| Return Reference | Explanation |
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| FORM 990, PART I, LINE 1 & PART III, LINE 1 | DETAIL REGARDING THE ORGANIZATION'S MISSION TUFTS ASSOCIATED HEALTH MAINTENANCE ORGANIZATION INC.'S ("TAHMO") PURPOSE IS TO GUIDE AND EMPOWER HEALTHIER LIVES FOR EVERYONE. TAHMO SEEKS TO IMPROVE THE HEALTH AND WELLNESS OF THE DIVERSE COMMUNITIES WE SERVE. TAHMO IS RESPONSIBLE FOR ARRANGING FOR THE DELIVERY OF COMPREHENSIVE, PREVENTIVE AND THERAPEUTIC HEALTH CARE SERVICES TO SUBSCRIBING INDIVIDUALS IN RETURN FOR A FIXED MONTHLY PAYMENT. SERVICES ARE PROVIDED THROUGH A CONTRACTED NETWORK OF INDEPENDENT PROVIDER GROUPS AND HOSPITALS WITHIN THE SERVICE AREA. TAHMO PRODUCTS ARE AVAILABLE TO ALL SIZE EMPLOYER GROUPS, INCLUDING A MERGED SMALL GROUP AND INDIVIDUAL MARKET. TAHMO ALSO OFFERS PRODUCTS TO INDIVIDUALS WHO ARE MEDICARE AND/OR MEDICAID ELIGIBLE. TAHMO PROVIDES A BROAD RANGE OF PROGRAMS DESIGNED TO EDUCATE ITS MEMBERS IN HEALTH MAINTENANCE AND DISEASE PREVENTION. TAHMO IS DEDICATED TO OFFERING A VARIETY OF QUALITY, INNOVATIVE HEALTH COVERAGE OPTIONS, AND TO IMPROVING ACCESS TO AFFORDABLE HEALTH CARE BY DEVELOPING AND EMPLOYING STRATEGIES THAT IMPROVE THE ALLOCATION OF HEALTH CARE RESOURCES. IN ADDITION TO PROVIDING THESE SERVICES TO ITS MEMBERS, TAHMO IS DEDICATED TO PROVIDING AND FUNDING HEALTH PROGRAMS THAT BENEFIT THE COMMUNITIES TAHMO SERVES. TAHMO IS PART OF THE POINT32HEALTH, INC ("P32H") FAMILY OF COMPANIES. ---------- |
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE ACCOMPLISHMENTS - COMMERCIAL HMO PRODUCT ONE OF TAHMO'S LARGEST PRODUCTS IS ITS COMMERCIAL HMO WHICH PROVIDES AFFORDABLE HEALTH COVERAGE TO ITS MEMBERS. TAHMO STRIVES TO PROVIDE HMO COVERAGE THAT IS AFFORDABLE AND PROVIDES ACCESS TO TOP QUALITY HEALTH CARE SERVICES. TAHMO ALSO PROVIDES PROGRAMS THAT TARGET THE IMPROVEMENT OF THE HEALTH OF ITS MEMBERS, AS WELL AS THE COMMUNITY AT LARGE. QUALITY: NCQA EVALUATES HEALTH PLANS ON THE QUALITY OF CARE PATIENTS RECEIVE, HOW SATISFIED PATIENTS ARE WITH THEIR CARE, AND HEALTH PLANS' EFFORTS TO KEEP IMPROVING. TUFTS HEALTH PLAN HMO/POS/EPO's NCQA QUALITY RATING IS CONSISTENTLY WITHIN THE TOP 10% OF PLANS THROUGHOUT THE COUNTRY. TAHMO CONTINUES TO IMPLEMENT OUTREACH PROGRAMS WITH BOTH PROVIDERS AND MEMBERS WITH THE GOAL OF IMPROVING THE QUALITY OF CARE PROVIDED AND RECEIVED. UPDATED RATINGS WILL BE RELEASED IN SEPTEMBER 2024. TAHMO PROVIDES SPECIALTY CARE MANAGEMENT SERVICES FOR ITS MEMBERS WITH COMPLEX MEDICAL AND BEHAVIORAL HEALTH CONDITIONS. TAHMO MEMBERS RECEIVE TARGETED