Delaware | 001-15925 | 13-3893191 | ||
(State or other jurisdiction of incorporation) |
(Commission File Number) | (I.R.S. Employer Identification No.) |
99.1
|
Letter from CtW Investment Group, dated September 28, 2010. | |
99.2
|
Letter from Community Health Systems, Inc., dated October 12, 2010. | |
99.3
|
Letter from CtW Investment Group, dated April 15, 2011. |
Date: April 18, 2011 | COMMUNITY HEALTH SYSTEMS, INC. (Registrant) |
|||
By: | /s/ W. Larry Cash | |||
W. Larry Cash | ||||
Executive Vice President, Chief Financial Officer and Director (principal financial officer) |
Exhibit No. | Description | |
99.1
|
Letter from CtW Investment Group, dated September 28, 2010. | |
99.2
|
Letter from Community Health Systems, Inc., dated October 12, 2010. | |
99.3
|
Letter from CtW Investment Group, dated April 15, 2011. |
2
3
In FFY 2008, half of the facilities within their first full FFY of CHS ownership or later placed in
the 80th percentile nationally.8 We believe that CHS management therefore knows or
should have known about this risk. Of further concern, the chart shows that the proportion of CHS
hospitals that reach this level has been increasing in recent years. CHS Corporate Strategy Rests on Increasing Inpatient Admissions |
4
5
6
§ | Retain independent outside counsel and investigators, with no prior financial or other ties to the Company, its executives, or the board, to conduct this investigation; and | ||
§ | Instruct CHS to immediately correct inadequate disclosure on this issue by providing shareholders with information on admissions volume impacts, potential risks, and the potential for greater federal scrutiny. |
cc.: | Office of the Inspector General, U.S. Department of Health and Human Services |
1 | The Federal Fiscal Year runs from October 1 through September 30; | |
ED admissions are identified in accordance with ResDACs recommendation. Please see: How to Identify Emergency Room Services in the Medicare Claims Data. Technical Brief, ResDAC Publication Number TN-003, January 2003, Updated June 2008. Research Data Assistance Center, University of Minnesota, Minneapolis, MN. http://www.resdac.umn.edu; | ||
All analysis described in this letter share some common methods and restrictions. Analysis is based upon Medicare claims submitted for reimbursement by short-term acute care hospitals from FFY 2002 through FFY 2008. Claims are excluded from analysis if at least one of the following conditions about a claim is true: 1) the patient is less than 65 years of age; 2) the claim has a null or otherwise invalid value coded for patient age, sex, or primary diagnosis; 3) the claim did not have any reported charges and/or payments received; or 4) the claim did not have frequency code of 1, 2 or 7. For ED one day stay rate reporting, only those hospitals that had at least 250 qualifying ED admissions in a given Federal Fiscal Year were included in analysis for reporting, ranking, and averaging purposes. For ED admission rate reporting, there was an additional requirement of a positive number of outpatient-only encounters in the ED. In addition, whenever CHS totals are reported for a given FFY, those totals do not include hospitals that CHS has sold either before or during that given FFY. | ||
2 | Evans, Melanie. One Day Stays a Big Reason for Excess Pay to Hospitals, RAC Project Finds. Modern Healthcare July 31, 2009. http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090731/REG/907309998 | |
3 | Tenet Healthcare (THC) Q2 2010 Earnings Call August 03, 2010 | |
4 | Office of Inspector General. Department of Health and Human Services. Review of the Health Care Financing Administration Philadelphia Regional Offices Efforts to Identify and Recover Overpayments for 1-day Inpatient Hospital Stays in Pennsylvania. April 2001. | |
5 | Evans, Melanie. supra n. 2 | |
6 | Short-Term Acute Care Program for Evaluating Payment Patterns Electronic Report Users Guide, Fourth Edition | |
7 | Certain CHS hospitals are removed from this and all other analyses reported here that examine or combine rates across years, because we believe that they may have at least partially combined Medicare reporting efforts during this period. Combined Medicare reporting would make comparisons of these hospitals across different years more difficult to untangle. These hospitals are Vista Medical Center East and Vista Medical Center West in IL; Northwest Medical Center Bentonville and Northwest Medical CenterSpringdale in AR; both campuses of Affinity Medical Center in OH; and both campuses of SkyRidge Medical Center in TN. | |
8 | Analysis shows that newly-acquired hospitals take varying amounts of time to adopt the practices of the overall system. With this in mind, CHS average rates in this analysis include only those facilities that are within their first full FFY of CHS ownership or later; facilities are not included in analysis within their first Federal Fiscal Year under CHS control. However, given the large number of acquisitions in FFY 2007, their inclusion in this analysis would dominate the overall numbers for FFY 2008, and are therefore not included in this analysis. | |
9 | JP Morgan Conference, January 2010 | |
10 | CHS Oppenheimer and Co. Health Care Conference, Nov. 3, 2009 | |
11 | Robert Baird Health Care Investor Conference, 2009 | |
