> ## Documentation Index > Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt > Use this file to discover all available pages before exploring further. # The complete agreement stack (checklist) > Master table of every document a mature DSO group holds: parties, purpose, refresh cadence, registration filings, and who typically drafts. Every document a dental support organization (DSO) group should hold, with who the parties are, what it does, how often it needs review, and who drafts it. Use it as a completeness check and as a diligence preparation list. ## The core five Required for any DSO-PC structure. See [Step 5: Sign the agreement stack](/start/zero-to-paid/sign-the-agreement-stack). | Document | Parties | Purpose | Refresh | Drafted by | | ---------------------------------------- | ------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------- | ------------------------------- | | **Management services agreement** | DSO ↔ each PC | Defines services, fee, and the clinical carve-out | **Annually**, and on any state law change | Healthcare regulatory counsel | | **Stock transfer restriction agreement** | PC, its owner, and typically the DSO | Establishes a succession process for death, disability, license loss, exclusion, or departure, subject to the state's statutory transition window | **Annually**, heavily targeted by current legislation | Healthcare regulatory counsel | | **Dentist employment agreements** | PC ↔ each dentist | Compensation, duties, malpractice, and restrictive covenants; exclude production quotas | Annually; **immediately** on state noncompete changes | Employment + healthcare counsel | | **Business associate agreement** | Each PC ↔ DSO | HIPAA compliance; required content at 45 C.F.R. § 164.504(e) | Annually | Privacy counsel | | **IP / brand license** | DSO ↔ each PC | Lets the PC operate under the DSO's brand | On brand changes | Corporate counsel | **One MSA, one transfer restriction, and one BAA per PC.** Each professional entity is a separate contracting party and a separate covered entity. A ten-PC group holds ten of each. ## Registration and name filings Not agreements, but they live or die with the agreement stack and belong in the same binder. | Filing | Where | Trigger and cadence | | ------------------------------------ | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------- | | **DSO registration** | Texas (Secretary of State, annually by January 31), Kansas (Dental Board, within 30 days of contract execution), Nevada (Board manager registration), Arizona (business-entity registration, with a designated records custodian), New Mexico (non-dentist owner license) | On formation or first contract in the state; renew per state. See [Register a DSO](/guides/compliance/register-a-dso) | | **Dental trade-name registration** | States that register practice trade names with the dental board or restrict name use; check each operating state's row on [DSO laws by state](/reference/legal/dso-laws-by-state) | On adopting or changing a practice name | | **Registered-entity change notices** | Registration states | Owner, records-custodian, or contract changes often carry 30-day notice windows. Put each applicable deadline on the compliance calendar. | ## Corporate documents | Document | Entity | Purpose | Refresh | Drafted by | | ------------------------------------------ | ------------------------------- | ------------------------------------------------------------------- | ----------------------- | -------------------------- | | Articles of incorporation / organization | Each entity | Formation | On amendment | Counsel | | Bylaws or operating agreement | Each entity | Governance | On material change | Counsel | | Organizational consents | Each entity | Initial authorizations | Once | Counsel | | **Annual consents / minutes** | Each entity | Elect officers, ratify actions, **evidence PC clinical governance** | **Annually** | Internal, counsel-reviewed | | Stock ledger / membership register | Each entity | Ownership record | On any transfer | Internal | | Stock certificates with restrictive legend | Each PC | Enforceability against transferees | On issuance | Counsel | | Spousal consent | Each PC owner, where applicable | Community property states | On marriage or transfer | Counsel | ## Real estate and equipment | Document | Parties | Purpose | Refresh | | --------------------------------- | -------------- | ------------------------------------- | ---------------------------------------------------------- | | Lease | DSO ↔ landlord | Premises | At renewal | | Sublease or occupancy arrangement | DSO ↔ PC | How the PC uses the space | Annually, **FMV matters if a referral source is involved** | | Equipment leases | DSO ↔ vendor | Operatories and equipment | At renewal | | Equipment use arrangement | DSO ↔ PC | Provided under the MSA, or separately | Annually | **Who holds the lease and the chairs is state-specific.** Several proprietor-clause states regulate DSO ownership or leasing of practice space and clinical equipment. Colorado's Rule 1.7 bans both outright beginning in 2027. Check the [dental legislation tracker](/reference/legal/dental-legislation-tracker) and [MSA clause anatomy](/reference/legal/msa-clause-anatomy) before reusing an asset schedule across states. Space and equipment arrangements with anyone who can refer patients should follow the AKS space and equipment rental safe harbors: written terms of at least one year, compensation set in advance at fair market value, and no variation based on referrals. See [Stark and anti-kickback](/concepts/compliance/stark-and-anti-kickback). ## Vendor and technology | Document | Parties | Purpose | Refresh | | ---------------------------------- | ------------------------------ | ------------------------------------ | ---------------------------------------- | | PMS agreement | DSO ↔ vendor | Practice management system licensing | At renewal; **check data export rights** | | Clearinghouse agreement | DSO or PC ↔ clearinghouse | Claim and attachment transmission | At renewal | | **Subcontractor BAAs** | DSO ↔ each PHI-handling vendor | HIPAA chain | Annually; on every new vendor | | RCM services agreement | DSO or PC ↔ vendor | Outsourced billing | At renewal | | Payroll