HEALTH REMINDERS TO ENCOURAGE PREVENTIVE HEALTH CARE.TAHMO'S CARE MANAGERS ASSIST MEMBERS WHO ARE ILL OR DISABLED IN NAVIGATING THE HEALTH CARE SYSTEM AND PROVIDE REFERRALS TO COMMUNITY RESOURCES. TAHMO'S WEBSITE, WWW.TUFTSHEALTHPLAN.COM, IS AVAILABLE TO THE COMMUNITY AT LARGE, AND INCLUDES A LIBRARY OF TOOLS AND READY-MADE PRINT AND ELECTRONIC MATERIALS. THESE RESOURCES HELP TO ENCOURAGE HEALTHY BEHAVIORS, INCREASE DEMAND FOR PREVENTIVE HEALTH, AND DRIVE ENGAGEMENT IN PROGRAMS THAT EDUCATE AND EMPOWER HEALTHIER LIFESTYLES AND REDUCE HEALTH RISKS. TOPICS INCLUDE PREVENTIVE CARE BENEFITS, HEALTHY EATING AND WEIGHT CONTROL, EXERCISE AND FITNESS, MANAGING STRESS AND HEART HEALTH, CANCER PREVENTION, AND TOBACCO CESSATION. TAHMO ALSO OFFERS A VARIETY OF WELLNESS PROGRAMS AT THE WORKSITE, SUCH AS FLU SHOTS, CHOLESTEROL SCREENINGS, STRESS MANAGEMENT, AND MORE. TAHMO'S SECURE ONLINE ACCOUNT SERVES AS A CENTRAL HUB FOR LIFESTYLE MANAGEMENT PROGRAM COMPONENTS, HEALTH AND WELLNESS CONTENT, AND TOOLS. THE ONLINE ACCOUNT OFFERS A PERSONAL HEALTH ASSESSMENT AND RESOURCES DESIGNED TO ENCOURAGE INDIVIDUALS TO LEAD HEALTHIER LIVES BASED ON THEIR INTERESTS, OVERALL HEALTH CONDITION, AND OTHER PERSONAL ATTRIBUTES. COMMERCIAL MEMBERS OF TUFTS HEALTH PLAN CONTINUE TO RECEIVE THE MEMBER NEWSLETTER 3-4 TIMES EACH YEAR, THE NEWSLETTER IS AN EDUCATIONAL RESOURCE ON TOPICS PERTAINING TO ACCESS TO SERVICES, PREVENTIVE CARE, HEALTH EDUCATION AND LIFESTYLE REMINDERS. IT ALSO HELPS MEMBERS UTILIZE THEIR COVERED HEALTH PLAN BENEFITS, SERVICES AND FEATURES TO THE FULLEST AND IS AIMED AT SUPPORTING THEIR IMPROVED HEALTH. ACCESS: TAHMO'S MEMBERS HAVE ACCESS TO HOSPITALS, PRIMARY CARE PROVIDERS AND SPECIALISTS AND ALLIED HEALTH PROFESSIONALS, AS WELL AS CONDITION MANAGEMENT PROGRAMS, PREVENTION AND WELLNESS PROGRAMS. AFFORDABILITY: TAHMO'S GOAL IS TO PROVIDE ACCESS TO THE HIGHEST QUALITY HEALTH CARE SERVICES THROUGH AFFORDABLE HEALTH COVERAGE TO AS MANY MASSACHUSETTS AND RHODE ISLAND RESIDENTS AS POSSIBLE. TAHMO HAS DESIGNED HEALTH MANAGEMENT PROGRAMS TO SIMULTANEOUSLY LOWER MEDICAL COSTS AND IMPROVE QUALITY AND OUTCOMES. BY LOWERING MEDICAL COSTS, TAHMO IS ABLE TO OFFER COMPETITIVE PREMIUM RATES AND PROVIDE COVERAGE TO MORE PEOPLE. TAHMO IS COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITY AS WELL AS THAT OF ITS MEMBERS. THE ORGANIZATION TAKES THIS COMMITMENT SERIOUSLY AND HAS A DEDICATED COMMUNITY PARTNERSHIP PROGRAM THAT PROVIDES IN-KIND AND FINANCIAL SUPPORT TO NOT-FOR-PROFIT PROGRAMS THROUGHOUT MASSACHUSETTS. SUPPORT IS BROAD BASED AND REFLECTS DIVERSE SPONSORSHIP OF ORGANIZATIONS THAT PROMOTE IMPROVED COMMUNITY HEALTH. ---------- |