12 | Mixed Ownership refers to the actual Federal Fiscal Year in which a given hospital was acquired; in other words, the hospital is owned by CHS for only part of the year. Because acquisitions from FFY 2007 or later would reach only CHS Year 1 on this chartand would dominate it, since they represent roughly 50 hospitalstheir rates are not included as a component of this chart. | |
13 | Office of the Inspector General, National DRG Validation Study: Short Hospitalizations. May 1989. | |
14 | Adjustments were made for patient age, sex, and primary diagnosis (grouped according to Clinical Classifications Software, or CCS, groups), as well as by adjusting for whether the respective hospital held a rural geographic location. ED outpatient claims were excluded from analysis if they had discharge status codes indicating that patients either died in the ED, left the ED against medical advice, or were transferred from the ED to another hospital for inpatient care. Hospitals were classified as rural if their most recent Medicare Cost Report listed them as rural (starting in 2008, since that is the most recent year of our claims data). If a designation of rural or otherwise could not be obtained from this method, then the hospital was classified as rural if its zip code was not part of a CBSA, as defined in OMB Bulletin No. 09-01. Patient case mix adjustments are necessary to take into account the different complexity of cases that different EDs will face. Adjustments for hospitals with rural |
geographic status were performed due to CHSs general comments that they favor acquiring rural hospitals. See CHS 2009 10-K, p.7. | ||
15 | To calculate expected numbers for comparison, we first calculate the national average rate by FFY for each combination of the patient- and hospital-based characteristics listed above: patient age, patient sex, patient primary diagnosis, and hospital rural-or-otherwise designation. Upon finding these national rates, we then multiply them by the corresponding number of ED encounters at each qualifying hospital within that given characteristic combination group; this gives us the expected number of ED admissions for that group. To determine the overall number of expected ED admissions at a hospital, the expected ED admissions total for all applicable groups are aggregated for the given FFY. So, for facilities meeting admission total restrictions for a given FFY, two totals were available: the total number of expected ED admissions for that facility, and that facilitys observed (or actual) number of ED admissions. We compare facilities based on the percent to which their actual number of ED admissions exceeds or falls below their expected ED admission totals. | |
16 | Results reported for Northwest Medical CenterBentonville and Northwest Medical CenterSpringdale in AR have been removed from this part of the analysis, as we believe they may have combined Medicare reporting efforts during FFY 2008. The results reported for Affinity Medical Center in OH are removed for the same reason. | |
17 | Short-Term Acute Care Program for Evaluating Payment Patterns Electronic Report Users Guide, Fourth Edition | |
18 | FFY 2007 or later acquisitions by CHS are thus not included in this analysis. If they were, the average ED admission rate at CHS hospitals would be 48%still well above the national average. | |
19 | Compliance Monitor. St. Josephs Hospital of Atlanta to Pay $26M to Settle FCA Allegations, January 9, 2008. (available at http://www.hcpro.com/CCP-203394-862/St-Josephs-Hospital-of-Atlanta-to-pay-26M-to-settle-FCA-allegations.html) | |
20 | Evans, Melanie, supra n. 3. http://www.modernhealthcare.com/apps/pbcs.dll/article?AID=/20090731/REG/907309998 |
|
21 | Report on Medicare Compliance, Vol. 15, Num. 37. In Hospital Observation Struggle, Uncertain Outcomes May Justify Inpatient Admissions. October 23, 2006. |
Very truly yours, |
||||
/s/ Rachel A. Seifert | ||||
Rachel A. Seifert | ||||
Executive Vice President, Secretary, and General Counsel |
||||
1%22#(.<2!H'/"(R3RHP0)YL`A(';I).UCDH8YTI!WL
M8`&Q.!0(,[""' 5!`"-/RK!PZ0@RG:D(#_&:3AP1DHEP("H`,K$*`(::#"`](@!"#4
M00IBP,(^_RP#Z#%`TUKH/`'*@`8)%"`"5$@#!JP`@ >@'CP
M`TQ@`"G`+T4@^D"``ET@!B^`3'-``B0`!SP0`VX`"!E@*!9J;2([.AL>!@U#
M8&M6,!A);A86?E84;!Y>%%IM?A)(;CI%1T5^"00S7D4;'%Y.;55$5ELS5%55
M*T0.7C!N'P1P*&A@8%1_4U=__\XJ4%!G:DL?8"4&3R`!+A-J3EAN%3AL-F`O
M+!@\;G%.(7Y=I"M%.V!A;6W.^OO\_?[_``,")*)$C1]^?A1($,BPH4.&;.I,
M*3+"CQ\M&])$@2%!1Q4S3M2X,>%%AA`-`4CX`"!`1A4)9$X$T(&&0PTT.%AH
M42,!318)!,)4T?%DIQ\X#,)@.'###(`D+:JX*>`%@HLN)R2LZ9'/CP8R&YS]
MV-'A`!@/)M!T8*!"A8\7;KH$"4!``9`"V@Q-@1XEL*+40B^-GB10*,%E%&:#G"PT^*(UJ8[+C1`X&:Q`\%
M*&!#:E0PA!P'\:/0@`PVR(\::M2@!`O.R-&$"&!T@<$G( %#
M5>B?1<;PQ3$^L0UUT((3ER@%4!P%'U!G`QK5>)0Q[D^#=^CL#-M@`1=T@`D%
M,$`\'S#P@1,J]G%G!.`%.Q"#/F&6A364(`U8N(`//D"%"K@!`630
M@#-O'LF+N&&?"R#"#(90AC(H`0,S:`$1CE"!"B1A`E28`!*0,('2BW[TJ"<"
M$2;`!!`\@`TPBUX`FM"UKL&.>@^`'1?.H`+J_]F^=08P0!7BP(4FQ`$@_W$#
M$%"0AC2(P0HE,%8@54`&=-]U#0T`0!VB&486A,$)=F9#+$90!1J4=@B].,(+
MGL"`*C10T(Q7W[[PQX;@/^`#9F`%&?+_\Y^3@0E?@@%$L0,3X7/?`G1#\"T^
MYW-B(`9K4`1DX`,06`134@3>XBW`D@8^QVH$0%?YQX$I8`9*8`94L``Z,`,4
MT`1-\``+T!8K.%5MD`!9(`8$@`$8P`HM@#+PMSXV4'W^H"@-X!&;ACOC=`1#
M8`4W(`"Q``$!@`@C``!/0`4_,`,;$`(-H`'&%G]%I$Q+Q`5+8#I&R`I%X'Q.
M0`,U@`&7IP1BL`$!\!$G`"7``!-+``)4`#(X``%%"'"``"=X@`&R`!&P`"
M)4`!%$`#>5B'9O@")*<$8!`!..`%/]=\UP(LUM*`/N`#8K`#]``&.T`&$3B!
