenueOverExpensesAmt>
        <NetInvestmentIncomeAmt>0</NetInvestmentIncomeAmt>
      </AnalysisOfRevenueAndExpenses>
      <Form990PFBalanceSheetsGrp>
        <CashEOYAmt>28230</CashEOYAmt>
        <CashEOYFMVAmt>28230</CashEOYFMVAmt>
        <TotalAssetsEOYAmt>28230</TotalAssetsEOYAmt>
        <TotalAssetsEOYFMVAmt>28230</TotalAssetsEOYFMVAmt>
        <TotalLiabilitiesEOYAmt>0</TotalLiabilitiesEOYAmt>
        <OrganizationFollowsSFAS117Ind>X</OrganizationFollowsSFAS117Ind>
        <UnrestrictedEOYAmt>28230</UnrestrictedEOYAmt>
        <TotNetAstOrFundBalancesEOYAmt>28230</TotNetAstOrFundBalancesEOYAmt>
        <TotalLiabilitiesNetAstBOYAmt>0</TotalLiabilitiesNetAstBOYAmt>
        <TotalLiabilitiesNetAstEOYAmt>28230</TotalLiabilitiesNetAstEOYAmt>
      </Form990PFBalanceSheetsGrp>
      <ChgInNetAssetsFundBalancesGrp>
        <ExcessRevenueOverExpensesAmt>28230</ExcessRevenueOverExpensesAmt>
        <SubtotalAmt>28230</SubtotalAmt>
        <TotNetAstOrFundBalancesEOYAmt>28230</TotNetAstOrFundBalancesEOYAmt>
      </ChgInNetAssetsFundBalancesGrp>
      <ExciseTaxBasedOnInvstIncmGrp>
        <InvestmentIncomeExciseTaxAmt>0</InvestmentIncomeExciseTaxAmt>
      </ExciseTaxBasedOnInvstIncmGrp>
      <StatementsRegardingActyGrp>
        <LegislativePoliticalActyInd>false</LegislativePoliticalActyInd>
        <MoreThan100SpentInd>false</MoreThan100SpentInd>
        <Form1120POLFiledInd>false</Form1120POLFiledInd>
        <ActivitiesNotPreviouslyRptInd>false</ActivitiesNotPreviouslyRptInd>
        <ChangesToArticlesOrBylawsInd>false</ChangesToArticlesOrBylawsInd>
        <UnrelatedBusIncmOverLimitInd>false</UnrelatedBusIncmOverLimitInd>
        <OrganizationDissolvedEtcInd>false</OrganizationDissolvedEtcInd>
        <AtLeast5000InAssetsInd>true</AtLeast5000InAssetsInd>
        <OrgReportOrRegisterStateCd>IL</OrgReportOrRegisterStateCd>
        <Form990PFFiledWithAttyGenInd>true</Form990PFFiledWithAttyGenInd>
        <PrivateOperatingFoundationInd>true</PrivateOperatingFoundationInd>
        <NewSubstantialContributorsInd referenceDocumentId="990PF:140">true</NewSubstantialContributorsInd>
        <OwnControlledEntityInd>false</OwnControlledEntityInd>
        <DonorAdvisedFundInd>false</DonorAdvisedFundInd>
        <ComplyWithPublicInspRqrInd>true</ComplyWithPublicInspRqrInd>
        <WebsiteAddressTxt>WWW.DENTALPATIENTSAFETY.ORG</WebsiteAddressTxt>
        <IndividualWithBooksNm>ROBERT C BOSACK</IndividualWithBooksNm>
        <PhoneNum>8332167931</PhoneNum>
        <LocationOfBooksUSAddress>
          <AddressLine1Txt>16011 S 108TH AVE</AddressLine1Txt>
          <CityNm>ORLAND PARK</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>60467</ZIPCd>
        </LocationOfBooksUSAddress>
        <ForeignAccountsQuestionInd>false</ForeignAccountsQuestionInd>
      </StatementsRegardingActyGrp>
      <StatementsRegardingActy4720Grp>
        <SaleOrExchDisqualifiedPrsnInd>false</SaleOrExchDisqualifiedPrsnInd>
        <BrrwOrLendDisqualifiedPrsnInd>false</BrrwOrLendDisqualifiedPrsnInd>
        <FurnGoodsDisqualifiedPrsnInd>false</FurnGoodsDisqualifiedPrsnInd>
        <PayCompDisqualifiedPrsnInd>false</PayCompDisqualifiedPrsnInd>