| FORM 990, PART III, LINE 4B | PROGRAM SERVICE ACCOMPLISHMENTS - MASSACHUSETTS MEDICARE PRODUCT TAHMO ALSO OFFERS PRODUCTS TO MEDICARE ELIGIBLE ENROLLEES. TUFTS HEALTH PLAN MEDICARE PREFERRED ("TUFTS MEDICARE PREFERRED") PROVIDES AFFORDABLE HEALTH COVERAGE TO ITS MEMBERS IN MASSACHUSETTS. TUFTS MEDICARE PREFERRED STRIVES TO PROVIDE COVERAGE OPTIONS THAT ARE AFFORDABLE AND PROVIDE ACCESS TO TOP QUALITY HEALTH CARE SERVICES FOR SENIORS. TUFTS MEDICARE PREFERRED ALSO OFFERS PROGRAMS THAT TARGET THE IMPROVEMENT OF THE HEALTH OF ITS MEMBERS, AS WELL AS THE COMMUNITY AT LARGE. WITHIN THE MASSACHUSETTS MEDICARE ADVANTAGE MARKET, TUFTS MEDICARE PREFERRED IS THE MARKET LEADER - COVERING MORE INDIVIDUALS THROUGH MEDICARE ADVANTAGE PRODUCTS THAN ANY OTHER CARRIER. TUFTS MEDICARE PREFERRED ALSO OFFERS CARE MANAGEMENT AND CONDITION MANAGEMENT SERVICES TO MEMBERS AND PUBLISHES WELL! MAGAZINE FOR ITS MEDICARE POPULATION ONCE A YEAR. THE MAGAZINE IS AN EDUCATIONAL RESOURCE ON TOPICS PERTAINING TO GENERAL HEALTH, ACCESS TO CARE, PREVENTIVE CARE, HEALTH INFORMATION AND HEALTH CARE REMINDERS, TARGETED TO ITS SPECIFIC POPULATION. IT ALSO PROVIDES INFORMATION FOR MEMBERS ON HOW TO GET THE MOST OF TUFTS HEALTH PLAN'S BENEFITS. ---------- |
| FORM 990, PART III, LINE 4C | PROGRAM SERVICE ACCOMPLISHMENTS - DUAL-ELIGIBLE PROGRAM THE ORGANIZATION ALSO PROVIDES ACCESS TO AFFORDABLE CARE THROUGH A DUAL-ELIGIBLE PROGRAM. TAHMO PROVIDES COVERAGE FOR PEOPLE AGE 65 OR OLDER WHO ARE ELIGIBLE FOR MASSHEALTH STANDARD, HAVE BOTH MEDICARE PART A AND B, AND HAVE NOT BEEN DIAGNOSED AS HAVING END STAGE RENAL DISEASE. THIS PROGRAM, CALLED SENIOR CARE OPTIONS, INTEGRATES MEDICAID AND MEDICARE BENEFITS AND SERVICES, PROVIDING THOSE ELIGIBLE WITH COORDINATED HIGH-QUALITY AND COST-EFFECTIVE HEALTH CARE. ---------- |
| FORM 990, PART III, LINE 4D | DETAIL OF OTHER PROGRAM SERVICE ACCOMPLISHMENTS - MEDICARE COMPLEMENT TAHMO PROVIDES COVERAGE FOR MEMBERS OF ELIGIBLE EMPLOYER GROUPS WHO ARE ENROLLED IN MEDICARE PARTS A AND B. THIS PROGRAM IS CALLED TUFTS MEDICARE COMPLEMENT ("TMC") PLAN AND IS A MANAGED CARE PLAN THAT COMPLEMENTS A MEMBER'S EXISTING MEDICARE COVERAGE. IT IS OFFERED TO TUFTS HEALTH PLAN MEMBERS IN ELIGIBLE EMPLOYER GROUPS WHO ARE ENROLLED IN MEDICARE PARTS A AND B. THE TMC PLAN REQUIRES MEMBERS TO CHOOSE A PRIMARY CARE PHYSICIAN ("PCP") WHO IS RESPONSIBLE FOR MANAGING OR PROVIDING THE MEMBER'S CARE. ---------- |