M:T`&UM(%9C`$=)4M&/`&1=`!AO!'&X`&UK-K`&%7`#[B=%4M`U<8`'5U`"
M`^`%"!`%`%(*"&0P`!<=`D<6`!9`,S\Z,[$00*!J$%30)-_V$(:M",^#`&
M:C``)M""=4B(A%@"`BF0)E"0)H"'-+"'W3@"(V`"AC@"+N`#9H"`.=9_,_#_
M`P/@:$($!W(@!S+@6_XPBT?``28C1540`3J@`0W0!3T``#.P`C#0!4>`!Q9P
M`VD@!"P`!C7@`CS`!G7WC`["1$IG$7+@`07``!_P!"W0!3.0!A(H`26``%S0
M!G)`E36D!="E+H8`!SYI/WQ#!W-#0U04/P;F=%/T$$AT83:P`1K0EB9@!CY0
M!AB0!EV@`G]T$0^0!$.`;_OP0T%P`$+C#W$0`P3P`2DP``6`53@!!0)P$%$P
M!3```U#``T1``5+@C$#)(#4D!6[``$JX`61@5GE'`$/0`")3`'C061;``ON#
MF:-$=O4S81.`!FCP`0%@!W=I$`YP;_[P0SB@`]4&_S_"8P(,D`'6404A4`(0
MD"`2X``?U`0T$'.9J3USU#%I(1MH0`:RT@`VL`47`$YSH)'.4`B%$)R[]%\0
M4@54(`0&4$.`=!`]``96U0_H$@$WL&P/QP:-XPP'%"35QCWZTD^#,YT-X0=5
M*046<&5MP`4).0(Q\`1BD`:TN0,^4`);D``7L``[V%))MZ%#=`(@V0\+,`-.
M``#-N#U4-"1B.5Y71*`%RD!N@`(QH`,X\`$Y5D=60`51<`()H`)6!B$JY*$J
M=13DUD=<,`-\J0]`L`8Y<`']YJ+G4T-B*99^P``NX`(?H(8[H`170`(=0`49
M8#:88$&FHD5"FFH/L`9)ZO\,0#`#&J``JP6EYF,1<^`\%L0)HE=Z6+`#,W`%
M5D`"4'`"3B1UMR.G^F``>^D/33`$#*``4C"$AMHO-20'```%4S`%7>`#;U"#
M4!`%-``'^$!\?=.AD:H/`>`#;\39`&'A``^E.J#E%#/3,&E<%$#4`"6=`"
M14``/C`!(2`$'U```G&FC-<$Q.8/;E$`)^`&0@*K#%%#%@`$2[`$1X54NEH$
M:("J,O`#Y$2FQ"JG]I:J^Z`":W``,2">6KA&8_D'Z$24J0,#-]"I4-`"4T(&
M.!`#,:``+R`P9NFL#'&D:_H';C$`(V`!DN6B4`<`6V`#>*`[IK(R,``X`#`!
M,U#_)G))!B_P`B`0/O[:+U60!CG@#P&0!AF@`>TIIVK``-92!@70)PG@``4P
M&JP@@;)!`R<``6L5))ET1-_:L0&P!A$0;3L``3F@!9`*;'YP!\TJ/EH@80R`
M`KF56UC``%=0!C.P`XX5BC<``1U3!:P!7,Z@.#_9L0(1`,?:#TNP`P)`-87*
M;/3#!AW9D5K'!B?0`RC0`UC0+#]WBC/P!BD@`B QFA*PN9O[`R\@`23`+,R2!F6PMT#'(Q[0
M!%4W0U-G"#-6/XD;("6`<2)+A3W@.UZV+^?$1*JR$Y -G+%60!"B1H`1FNIQ?LW>I6IL2>#ZP@!`P@00A5
ME($,<.""?DQ3=EQ[P/Z$8X$,4`$,,ED%'/@HA`S@,(=J*.78D'CG>NQ`UU(((2:+B*T()!"`P@;>BD`((WEO4U4YA"!6C0
M6D"6P@`60,$^4=N^'%"`!C2H7>U*0`$3)(\!<(`5&VYD)M]XL%&-`LGS"L(&
M[P:C#0[0P``&P(`.#X`#"S"`((33J!X400B'&"H8(I!>"QLLP8V:`RO3>)KZ
MYM`W=*A"#]+@UA:F=F[-*\5IVB(5"3U/(MX"3"_,F*B5+&05_),##/TP`"\$
MX1!S,`$8/F!4%QO,)"9<,`=O],@QS>%0-HZ'!4J`U;IJ:0A/&$":5Q2)*G^V
M$`YI6`0&H-XYCRF"?G:$&VS_@(`1C``!A38T!%00:.SHI\I.,,16&I:#$S3Z
MTI#TPV" ;2!6?^!/FW`*,`67GOF9BA$8/%`&*.,G=1`$+2`2U]`$C=/D-LC!6;,8>V"5PT3F>Y-D[LRD#8H!-OB`'/)`%
M%5">\!F?NAD8$9`&1F`=;-">[RF?_-F?:#@';M`!:?"64^$&(>">_IF@"GI#
M8^D%0T"@/B4'3D`"1+"@%GJA>.,'7(`%,Z"0<\-75E`!VXF&?--^&'JB.D'_
M<"D!H#*P!@$@8VT`F"):GG239F69H8XE-(JC78HQ&L8B-$.!"BDR(E9Q)T,!