        <TransferAstDisqualifiedPrsnInd>false</TransferAstDisqualifiedPrsnInd>
        <PaymentToGovernmentOfficialInd>false</PaymentToGovernmentOfficialInd>
        <UncorrectedPriorActsInd>false</UncorrectedPriorActsInd>
        <UndistributedIncomePYInd>false</UndistributedIncomePYInd>
        <UndistrIncmSect4942a2NotAppInd>false</UndistrIncmSect4942a2NotAppInd>
        <BusinessHoldingsInd>false</BusinessHoldingsInd>
        <JeopardyInvestmentsInd>false</JeopardyInvestmentsInd>
        <UncorrectedPYJeopardyInvstInd>false</UncorrectedPYJeopardyInvstInd>
        <InfluenceLegislationInd>false</InfluenceLegislationInd>
        <InfluenceElectionInd>false</InfluenceElectionInd>
        <GrantsToIndividualsInd>false</GrantsToIndividualsInd>
        <GrantsToOrganizationsInd>false</GrantsToOrganizationsInd>
        <NoncharitablePurposeInd>false</NoncharitablePurposeInd>
        <MaintainedExpenditureRspnsInd>false</MaintainedExpenditureRspnsInd>
        <RcvFndsToPayPrsnlBnftCntrctInd>false</RcvFndsToPayPrsnlBnftCntrctInd>
        <ProhibitedTaxShelterTransInd>false</ProhibitedTaxShelterTransInd>
      </StatementsRegardingActy4720Grp>
      <OfficerDirTrstKeyEmplInfoGrp>
        <OfficerDirTrstKeyEmplGrp>
          <PersonNm>ROBERT BOSACK</PersonNm>
          <USAddress>
            <AddressLine1Txt>16011 S 108TH AVE</AddressLine1Txt>
            <CityNm>ORLAND PARK</CityNm>
            <StateAbbreviationCd>IL</StateAbbreviationCd>
            <ZIPCd>60467</ZIPCd>
          </USAddress>
          <TitleTxt>DIRECTOR</TitleTxt>
          <AverageHrsPerWkDevotedToPosRt>000.00</AverageHrsPerWkDevotedToPosRt>
          <CompensationAmt>0</CompensationAmt>
        </OfficerDirTrstKeyEmplGrp>
        <OfficerDirTrstKeyEmplGrp>
          <PersonNm>MICHAEL ROLLERT</PersonNm>
          <USAddress>
            <AddressLine1Txt>6850 E HAMPDEN AVE</AddressLine1Txt>
            <CityNm>DENVER</CityNm>
            <StateAbbreviationCd>CO</StateAbbreviationCd>
            <ZIPCd>80224</ZIPCd>
          </USAddress>
          <TitleTxt>DIRECTOR</TitleTxt>
          <AverageHrsPerWkDevotedToPosRt>000.00</AverageHrsPerWkDevotedToPosRt>
          <CompensationAmt>0</CompensationAmt>
        </OfficerDirTrstKeyEmplGrp>
        <OfficerDirTrstKeyEmplGrp>
          <PersonNm>STUART LIEBLICH</PersonNm>
          <USAddress>
            <AddressLine1Txt>34 DALE ROAD SUITE 105</AddressLine1Txt>
            <CityNm>AVON</CityNm>
            <StateAbbreviationCd>CT</StateAbbreviationCd>
            <ZIPCd>06001</ZIPCd>
          </USAddress>
          <TitleTxt>DIRECTOR</TitleTxt>
          <AverageHrsPerWkDevotedToPosRt>000.00</AverageHrsPerWkDevotedToPosRt>
          <CompensationAmt>0</CompensationAmt>
        </OfficerDirTrstKeyEmplGrp>
        <OfficerDirTrstKeyEmplGrp>
          <PersonNm>JASON BRADY</PersonNm>
          <USAddress>
            <AddressLine1Txt>3343 E INDIGO BAY CT</AddressLine1Txt>
            <CityNm>GILBERT</CityNm>
            <StateAbbreviationCd>AZ</StateAbbreviationCd>
            <ZIPCd>85234</ZIPCd>
          </USAddress>
          <TitleTxt>DIRECTOR</TitleTxt>