| FORM 990, PART VI, LINE 2 | DETAIL OF FAMILY OR BUSINESS RELATIONSHIPS BUSINESS RELATIONSHIP - THE FOLLOWING INDIVIDUALS SERVED ON THE BOARDS OR WERE AN OFFICER OR KEY EMPLOYEE OF ONE OR MORE FOR-PROFIT ORGANIZATIONS AFFILIATED WITH THE FILING ORGANIZATION FROM 1/1/2023 TO 12/31/2023: CAIN HAYES, PRESIDENT & CEO TISA HUGHES, CLERK/SECRETARY SUSAN KEE, CLERK/SECRETARY (START 12/11) EILEEN AUEN, DIRECTOR, CHAIR UMESH KURPAD, CFO (END 7/4) R. SCOTT WALKER, CFO (START 7/5) ---------- |
| FORM 990, PART VI, LINE 3 | DELEGATION OF CONTROL OF MANAGEMENT DUTIES THE FILING ORGANIZATION'S SOLE MEMBER IS P32H, ITS AFFILIATE, POINT32HEALTH SERVICES, INC., PERFORMS CERTAIN MANAGEMENT, ADMINISTRATIVE, AND MARKETING SERVICES FOR THE FILING ORGANIZATION AND OTHER AFFILIATES. THE OFFICERS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES LISTED IN PART VII, SECTION A ARE EMPLOYEES OF POINT32HEALTH SERVICES, INC. THEIR COMPENSATION IS LISTED IN PART VII, SECTION A AND SCHEDULE J. ---------- |
| FORM 990, PART VI, LINE 6 | MEMBERS OR STOCKHOLDERS P32H IS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION. ---------- |
| FORM 990, PART VI, LINE 7A | POWER TO ELECT OR APPOINT MEMBERS P32H, AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, ELECTS THE MEMBERS OF THE ORGANIZATION'S GOVERNING BODY. ---------- |
| FORM 990, PART VI, LINE 7B | DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS P32H, AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, HAS THE RIGHT TO MAKE CERTAIN DECISIONS REGARDING THE ORGANIZATION, AND IS REQUIRED TO APPROVE ANY CHANGES TO THE ORGANIZATION'S BYLAWS. ---------- |
| FORM 990, PART VI, LINE 8B | CONTEMPORANEOUS BOARD MEETING DOCUMENTATION FOR A MAJORITY OF THE TIME, THE ORGANIZATION CONTEMPORANEOUSLY DOCUMENTS MEETINGS HELD AND WRITTEN ACTIONS UNDERTAKEN BY ITS GOVERNING BODY AND COMMITTEES. HOWEVER, ON LIMITED OCCASIONS, THE GOVERNING BODY OR A COMMITTEE MAY HAVE A SERIES OF CONFERENCE CALLS AND MINUTES FOR THOSE CALLS ARE NOT APPROVED UNTIL THE NEXT MEETING. ---------- |
| FORM 990, PART VI, LINE 11B | PROCESS USED TO REVIEW THE FORM 990 THIS FORM 990 WAS PREPARED BY THE ORGANIZATION'S EXTERNAL ACCOUNTANT, REVIEWED BY P32H FINANCE DEPARTMENT AND CERTAIN SECTIONS ARE REVIEWED FOR INPUT BY SUBJECT MATTER PERSONNEL IN OTHER DEPARTMENTS THROUGHOUT THE ORGANIZATION. THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS BEFORE FILING. ---------- |