M%42J9O#@AQYI&I-QHRT!?V6&6NS!!DK"09/!.-*S0^HG,@07"G0RHL2P"C+@
M`R^Z3B%P!17@G-[B-XXS?_`0D'03I'WC" @8(4CP$$4"K@""Q@0!@H(H`54<$`%=&``*Z1``FT8`!8P
M8(4#6$!T(VC!"X"0`BKL20%L`)D"#"`!)FC!"E!P0PBP``$$=,`&TN)"!'P0
M@2Y0L``[&,(58)"*#9!`!7'H0`I`P`8F)*$**/](`@QVD`59,F$(0PB#`!:`
M@0F<(`D,8,$:TB"$*OA!`",``00.<`(:^*`,Z$2G$LB``_&-#P$@M,':+.``
M`:@!"P>(0P!FH`$G>,$'+^@!P'PP!`K,(14X*$($M!""->#`BPP8A1\2L(,@
MH*`"33!!$2#@CB(4X`!@2($':("&(6``"PY0@QSFX#4<].`&+?CH$'*0@3!H
M001%,$,%#!"%,*;@`1I(PP<4$`8#X&`'84C!$$;`!2OL0`8!Z``"X&`%"G`A
M"ABP`!2.@`_N_,`L[7`"`:8PJ&CX00YI;%07GH"!%/A`#$,H`P9F@(6O=:$%
M+4A!"B"@!03L0%)VPX+_"+CV`1S$H0$5:$,5E'`$!N2`!'Z0@AH4X`,,B"$"
M*B@`&'(ZA&[-H`(%F,,56G``#21``&CH&!F@`(,9Y*`*/`B"&EZ@A(?=8`I^
M&&T<)N`#`HB!!#:@SPG6\`$.9(`',F#`#"`P`*#X`0*_U,((O#`"-U2@!6JH
MP!$VD((,X,$%#0AGB@`3308`59>)X/*,"!3\"F#$H80AJ*@`8Q*`%[!"C8
M&K:97S%T0`L)(``0VI`#!:BA!1J(UA,@P`$R2.`"*`C#"0YP!!D4Q`\NB(('
M%BL"#YR@"`JX!!P&8(8T$"`*%Z!`$0[@AP#X@`,7,,/#**"$`0B`"!*PA!\N
M_]"%&6!@"!\PP`1FL`0.=*$-.BB"!EA@@S5`H)Y:6$%!:Z"$!S0422$(`1LF
M((8%!``*(_##"FH`@!U$(`93X($2_V$`)JRA"8M0@Q-\X(`Q7,--$)"!`G`0
M`07(X`@ $,@!@3@`T=P3FF0!NCT!-"$`=?C`RLPH$&P5R:,!A#P+1]``2!`
M`#Q7`U@P,RM``\(Q_SR3#%(:,`86,`0"D`HJ,`1(E>,@T#X@8`%V(`89<`+8
MQ0848`9J7@$2@-F:?01?RP!L,.%MH`*R7`)HP`%VT`1%L,N5>P%#8``!4`,)
M(`-ID` P3.">P;FH`S#^!; 0<"#
MRU%.\YH3F^,L9]C+/\"#`3C;YD`/>C$#\(8B+$#GY8@/%'XN]*8['5Q-N.("
MK*6(8SW!=[[*SY!*+B.M>_WK8-=ZL[J5-$(9R$&\$9&(M*`7C#\=NGYH`@:,
MC@XU""$$-.""O03$=X.IVW:$J@F`V`#>`05+;W>P`!OP(+\@P=I`LBE-::B-
MFM!UKN%P($V0.#*&QT>^NY+GB.3E0'K2EZ;TI)="'-AN^@@1Z&AT>;1LZ,#W
MSP`!
M;.F"%;*P`+I51PYNH%%42CA"JO!/"^C9B0I8D((9',```WC"&HY0O$`M@!#R
M.X4::G($WN'P&WCHB,7P$`!9J*$)_U5HG][@D1B^F4@QIGH.=!90!2"P@`4A
MJ(`^\%&!*5#A2VGP5VY\0`8FY$`&.5"``G3P`B'XP`HMV$$(=@`%$^@@0#J0
MY2S30(9^%9,L"#'#$Y28ER1&00`%```,I@F`:@+``C7*B05(@(03U,L`'(B`
M#V00ASY>+P,%VI&?U,"$+#P!!H>,A@4R@`,W&"`#&["8'1K``)S@KPD!T(0?
MFE!"(-B@*H_34VJ@H085)$!42U#!!3S`@BE``0I9R&@6DI"%,(2!#(L@A$$(
M@($(B.`&M(F!#"1P`P#`D0WS<8,"E("!`4Q`"3:(`1I<8*E=L`$J
,&;3B+#T%&'.\:@
ML\VFPDQ2R&7M2O8LL:A>!=Y5*VE'K$T1=0.D4_Q@EVLYE84$'SE[!$NR/PNY
M4XZYA^0UQQS\7*P4AYY,.&TESYYVX:O7I39*SHN,:TBYWY&(+$XD2CIE*'!"
M`^],4-(;'E\7T*"5?EWE>`M8B+&T$EZ>@0C,.JY"Z4A)R&BZ+&3J%364>I1,
M.=G!E/B1C^`H6\&>4L"L%%`_#XY"(UO(1!@1(_^7]-.3."'Q`,")PCQLU:NB
M/`-O=X98"V1E4#U8(3'XV"&6R4`"O:Q1DG#(WFD[]P$?R?`L9@_5Z';7HA^7
M4!3-Q6SVLDDF%09TAS%S+G1()/#8@H8.JI!=@RD`TA$5(=)4C]=!L%&5SN]J
M<>C9\SQQ@YZ[V!(FBCESB`-NWB3>X;XBVY1SV:TD>-@V>(0CF9BK'WH0Q$+H
M,(4-?,86/Q`>8Q("#&?$*SQ6J`/.J,,>$.%),=TP#V:4,9YT281UUY$.R:)U
M&9S8Q#]XT@-;GG4(:%3H?2!AD6``LA!9404/5N!+%E*2/:YL#T`DL,J+&G.6
M0?!B%E3QDW9*ET!*Y*'_@\][WQW4LZX_`.`$LJ&?_3##+D:4YS2?B(K_Z.2'
M6]FA"AD!`!/.4"H,J8T]WJ$#"7:0@L_0X03E64Q`Z"`9MERP1>@(A2$N=`G*
MW!`JR%`&9L310Q\:I84DTE"&,,0VG:A-5,C*&E"8-`>-T$EZ<\+AYB`QF2`.