          <AverageHrsPerWkDevotedToPosRt>000.00</AverageHrsPerWkDevotedToPosRt>
          <CompensationAmt>0</CompensationAmt>
        </OfficerDirTrstKeyEmplGrp>
        <OfficerDirTrstKeyEmplGrp>
          <PersonNm>ROY STEVENS</PersonNm>
          <USAddress>
            <AddressLine1Txt>8283 SOUTH WALKER AVE STE B</AddressLine1Txt>
            <CityNm>OKLAHOMA CITY</CityNm>
            <StateAbbreviationCd>OK</StateAbbreviationCd>
            <ZIPCd>73139</ZIPCd>
          </USAddress>
          <TitleTxt>DIRECTOR</TitleTxt>
          <AverageHrsPerWkDevotedToPosRt>000.00</AverageHrsPerWkDevotedToPosRt>
          <CompensationAmt>0</CompensationAmt>
        </OfficerDirTrstKeyEmplGrp>
        <CompOfHghstPdCntrctOrNONETxt>NONE</CompOfHghstPdCntrctOrNONETxt>
      </OfficerDirTrstKeyEmplInfoGrp>
      <SummaryOfDirectChrtblActyGrp>
        <Description1Txt>N/A - INITIAL YEAR SOLICIT CONTRIBUTIONS, DESIGN AND DEVELOP WEBSITE FOR DATA COLLECTION</Description1Txt>
        <Expenses1Amt>4490</Expenses1Amt>
      </SummaryOfDirectChrtblActyGrp>
      <SumOfProgramRelatedInvstGrp>
        <Description1Txt>N/A</Description1Txt>
      </SumOfProgramRelatedInvstGrp>
      <MinimumInvestmentReturnGrp>
        <AverageMonthlyFMVOfSecAmt>0</AverageMonthlyFMVOfSecAmt>
        <AverageMonthlyCashBalancesAmt>19605</AverageMonthlyCashBalancesAmt>
        <FMVAllOtherNoncharitableAstAmt>0</FMVAllOtherNoncharitableAstAmt>
        <TotalFMVOfUnusedAssetsAmt>19605</TotalFMVOfUnusedAssetsAmt>
        <AdjustedTotalFMVOfUnusedAstAmt>19605</AdjustedTotalFMVOfUnusedAstAmt>
        <CashDeemedCharitableAmt referenceDocumentId="990PF:166">294</CashDeemedCharitableAmt>
        <NetVlNoncharitableAssetsAmt>19311</NetVlNoncharitableAssetsAmt>
        <MinimumInvestmentReturnAmt>966</MinimumInvestmentReturnAmt>
      </MinimumInvestmentReturnGrp>
      <DistributableAmountGrp>
        <MinimumInvestmentReturnAmt>966</MinimumInvestmentReturnAmt>
        <DistributableBeforeAdjAmt>966</DistributableBeforeAdjAmt>
        <DistributableBeforeDedAmt>966</DistributableBeforeDedAmt>
        <DistributableAsAdjustedAmt>966</DistributableAsAdjustedAmt>
      </DistributableAmountGrp>
      <QualifyingDistriPartXIIGrp>
        <ExpensesAndContributionsAmt referenceDocumentId="990PF:167">4641</ExpensesAndContributionsAmt>
        <QualifyingDistributionsAmt>4641</QualifyingDistributionsAmt>
        <AdjustedQualifyingDistriAmt>4641</AdjustedQualifyingDistriAmt>
      </QualifyingDistriPartXIIGrp>
      <UndistributedIncomeGrp>
        <DistributableAsAdjustedAmt>966</DistributableAsAdjustedAmt>
        <QualifyingDistributionsAmt>4641</QualifyingDistributionsAmt>
        <AppliedToCurrentYearAmt>966</AppliedToCurrentYearAmt>
        <RemainingDistriFromCorpusAmt>3675</RemainingDistriFromCorpusAmt>
        <TotalCorpusAmt>3675</TotalCorpusAmt>
        <UndistributedIncomeCYAmt>0</UndistributedIncomeCYAmt>
        <ExcessDistriCyovToNextYrAmt>3675</ExcessDistriCyovToNextYrAmt>
        <ExcessFromCurrentYearAmt>3675</ExcessFromCurrentYearAmt>
      </UndistributedIncomeGrp>
      <PrivateOperatingFoundationsGrp>
        <LessorAdjNetIncmMinInvstRetGrp>
          <CurrentYearAmt>0</CurrentYearAmt>