| FORM 990, PART VI, LINE 12A & 12C | MONITORING & ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE P32H'S CONFLICT OF INTEREST ("COI") POLICY AND PROCEDURES ("P&P") APPLIES TO THE FILING COMPANY AS A SUBSIDIARY ORGANIZATION. P32H'S COI P&P IS REVIEWED ANNUALLY, REVISED AS NEEDED AND APPROVED UPON MATERIAL REVISIONS. THE POLICY REQUIRES ALL EMPLOYEES, INCLUDING THE PRESIDENT AND CEO AND GOVERNING BODY MEMBERS TO COMPLY WITH THE COI POLICY AND PROCESSES. ALL EMPLOYEES RECEIVE ANNUAL COMPLIANCE TRAINING WHICH INCLUDE EXPECTATIONS RELATED TO FOLLOWING THE COI P&P. THE COI P&P REQUIRES THE OFFICERS, KEY EMPLOYEES AND BOARD OF DIRECTORS OF THE TAX-EXEMPT ENTITIES TO COMPLETE AND SUBMIT AN ANNUAL DISCLOSURE SURVEY AND STATEMENT TO THE CHIEF LEGAL OFFICER ("CLO") OR DESIGNEE IN THE LEGAL DEPARTMENT, LISTING ANY OUTSIDE RELATIONSHIPS, INCLUDING FINANCIAL AND/OR BOARD RELATIONSHIPS THAT THEY OR A FAMILY MEMBER HAVE WITH P32H'S (OR ITS SUBSIDIARIES) SUPPLIERS, PURCHASERS, PROVIDERS AND/OR COMPETITORS. ADDITIONALLY, P32H. REQUIRES EXECUTIVE MANAGEMENT AND SENIOR MANAGEMENT (AS DEFINED IN THE COI POLICY) TO COMPLETE AND SUBMIT AN ANNUAL DISCLOSURE SURVEY AND STATEMENT TO THE CHIEF COMPLIANCE OFFICER OR DIRECTOR, CORPORATE COMPLIANCE. BY COMPLETING THE ANNUAL DISCLOSURE STATEMENT, THESE INDIVIDUALS ACKNOWLEDGE THE POINT32HEALTH COI P&P. ALL EMPLOYEES ARE REQUIRED TO REPORT THE OFFER BY AN OUTSIDE ENTITY OF GIFTS OVER $250, HONORARIA OR COVERAGE OF BUSINESS EXPENSES, OR OTHER EVENTS OR RELATIONSHIPS THAT MAY BE PERCEIVED AS CONFLICTS TO THE CHIEF COMPLIANCE OFFICER, DIRECTOR, CORPORATE COMPLIANCE OR DESIGNEE AND THE EMPLOYEE'S MANAGEMENT. BOTH MUST APPROVE BEFORE ACCEPTANCE IS ALLOWED. THERE ARE PROTOCOLS AND PROCESSES TO REVIEW ANY DISCLOSURE THAT MIGHT BE A POTENTIAL CONFLICT OF INTEREST. BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES' RESPONSES TO THE DISCLOSURE SURVEY AND STATEMENT ARE REVIEWED BY THE CLO, WHO WILL REVIEW THE SELF-DISCLOSURE WITH THE CHAIR OF THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS Of P32H AND DETERMINE EXPECTATIONS AND RECOMMENDED ACTIONS IF NEEDED. A SUMMARY REPORT OF ALL DISCLOSED ACTUAL OR POTENTIAL CONFLICTS ALONG WITH ANY RECOMMENDED ACTIONS TO ADDRESS A DISCLOSED ACTUAL OR POTENTIAL CONFLICT IS REVIEWED AND APPROVED BY THE GOVERNANCE COMMITTEE AND THE COMMITTEE'S REVIEW/FINDINGS ARE REPORTED TO THE FULL BOARD. THE CLO COMMUNICATES THE RECOMMENDED ACTIONS TO INDIVIDUAL SURVEY RECIPIENTS. THE CHIEF COMPLIANCE OFFICER IS CONSULTED AND INFORMED OF THE DECISIONS MADE BY THE CLO OR LEGAL DESIGNEE. EXECUTIVE MANAGEMENT AND SENIOR MANAGEMENT'S RESPONSES TO THE DISCLOSURE SURVEY AND STATEMENT ARE REVIEWED BY THE DIRECTOR, CORPORATE COMPLIANCE, LEGAL, AND CHIEF COMPLIANCE