M@A_G>Q%:[%-$-G0%423(B)`410<\P*` 94@.WS`9
MUHEY4A@G'_(\/#(Z`+6-(R>>:($&20`' >'BM]_AC,H]FQL3K+SI'`HV,T'S1J2*#1H>9"+8QU]O"K7#-SKSXG
M`]XS6!E/9IQ^4/D1*(W@'8-W?BUL^#"B1#(RZ%S,2/B61Y`B2>(VK*<[@#DU
M3^SD]W).3&LO:UJIP\[?LWFQ^N"IR6>,*"-,C(PQ<&``DP1-+&'!"CF(T$4;
M;(C!!0(4!$!"&0$81[CA`1@)K!#&'$TH4,,2`NRP0@(V(''!)P*((L`9
M`B"A1QY\M)390BL=@(`9"/#0_T(L/)[@8Q-F`%"'>&9@\D5@2.[4QQ[L00.0
M07/,D1`> 0!$ZP`VL@`T80`>$R!B]@
M!J*];*T@"@?PR32@X4D@O'WP"6 R``&>`"!8`'
M!H`%>N`.9S`(D)5P6/``.G`"="`%<8,)AL,'"=()BS`6G-4':+`$HE!MG>""
M`&`@/P`-S@(D:E:-NP52F'%3W>B-X&@(XNAQ2)![N8".]M1/^5$-TK,@7@DM
MUW@7B$-3.F$-K8`F2Q9$T[=(J]`X2M$3K$`[60$Z![`$4``"Q;(!*F`#'U`#
M%5`"&*`$0M``,1`'1'``5!`#0+#_!1W@`#6``S:``@XP`$R``5$0!3*P`T!0
M!0+``FYB!TP@`"IP`,#D&%9@!US`*0`@.!G7EE%``VCP-T9Y(7.U"4&!!C8@
M`GG0`2`@`$D0`R_@`D'@`#U@`-_&`Q10!@`A\P2(6#)FTQ)%@B&MB"(\A0
M!@Q2#M5PA]1RE$PT:7,9)J)`)L93#F0B1F+4'Q-3"M?@7=Z%C#20!FWP!G^I
M!NF(;-M6/:]P#1S3"4?A!X[S#'<#(R]"":W`,*)W<>XFF:,AA(93!P6E`[]9
M!1@`!2R0`5"@`B*P!1F0`Q;@!DN0`@'@FA"PI!Y@`F)P`VD0`BLPI!!@`QVP
M`CO`54VP_P0Y,`,$P`5<4`1YH`)+D`?&$!A&,$1X\XDG$`$G``87H`-&"24D
M8`#;%@YS=@`;$`)-X`-.T`0$H`1EH`)7<`1!$`$-T`!4`!P>(`0=($4(,E-S
MB2^=\!-C``VJ<10"<'>I@:-H>@%140>A`RZ1(#N8X#@0]1=DL@Q^,4:I)VDU
M`4B<112^D`4:NB0I$&;V!`,RMVV)@0?&126&$PQUT6;K16:2P3`C>IDKA1<-
M9Z(^(BA[P%-%L`!7()H+,`06<``-T`(K<`,[$`,A(&3FV`88(`8H0`$1T`92
M@`,Q()(XL`(%@`1@8%4#4`,'L`!JT!HJ(`50(G<-\B7+LP Y9$4;,@QX,:
M-90T8;`@21PI#N)`J%`@`@8&%`KD8##`!`$/,J"84($&1J&KCB]8T:-"BC@[
M,/C,P8>98KD_>9SRPS/HSYX_7AW5.1K.7:5&=/[Y"8APWDJ(94LI4FA*H!Z4
MMOD@7>E(X6ZH'XDFXL.T-\*R&542/QC3"@ERIFG2L
M9DW`.E8EPU7X+H
M56K?.<7$"._XRK3$F\21&8%EDQE[N%HS?@A?$1KJX>)(+9\D:;2CCN8J/SEJ
MT';(C-98<;26$YHP:(!Y:,E`\RRT^+]KP
'2`!QA12#[3!5``#$%1"P1A"CUD#*AG)2`%4B%1
M$Z72-+;&*LJ0!]6`#+=6*0EG!
XTWF
MT">LYA.!=6!L((#3$!0)AX5@Y6D6=S"Q$%'@G((!\`%S8,&7T`'`'""U``:S6,%
M:+`'%X`'%\`'J&=*`U$?=N"$G!,0].<<=30S56@1G>8-FS5?Y-2%!W.&GZ$4
M;_
;V46GL"<`V6DD^$R*,&0(H1HH,23O(&!^.I6-
MZ3EE87*GDQV%*@Z0XO\\6=`=*=,`H+%&2[9&'J@)S!$0F'`22%-7W=,ZJ#(2
M)[`(JN`.@^`8@T@=H*H1L;,90WH?*C$..5.0I;6D='`!;^2DH`*E>,<[=2``
M(0`$358`7_`"/T('3?`!:+``!$`#+X`!(``"!\`')[`"*["F8]EX:O8O+"$5
M
ZC#'"S3/P#4`0_Y
M(\L
M'U903EU85O3S\>KIY_GY^"PF)TU'1CPW-O?W]A`-#C4N+PT*"QL6%S,O+A(/ M$"PG)Y*/C_W]_4I'1XF'ASXV-OS\_/S\^_W]_/[^_?W\_/[]_?O[^OW^_?S] M_/W^_OO\^_S]_5-/3D<_/V-?7_GZ^20?'UM75G-O;O[^_O___R'Y!``````` M+`````"<`20!``?_@'^"9W]N9UIN;GZ+C(V.C&U^BHQQ9W&&BW]^:V>-BFN" M:W%^<95M-&RII7"ECWYG9Y.NL[2UM(F.J8^:J;!MFHV:@L/$Q<;$C&>I;)&2 M<+!G;=+3TG)R9\_3T-O<:YROW+#!P(*,Q^6VM.CFY^WN[_#Q\O/T]>9-+SA8LTZ5Q@E:FU1MPD%SN6V.PG+D&'GKM'36.D>P_^2T M96>OKMV[>./Y`6"`BY$:#`#7$,,@,&`&51CL25Q8\8O'>_8(,`P>/'`:IL M82"FAF?`:@(S&*!F2Q4P`Q@@65U:`!(P:O"H<8('CP(!29RH4;"[=A,\5*C8 MIEV[^`(\3A0H`%Z\^&_GOX4[7Z`<.)4%7!HX>/`@!Q,F5KA8(=(`AP,K2CHX MZ'"%"04E4Z;,)_B(3[]^GC'V+_R1,,.V"`P05F3'#!!AMDX,.""