          <TotalAmt>0</TotalAmt>
        </LessorAdjNetIncmMinInvstRetGrp>
        <QualifyingDistributionsGrp>
          <CurrentYearAmt>4641</CurrentYearAmt>
          <TotalAmt>4641</TotalAmt>
        </QualifyingDistributionsGrp>
        <QualifyingDistriMadeDrtGrp>
          <CurrentYearAmt>4641</CurrentYearAmt>
          <TotalAmt>4641</TotalAmt>
        </QualifyingDistriMadeDrtGrp>
        <TwoThirdsMinimumInvstRetGrp>
          <CurrentYearAmt>644</CurrentYearAmt>
          <TotalAmt>644</TotalAmt>
        </TwoThirdsMinimumInvstRetGrp>
      </PrivateOperatingFoundationsGrp>
      <SupplementaryInformationGrp>
        <ContributingManagerNm>NONE</ContributingManagerNm>
        <ShareholderManagerNm>NONE</ShareholderManagerNm>
        <OnlyContriToPreselectedInd>X</OnlyContriToPreselectedInd>
      </SupplementaryInformationGrp>
      <TrnsfrTransRlnNonchrtblEOGrp>
        <TrnsfrOfCashToNonchrtblEOInd>false</TrnsfrOfCashToNonchrtblEOInd>
        <TrnsfrOtherAssetNonchrtblEOInd>false</TrnsfrOtherAssetNonchrtblEOInd>
        <SalesOrExchangesOfAssetsInd>false</SalesOrExchangesOfAssetsInd>
        <PurchaseOfAssetsNonchrtblEOInd>false</PurchaseOfAssetsNonchrtblEOInd>
        <RentalOfFacilitiesOthAssetsInd>false</RentalOfFacilitiesOthAssetsInd>
        <ReimbursementArrangementsInd>false</ReimbursementArrangementsInd>
        <LoansOrLoanGuaranteesInd>false</LoansOrLoanGuaranteesInd>
        <PerformanceOfServicesEtcInd>false</PerformanceOfServicesEtcInd>
        <SharingOfFacilitiesEtcInd>false</SharingOfFacilitiesEtcInd>
        <RelationshipsNonchrtblEOInd>false</RelationshipsNonchrtblEOInd>
      </TrnsfrTransRlnNonchrtblEOGrp>
    </IRS990PF>
    <IRS990ScheduleB documentId="990B" softwareId="17005317" softwareVersionNum="18.2.0.0">
      <Organization501c3ExemptPFInd>X</Organization501c3ExemptPFInd>
      <GeneralRuleInd>X</GeneralRuleInd>
      <ContributorInformationGrp>
        <ContributorNum>1</ContributorNum>
        <ContributorPersonNm>ANESTHESIA RESEARCH FOUNDATION</ContributorPersonNm>
        <ContributorUSAddress>
          <AddressLine1Txt>211 EAST CHICAGO AVE STE 1729</AddressLine1Txt>
          <CityNm>CHICAGO</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>60611</ZIPCd>
        </ContributorUSAddress>
        <TotalContributionsAmt>10000</TotalContributionsAmt>
        <PersonContributionInd>X</PersonContributionInd>
      </ContributorInformationGrp>
      <ContributorInformationGrp>
        <ContributorNum>2</ContributorNum>
        <ContributorPersonNm>AMERICAN ASSOCIATION OF ORAL AND MA</ContributorPersonNm>
        <ContributorUSAddress>
          <AddressLine1Txt>9700 W BRYN MAWR AVE</AddressLine1Txt>
          <CityNm>ROSEMONT</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>60018</ZIPCd>
        </ContributorUSAddress>
        <TotalContributionsAmt>10000</TotalContributionsAmt>
        <PersonContributionInd>X</PersonContributionInd>
      </ContributorInformationGrp>
      <ContributorInformationGrp>
        <ContributorNum>3</ContributorNum>
        <ContributorPersonNm>FLORIDA DENTAL SOCIETY OF ANESTHESI</ContributorPersonNm>