OFFICER, WHO WILL REPORT TO THE CLO ANY POTENTIAL CONFLICTS ALONG WITH ANY RECOMMENDED ACTIONS TO ADDRESS THE POTENTIAL CONFLICT, IF NECESSARY. RECOMMENDED ACTIONS/EXPECTATIONS ARE COMMUNICATED BY THE DIRECTOR, CORPORATE COMPLIANCE, LEGAL, AND CHIEF COMPLIANCE OFFICER TO IMPACTED INDIVIDUALS. FOR CONFLICT DISCLOSURES INVOLVING THE CHIEF COMPLIANCE OFFICER, THE CLO WILL MAKE THE FINAL DETERMINATION. ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST THAT ARISES AFTER COMPLETION OF THE DISCLOSURE SURVEY WILL FOLLOW THE SAME REVIEW PROCESS. ---------- |
| FORM 990, PART VI, LINE 13 | WRITTEN WHISTLEBLOWER/NON-RETALIATION POLICY THE FILING ORGANIZATION IS SUBJECT TO THE WRITTEN WHISTLEBLOWER/NON-RETALIATION POLICY WITHIN THE CODE OF CONDUCT THAT WAS APPROVED BY THE BOARD OF DIRECTORS OF P32H. ---------- |
| FORM 990, PART VI, LINE 14 | WRITTEN DOCUMENT RETENTION POLICY THE FILING ORGANIZATION IS SUBJECT TO THE WRITTEN DOCUMENT RETENTION POLICY AND RECORD RETENTION SCHEDULE OF P32H. ---------- |
| FORM 990, PART VI, LINES 15A & 15B | COMPENSATION REVIEW AND APPROVAL THE FILING ORGANIZATION'S PARENT COMPANY, P32H HAS AN INDEPENDENT HUMAN RESOURCES COMMITTEE (THE "COMMITTEE") THAT ANNUALLY REVIEWS THE TOTAL REMUNERATION OPPORTUNITIES, POLICIES AND PROGRAMS OF THE CEO AND CERTAIN EXECUTIVES, INCLUDING OTHER OFFICERS AND KEY EMPLOYEES AS WELL AS INDIVIDUALS THE COMMITTEE DEEMS APPROPRIATE TO REVIEW. THE COMMITTEE IS COMPRISED OF INDEPENDENT DIRECTORS OF THE COMPANY. THE COMMITTEE CONSIDERS MARKET DATA AND ANALYSES ASSEMBLED BY INDEPENDENT AND INTERNAL COMPENSATION CONSULTANTS WITH THE GOAL TO DETERMINE EXECUTIVE TOTAL REMUNERATION THAT IS REASONABLE AND COMPETITIVE WITHIN THE INDUSTRY AND GEOGRAPHY IN WHICH P32H OPERATES. ---------- |
| FORM 990, PART VI, LINE 19 | PROCESS FOR MAKING DOCUMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION'S GOVERNING DOCUMENTS, COI POLICY, AND ANNUAL FINANCIAL REPORT AND QUARTERLY FINANCIAL UPDATES ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. ---------- |
| FORM 990, PART XI, LINE 9 | DETAIL OF OTHER CHANGES IN NET ASSETS CONTRIBUTION TO PARENT $(25,000,000) CHANGE IN NONADMITTED ASSETS 9,387,813 ------------ TOTAL $(15,612,187) ---------- |
| FORM 990, PART XII, LINE 1 | ACCOUNTING METHOD USED TO PREPARE THE FORM 990 TAHMO FOLLOWS THE STATUTORY ACCOUNTING METHOD PRESCRIBED BY THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS' ACCOUNTING PRACTICES AND PROCEDURES MANUAL FOR STATUTORY ACCOUNTING PRINCIPLES. ---------- |
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