\;@8`P> M1!CA!C[\8*&%*D2@P@\;1N"A"RZ,,`*('I88@0M!B"BB"Q&,D***+@:A`0HT M:F`C"@<<4,*..^H(PX\&``F#!0880"21!H!@P?^2(!0`PI/^"*0/`B),20(! M5Q+`#P(D=%D!EET2`(284@`Q9@5%I`G%!QRPR8$-"4`!A0TAS(E%"%C0>6<" M`/2IQ1)Q]-FG2M_HY( S`0R`VK@#K+9:M_GJ6^ZLG7:;+J_9"GSKN,\.,"NT M"^M;QK.=FDMKN.HB,0#_P@3CN]H+GBE&K&67,6:8$6(0ENJIII:<:LEB_&7J M9R5[1AA@G;WL614U_#68$620P4/++7_FF1%&&%;%'C4C-N^F`!>\J;GM\HK9 M`&,(4+4``R31Q=9=.-$UUU\[D9S88&^MG-C)G:W``U`04X$`,LCY`10 ,8K,N('2RD""(3P@QPEI9==%&,1N'!%6CH!"S@DBAW@ M>`4;8&"Z%GP`%(M@RQ\S4<=9K,$$/KC!*.B"#G=(ZO\5:_#!"*!BJ3H"@Q0% MP$`)UN"&0L3BE,$PY2+B(!56;@(I;'A%&]X`$F_TJ12I6,-&K!('"*1"4%)A MB9\@``$O\$D+"4A`"*(IS8Y0 BB/IA>]3:P401YU'MF"&D/0JJ]%(QT"@Q`@!J[ MD(&\N/2E>9EC)3EI%UBP ;GF'(]I` MD#JHXQY)940PPU+'J8A%)EC_L8I4:%**F\QDE]6(QB[9\`9OJ*`&*AW&&C-@ M2J&Z]:WE>`-;^(B7C,!!!=BU1X>@8`R!6N@+W+*Q*PT\`>(QG?F`4WWL#8 MQLIUJY2*)%MDX0BLR)*NI30&)3>[V35X`*UJ%,`&VFK8TIKVM*A-K6I7R]K6 M_F$-%E!`2D,[6M?:]K:XS:UN=\O;=WC!#V@00P%"R];>&O>XR$VNPAV*O"(9QA@IT0;[W#;"`!TQ@GK;A!PRX@:4(,(;Q%OC! M$(ZP_W:5\=FT:N(&`W"PA#?,X0[G5I@Q$,-^!2$'$VS!`Z1MK4R%D>+25K62 MYY`$3O\0ARN1H,6Y!:2E3MF.7,[5I2_^Q2!P?`Y)$MDN=;0E,J)A"`^_PRG/ MM;`?0+"''QSYM-$PP`\\$`00B`"8J'6*'WJAV004P`(<8(,@`'`'(Y0!"X3H M[5>@$*>.8$02[;A`&3#0#"`'JK"TU(([.L%?6+"!!D!-0`1\4(%4$.,GT@"` MDWD:!QSL0 1C"B"=MC#@8(`E[(`%_"Q``3=O6$CFH`A4Z MD(=/>8"6ILAE5Y$"@*I$JA-R""9B*[&&/ATJ)=QM@.T"%>=.<*`+UF+`!021 M@!1\@0@$9XLRF-$4L9IB$+241%?H,(DX%Y40:Y@#33I1\$HF4Q!M.,'/?G`% M,FQA!='0^!D@8,H55($/G.!T)PR9#(_[X1IC[JHI;U"#6:W@4$$00QX.94I< M!"H.=^A`"/J4@21HX+>/UD)4YJB(292##41/B07*@(038.31&S"7$2*P2SFP M\@^1B,68DX(5-R)VCD;&ZC,(S>+_K]P5MW&00@:JH.Y!%.`%'L!M2HY0A1$D M@`TX*(,.#F$`"0Q!!BX`0!LZ#P(?8"`&<4C`^&0P`2'PZ0Q1V`'Y#&`)%$P` M`2F8P`0B4(D1)&$`.,@`"=3\VC@4X`M)"$`-AA"+-ARA?1LXT`@BH05S3R\# M&3#!&B#@@Q@`05$H\`#M_5""!&7@!%#X-4D,$(03!`$%H_8#`2*@(P,0@+OE M\,`7!.`%$SQ!#&5`6&M``$:R)!`@""O``#FP!G`0`DPB`E"02_E@`\;D!4!` M6',`)IP@"&Q0+:B19BA0`T 0'A8``00H!)M8`'C<@!Q4`P`,`2I40,[8%1SX`4\ M)V,G<09;!Q,I40DD(7I9R`S-(!61!&V\0`I[A5MPL&I5H&`P)P(G9FV&U5<. MP``HH!--$`!/P`8<\'L/(`9;<```('-WL`<#4`9Q@`(N=$5%$`
8"DP\`(W)`8\L``WI@(\ M,!A[H`-C-@A,8`1\P"<>8`0#\`%L@`4.\`7<2`8:L`E34`/#EO\`&>`S-W0$ M&X$$/'`!G)`#/+`!58$#8M`%CA)M>_`P+]`'`#`"1N``AZ(`QD@&1C`&)%`" M1C`OFF(#,V`%*Y``B9<$/50#`P`%:U`!S$@83H``L```+P0&8@,#:U``T&(` M,T8(4@"0,T`[&U!C"R`$L*`%#R`!5G$#P:$`3F`!W+4!#5``$D`$'4`"X&$% M'2`!B-`&6M`!2#D%]/,*&L`$'3`$$T``A&=;;+!XC5<(%L``*'9;AY`'-:`! MH,@#91`!-^`:FG0!//`"04``EH$!0Q`%:T`%#.``%'`$$O`!%D`&79``!R`` M8&!E$I`94]`!#2`&%!`'%J`L`\`"A87_#?(H!0#``&7`5FN0![-#!4T@``$P M!@Z)!$:P`OO8*SO@!6,0`&E0?194`%I0!F$@!%Z``-98`*9T!@\PD!\0`8#A M!#?@`H'101BP"0`0&0!!90`CA0`Q^P$2O``SF0! Y!E6`!!T@A6.P!Z'W!N4@13%`,E[@`F+@CW[@!&5P`A=@ M&4(`!1B@?!,``VSP`#4@`6 @`62P``F0&3/`!NSF!&M``P`@!@H0!U#P>S(P M`V%PB0"@`F$@_P"*L0`&$`8YT`$EXP!]P@=DH$`TU`=^$`-(4`-.0`5D8`4A M(&2V59T,0`##X`864`.1=UNY1`2R(@#-@@,R:`0!0`1'8`(E4P!9T"L&0!4! M(``$L!>2(`$U4`8Y8`8I8`0JX`=#@`1HD`K*.`.D<`=;H`.&`G.AR`2P<`