and benefits agreements | Each employer ↔ vendor | Payroll | At renewal | | Collections agency agreement + BAA | PC ↔ agency | Patient collections | Annually | ## Payer | Document | Parties | Purpose | Refresh | | ---------------------------------- | ---------------------------------- | --------------------------------------------- | --------------------------------------- | | Participation agreements | **Each PC** ↔ each payer | Network participation and rates | Annually, review rates | | Fee schedules | Attached or referenced | The real economics | Annually | | EDI / ERA / EFT authorizations | Each PC ↔ each payer | Electronic plumbing | On any bank or clearinghouse change | | Single-case agreements | PC ↔ payer | Out-of-network individual cases | Per case | | Delegated credentialing agreements | PC ↔ payer | Where applicable at scale | Per payer terms | | Network leasing riders | Buried in participation agreements | Which leased networks may reprice your claims | Annually; **read for silent repricing** | ## Membership plan (where used) An in-house membership plan replaces insurance for fee-paying patients and needs its own paper. See [Launch a membership plan](/guides/payments/launch-a-membership-plan). | Document | Parties | Purpose | Refresh | | ------------------------------------- | --------------------------- | ------------------------------------------------------------------------------------------------------------- | ------------------------------ | | Membership plan terms | PC ↔ patient | Benefits, pricing, renewal, cancellation, refunds | Annually | | Plan administration agreement | DSO or PC ↔ platform vendor | Billing, auto-renewal, and plan management | At renewal | | State discount-plan compliance review | Counsel memo | Some states regulate discount or dental savings plans. Verify whether your plan design triggers registration. | On plan changes and new states | ## Financial | Document | Parties | Purpose | Refresh | | ------------------------------------------- | ----------------------- | --------------------------------- | ------------------------------------------ | | **Intercompany promissory notes** | DSO ↔ PC | Documented loans, at AFR or above | On each new advance; amend on modification | | Bank account agreements and signature cards | Each entity ↔ bank | Accounts and authority | On signer change | | Credit facility documents | DSO, and sometimes PCs | Working capital | At renewal | | Deposit account control agreements | Entity ↔ bank ↔ lender | Where a lender requires | Per facility | | Merchant processing agreement | Each entity ↔ processor | Card acceptance | At renewal | | **FMV study / opinion** | Third party | Supports the management fee | **Annually**, and before any fee change | ## Insurance | Policy | Held by | Notes | | ------------------------------------ | --------------- | --------------------------------------------------------------------------------------------- | | Professional liability (malpractice) | **PC** | Occurrence vs claims-made; **tail responsibility must be addressed in employment agreements** | | General liability | DSO | | | Property | DSO | | | Cyber liability | Both | Post-2024, effectively standard | | Errors and omissions | DSO | | | Employment practices liability | Both | | | Directors and officers | Both | | | Workers' compensation | Both, per state | | ## Compliance | Document | Purpose | Refresh | | ----------------------------------------- | -------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | HIPAA policies and procedures | Privacy and security program | Annually | | **Security risk analysis** | Required under the Security Rule | On material change and at a documented cadence that keeps the analysis accurate and thorough | | Notice of Privacy Practices | Patient-facing | On material change | | Compliance program policies | Billing and coding compliance | Annually | | Financial policy (patient-facing) | Payment terms; chargeback evidence | Annually | | **BAA inventory** | Tracks the whole chain | Continuously | | Exclusion and debarment screening records | OIG LEIE, SAM.gov, and required state lists tracked separately | At onboarding and the cadence required by the applicable payer, program, state, contract, and risk policy; monthly LEIE checks minimize the interval because OIG updates monthly | | Training records | HIPAA and compliance | Annually | ## Diligence readiness What an acquirer or investor asks for, in roughly this order. Being able to produce it quickly is worth real money. * [ ] Every MSA, with all amendments * [ ] Every transfer restriction agreement, and the stock ledgers * [ ] Every dentist employment agreement * [ ] All BAAs, plus the inventory * [ ] Formation documents and good standing certificates, every entity, every state * [ ] DSO registration filings and trade-name registrations, every registration state * [ ] **Board minutes and consents, all years**, including PC clinical governance records * [ ] Every payer contract and fee schedule * [ ] Intercompany notes and the payment history * [ ] FMV studies * [ ] Evidence the management fee was **paid in cash**, monthly * [ ] Per-entity financial statements plus consolidation with eliminations * [ ] Insurance policies and loss runs * [ ] The security risk analysis and HIPAA program * [ ] Exclusion screening records * [ ] Any regulatory correspondence, audits, or investigations **The most commonly missing items are board minutes and evidence of cash fee payment.** Both are cheap to maintain contemporaneously and expensive to reconstruct. See [Maintain corporate formalities](/guides/formation/maintain-corporate-formalities). ## Refresh calendar | Cadence | Documents | | ------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | **Monthly** | Exclusion screening; management fee invoices | | **Quarterly** | State legislation scan; access review | | **Annually** | MSA and full stack review; FMV; security risk analysis; training; entity consents; insurance; payer rate review; **DSO registration renewals** (Texas by January 31; see [Register a DSO](/guides/compliance/register-a-dso)) | | **On event** | State law change; new state; new entity; fee change; owner change; records-custodian change; new vendor; bank change |