        <ContributorUSAddress>
          <AddressLine1Txt>PO BOX 444</AddressLine1Txt>
          <CityNm>ORANGE PARK</CityNm>
          <StateAbbreviationCd>FL</StateAbbreviationCd>
          <ZIPCd>32067</ZIPCd>
        </ContributorUSAddress>
        <TotalContributionsAmt>6000</TotalContributionsAmt>
        <PersonContributionInd>X</PersonContributionInd>
      </ContributorInformationGrp>
    </IRS990ScheduleB>
    <GeneralExplanationAttachment documentId="990PF:144" softwareId="17005317" softwareVersionNum="18.2.0.0"></GeneralExplanationAttachment>
    <OtherExpensesSchedule documentId="990PF:131" softwareId="17005317" softwareVersionNum="18.2.0.0">
      <OtherExpensesScheduleGrp>
        <Desc>INTERNET EXPENSES</Desc>
        <RevenueAndExpensesPerBooksAmt>151</RevenueAndExpensesPerBooksAmt>
        <DisbursementsCharitablePrpsAmt>151</DisbursementsCharitablePrpsAmt>
      </OtherExpensesScheduleGrp>
      <OtherExpensesScheduleGrp>
        <Desc>LICENSES AND FEES</Desc>
        <RevenueAndExpensesPerBooksAmt>10</RevenueAndExpensesPerBooksAmt>
      </OtherExpensesScheduleGrp>
      <OtherExpensesScheduleGrp>
        <Desc>WEB SITE DEVELOPMENT</Desc>
        <RevenueAndExpensesPerBooksAmt>4490</RevenueAndExpensesPerBooksAmt>
        <DisbursementsCharitablePrpsAmt>4490</DisbursementsCharitablePrpsAmt>
      </OtherExpensesScheduleGrp>
      <OtherExpensesScheduleGrp>
        <Desc>MERCHANT SERVICE CC FEES</Desc>
        <RevenueAndExpensesPerBooksAmt>569</RevenueAndExpensesPerBooksAmt>
      </OtherExpensesScheduleGrp>
      <OtherExpensesScheduleGrp>
        <Desc>OFFICE SUPPLIES</Desc>
        <RevenueAndExpensesPerBooksAmt>150</RevenueAndExpensesPerBooksAmt>
      </OtherExpensesScheduleGrp>
    </OtherExpensesSchedule>
    <SubstantialContributorsSch documentId="990PF:140" softwareId="17005317" softwareVersionNum="18.2.0.0">
      <SubstantialContributorDetail>
        <BusinessName>
          <BusinessNameLine1Txt>ANESTHESIA RESEARCH FOUNDATION</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>211 EAST CHICAGO AVE STE 1720</AddressLine1Txt>
          <CityNm>CHICAGO</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>60611</ZIPCd>
        </USAddress>
      </SubstantialContributorDetail>
      <SubstantialContributorDetail>
        <BusinessName>
          <BusinessNameLine1Txt>AMERICAN ASSOCIATION OF ORAL AND MAXILLOFACIAL SURGEONS</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>9700 W BRYN MAWR AVE</AddressLine1Txt>
          <CityNm>ROSEMONT</CityNm>
          <StateAbbreviationCd>IL</StateAbbreviationCd>
          <ZIPCd>60018</ZIPCd>
        </USAddress>
      </SubstantialContributorDetail>
      <SubstantialContributorDetail>
        <BusinessName>
          <BusinessNameLine1Txt>FLORIDA DENTAL SOCIETY OF ANESTHESIOLOGY</BusinessNameLine1Txt>
        </BusinessName>
        <USAddress>
          <AddressLine1Txt>PO BOX 444</AddressLine1Txt>
          <CityNm>ORANGE PARK</CityNm>
          <StateAbbreviationCd>FL</StateAbbreviationCd>
          <ZIPCd>32067</ZIPCd>
        </USAddress>
      </SubstantialContributorDetail>
    </SubstantialContributorsSch>
  </ReturnData>
</Return>