80`V4`9=8`,B8`1;<`=OX`5A\%";`$ MGO@'-)0`A7D!&M"/CF(02Z`%3T`&$[`&'$`&R(D1#U`%`*H#8;`#"``%,E`8 M):)-)$'//`#6B`$8B``;8`% MO/H#(2`$7R`#&\L#$\`G[GD"`!85`%.Q`!(*!X#HD"]NJ0?V%NUB*5^:D` M$``%.\`#!)"$MR6E5"H(5JJ5N$4';9"O3:`"V[.F!_`S`JD`-U0$$%")JRH) M1N"FE0!K#[`%-6!S`F`$)\`&$O`"=T!CN$D!:[`$@KIY>'4&%,"B#I`'`M`I M'^`'7)`M6P>Q7?`5]0(+6,`$+]"G(3`&96#_`WW``RQ@?#G3`/[)`%Q0`:WT M!R6P&!7@#1L`&%G`:DAP"555#KMZ!UI@!G$H!B:@!44S&*Y2`Q4``.&H`VOP MB@3`!A!@`D@P!JF7!&30`A97!F)P`R!0LI(D"#7P`EIP`D4C`5)W!@G@`C&0 M`O59`SY0!P#``P.@$&O`!R_P!'%P!3P``ZW$`;VXED1C`'Y0!V5`!A8``$"@ M`AGP`F!0B5A@`O8RA1P(`)Z!`B"0`36P!5(0!_]'!4<9`"`0!QVP!UU@DPO` M`R[07V'``$CX$46``"M`!8`!`7%`!@D&`K^'$3M0`P+0`430!&30B;=%"D*0 M8%6:E5EZ6]U;`S'`_PR L(A, M\``X<,A1P`<\<`*7.PS):\?"FQ@=T`9>4`9I&1ESQPD\L`4H$0<-T(QK<`1R MO&::<@()&JU_,` <@<%$(^`'"!`&/``".M$"75`&.F,$6E"O8C`&R?<#G;`# M),,#`&T$0%"NK@4`/C"\+ZR5;AA8F\`'8G``F=`)!_`%1F`&ZY2"<0`$8K`' M(5`.7BH$><,!G2H&0T`1'`!G6A`%5<"I;""I%.`'`,L`.I``I-`)'D`&?.`@ MS2.7*]D$'(.):<``3*`%<[`'1H`"5J'!*PD`:1`&25`#[.@'(4`TRLH).B%D M0*``1N`#($$!53`#<,";`5`)I*6K+T`$<,`&Q5L#!J`%-P0$CF*4>\&L,N`' M1,`#*!`3!\``#>!7&F`9-?`#7E"8G2&;Q0`8HN#_`=!P!C#``U1``%@@ M`1EK" #\%_97,D,\!UU`!B"@!0J`5@[+`TX``!90!6.` M9]%&`213&!P3`$?`H5MPU`'0`R$1CD\H""H*`"8@IAL1!U30FC=``#_C!3\0 M!AV0`1'0`JT0M$]0(1Z@L5"J8D:;T#%`!ROL!TQPH;_V!UK@`MSX%SP@!&U0 M!`%,M&@+T"W#`R10!%5P0Y48`$2%`55P!P"P!LR;`[LD!"_P%R7P"EK@NV8P M*;@I!E#@`!PS19V1!H[B`"UC+3R@``)(`!H:`!&@#*1)!O3[,"N`$M&VB%4P M&PAK`+%F&62-#'F`,WR`_P8#0`9,\*1"V@5$\``.<`235P6(^@1&@`02\`1H M\`5GRU2NL0=^&(>#6H/(X$(QL0830!@YX`:P204KT`.!\>'9^P)3D`%>H``! MH`,`8+-WL`$_8`4\P`09Z!D@D,P!\`46D`"!$=T0W@5^8``!3'R"\`$*\`4C MP(4DR]9K`,4U0-_]M@,(NP,H8``%8`-Q<`-A``8?<09=$`8C``0]\`5@D``D MNP)A4@0`,`=-G0%H4@386-ZM!0!FP`#?A[19^=U =<@`$$G7K\^@6F^J9% M$`!.0'P0(`4^0`:\W@(T00)'0-%&`*!S@`%&$`.=``%$T`)N```5H,$\0'NL M-/\&1A!=-7@`1M``%V!Q/U"'8L`$%`D`!;`#7R!%?7!CYNT&`0OK"'X`0S!% M2"`&/Y!R'%@!Q;XN3A!Z9Q`!7]``M+3=:V"=$#-=U0<`$-`!OEK@3Z`,RQX$ M;(``1^!"59`$+-!OKX`!-=`%I9X")6,"HO=H-?``*-$&-M`K$Y!Z2J`I>[`` M9/#AO@S-2?`!&NP!5XP#7_0%3."015`T')#,2$#G$+"'2 #G M?Z`#/(".Q00!0$`%5<#B)4`&N\O!<>#>!\DQ9'`""%KII0`!Z$T81N#I";`! M-_0%/H,$'W`&,$`&T-PM&$>TMN7J-7"TB@("5;"5MC7_"15@`^7]"EB0)44` M2`10!+_6!DM``E"@L)T``!\0.2*PMV<`!3<@:)IPQ)M0):LK#@5@`@WG!PE@ M`'=C`Q:P$$U2!+ET*`E0`L49R,)P!D4P)"7'^RYP`C^``G!V6=V5(0
^,Q"1@])\*##"EV@ ML,,(6;3@!0I(9$%*!15D@<`0(R#@!19L7)#!E0!D@<8'))P1!0
T`94``)*$TM"8`,"@`4D``%"\(7.P`=%@&4V
MECI/<)\"40=M,)`+=2`P-59VT`AI@` *;>@P`:D@/1$]0&H&;ARLSI,000X`3]
MU<$DP-4-@"U)H0!M0%FG\@-)X`4V(!@_D!H-N"6N=!A!T`(W<`;L[*=CX/\!
M%O`$?1`%&0`$#1"K%V`$S_@3O<@`0[`"?4,!'N`#30``NE/8)T0N3<``B=T<
M:7"+6S!4/1!B2=@%/(!ID]UK*E`"M&!V!R0_#H"[#\`#1TMG!)0#6Q`4&K`&
MV4V<1>`$<4O.7I`8?&=JN=N+%A`&)R8"/LP9?64#;>`$Q^($\,<"&'!`C],!
M+K#$.M' ^'`A*W@+P(O$<``#IQ"/$@$'.O_!"&F6JB":=G+$6)9.(M&
M#"GK!1^EZ06@),+@<46RJPBP!=DM`ALP!E?0`8JQ+$@06W@^!#6@N^.A@``P
M>-O!DON&`X#S"S>P`%QP`$O4`0Q0!1'PY"I0!,\]$9N0S#=@!F[05[5T`2#0
M<6BB`&R0!`X(B`T7"`@W5!W$#D%"0`G%364L`-\IP`6,0`[AN`%2P`T"P
M!19P0:UG-!)0`RC@/1MP"V[T*]@R`\,G!1_P`50CZ?1"HD<``3Z0!9A>!430
M`-OYV#C@0SC`!=ORS&+@!(5S`R0P%-&622N5:,XG$FNTN5Z`!0_`!".-?%&P
MZU+R8 B!%#$#V@
MX$40->`!`B8P(!& "V0!!4@J0(P
M!`3@`D>@!A`(`]W!`4%L`A```&&\-)_U`0=`G-#@!@$P`DU@!R3@`BY``FE0
M`UZP`!K`JVV0`!RA49_9R&. @`P_P_P-(L+RM/NV1
MUUIJ<`)K\"0J,``QH`!:6W(-E00%$#71(%9UH`8$0*9;H`+SRP%-@`0WX`94
MU04^@`,*`+][0.WZCG+!`5,ZD`>670<`\`-?,(DDIP,;@%'E[0P1JU`J90(W
ML`,O4#!9,`!AT`2]M@4`4!R@MN\>/WEL$&Q2<.5+HUHX0$<+WPPZ``$PX`,J
M=0->$$07P`-?6L,0P``!;.`#5:<#PM(#GT;XI+\T
M`B`?+Y#R>ND&+M!C5UZV#U`!+"RG.@`$6<`,;)`'2K!0<$0#2USZP"\H;_"&
M;G1^=/`#0F"ETV!0=<1J>S`%:>MFS(U5Y$[RP7_]V3`%`8`#Y.Z#;$``%`!7
MV#_^\)<%K3-X/N@&7Z'VY-_^D]<&?6`$@A6<61"4O>[^^&]R6?`"1@`(`F]_
MA(6&AXB)BHAL;3)I:6J+DY25EI>8F9J;G)V>GZ"AHJ.DA&X%0W%MI9=I.A9N
M`$.G`,('2F
MPJ<%-+"FR54')\`%:N0%*2`&13`!.NH`#'(9<26H?BIR9F`">.DF::`#",`%
M';"0$-"C.].>2P`277`%0#":D^IU*U`M().I!`(#:R`">Q4&'S`$7`$SA@$0W"(18"G3,`$%W`#`T`$
M%8#_JO]*:UG`"9:P&40,+!1H`72WJ;-_
M&C=+(T5>7DL_1`UA,7=6`3`<76(Y9ETS6ST*4EP%7D4;&V*&8@%%*C!B(@\A
M<$)8!&QR:6E_S,W.S]#1TM/4U=;7V-G:V&D0"&]JVP5;/`Q'.EL7+'0!+BAJ
MX=%`7!9H02Q77A)=04=651O"=#&PQ(D&+TP,\).P9`F"(D24R.`3)HB!(%Y4
M]%CR@("3!D%$&!CBHH.8(3F"=`BR9$V?,$3(!,E@H8J2+A=H[#@#8XF("`[,
M]`GRA).+!4/Z2/"R`PV7%AR\&%!11`.7(`.\=*DA(HS_#0$J:G0I$D&($1Z;
MMBQ)HD.!QRX,%"S)<,'+%2=
(`A]F0F
MV7`6PC`'%1!1:D`'%0`';.,&)Y,\-J,W;V0-%54!;Z`#_",S<'"2)WE#-O,/
M:9(&&D`KMQ.5WN"4ZBB55MD,:1`#YG657$D,68D&71F6O>!82""69ID+I0)\G<]
MX`"1'8$RCSD:!!`!Y)$&%``&[UC_``,P```@45TX!2Z@!!.@!7(P`D(0!Y&X
M'UL0`!%B!X,@"T*6#D"@!![0!&IP!^+3-&H0/NW1(%1@`5XXF?\`B`VB+AGB
M#A&2!4@P!83P-W'P-9-I#8.9/I/9A0#!)N!C/H20GLXH-6AC`RT@"<;CA
&@7(J,!3NE,4H2$<3`)"AHO5XIP"H&G0`#4R%$9
M*7%)Q($P-3; (00#T:X0'RE.`!`90
M$"H00PLB401-28\!(Z`7"BX!A0-007N.\`*")C&`,83!`A@P`Q@*4``VT.`-
M(,#`&D;``R,.(@'S$H"YCB@(``S!@I"`@A/^U0\US&L(6$S$#L`@/DVD``F5
M(``(V(`O!LS%!>PQ@Q"$<(,OB`$+35C"'1I`!A4HH?\`4:@9'2=0`+B\Y`UN
M^,,&O$>(,IR`C%TP92(%$$--3.!JE>!`%IZP@2ME06N&T$,6A,`&`:QD"/3B
MXQ$'T`4M1$(*9L#7&E*0"`*,0`S#6V*#2!"`5/0!D6TC`P%4X(%"&J$+(/3"
M^@RQ!3+2JPH^F"#1^L"&Q3@"`!3@0`6044M"D"%J"AA#AAXA!6`2H@0"N"`G
M['`#1A!``DP(``3(V#"X?9)1;4.?&"Z0!1?DP`U@X$$@6^$51VS@!"E(P0CL
MP(,3=#!??Q`!%I19"`+(850Z$,`42A"`-2CB!6$X`CL@`X`U#$%+^3*`!(!0
M/4((CRRIP$`W%:$""Y#1"QO_44!I,G`"`;A!&?T\1`48.`9O":("#8"``%Y0
M@MYYHP(^**0B;,"#"8P@C4-0B@S<.@B*=:@?`5B+(`Y@AP'8JT*)B,(=A""Z
M0MBA`!$8D0=^\`0N](`O?P#`$>S@! -U@/Y&6+"=P
M`$A`,$4@_P!CEPDIH``D*`E6``*I$0)D9`%J@&P(P0)!\`4L2!`D4`"@]@F;
MMD6#@`)*(("+`$=SE`DTT`51F!4],`;=!PE<0D9C,&9MP`(9`(/`L`!A,PAD
MX`:8 92$?6`T-^8!YL(`-=J`!UD`2=
M"(R'L`'!\8/](`$'@&O,*`@KD"1?]P306(V)(`&/]X