 Whoever's going to testify, please raise your right hand, please. Do you swear the testimony you're about to give will be the truth, the whole truth and nothing but the truth? I do. I do. Thank you. Thank you, Joanne. And just want to remind people that please refrain from using the chat function. The chat function will not record a public comment. There will be a period after a board and HCA questions that will allow for the public to comment. And that would be the appropriate time so that it's accurately part of the record. So with that, Steve, I'll turn it over to you and whenever you're ready to begin, you may proceed. Thank you, Kevin. Really appreciate it. It's, as always, a pleasure to present to the board, especially in these kinds of very interesting times where I first like to do is introduce who's in the room. And what I'd like to do is just go around the room and we'll start with Andre. I'm sorry, this is a core reporter. I didn't hear who was after Andre. So we have Mike Rogers for finance. We have Dr. Sheehan, who is a medical director for the medical group. Dr. McGraw, Chief Medical Officer and Chief Information Officer. Jodi Steph, Chief Nursing Officer and VP of patient care services. Ellie Peterson, Chief Operating Officer. Excellent and Steve Gordon CEO president. Do you want to bring up our presentation? Just want to make sure you all can see that presentation that's up now. Yes. No, yeah. Now we do. Okay, great. Okay. Let's go to the next page. That's the group who is here today with the exception of Mike Rogers as our made a guest appearance. We're all glad to see Mike is doing well. So on my overview, the image is really weathered the storm of COVID pretty well on a number of different fronts. And we really appreciate all the federal assistance. Andre is going to go through the analysis of the federal monies that have been designated for BMH early on in the process or the pandemic. We acquired a $10 million line of credit, which we have not had to dip into, but we will maintain. As you've seen from our filings, our barrel balance sheet remains incredibly strong. To the point that our board has decided at this point in time to decline the state cares grant. We've also whether the storm through delaying the major modernization project that you all approved a couple of years ago. We are restarting that actually September 7 and we also suspended all routine capital expenditures. So those are some of the major initiatives that the hospital took to really, as I mentioned, whether weather this storm. The first week of March, the hospital went into incident command like most hospitals. Our incident command actually made over a thousand key decisions up until we moved out of incident command, which I think Ailey was June early, early June. Made a thousand key decisions. We call it a thousand points of light. We did. We had a huge amount of clinician and board engagement during these months. We had weekly community communications, email, Facebook website. And we also created our own COVID, the image dashboard for people to evaluate kind of how the hospital has done in our community has experienced related to COVID. We also sent out weekly staff email updates. And as we move into or moved out of the pandemic, we wanted to make sure we prepared ourselves what might be around the corner. And we have developed a future inpatient COVID unit approximately seven beds from where we are today in the new normal. We have brought back our gross revenues to about 95% of our budgeted target. And what's pretty amazing, a little bit different than what you heard with Joe and amount of Scutney, about 20% of our regulatory visits are through telemedicine. And we anticipate that to continue and potentially grow. So I'm going to ask Ailey to as a chief operating officer for the hospital to go through, give me a sense of what was pre COVID volumes and during COVID. And now how we're kind of climbing back to our budgeted volumes by key areas. Yes. So I will share with you how the hospital, how our visit volume has changed during the course of COVID. And there have been kind of two main reasons for how our visit volume has changed during the height of the pandemic, which is really March, April and May. One was because we made decisions as a hospital to pause certain services, all of the intention of keeping patients, employees and the community as safe as possible. We did this to help preserve PPE and to really be the most efficient and effective with our resources during this time. There was also a need to do this due to in the early stages of pandemic, a lack of availability of COVID testing. The other reason for why we saw the decline was patients decisions to delay their care. As you know, there was little information at the beginning of the pandemic and that caused fear for patients. We did put many safeguards in place here at the hospital and communicated frequently with patients about the fact that it was safe to receive their care here. And that it was important not to delay urgent or emergent care. But with that said, especially in the early days, we did see patients making decisions to delay care. Here you see our total OR cases, our surgical volume, as well as our inpatient admissions. This excludes the birthing center admissions with our surgical cases. We made the decision early in the pandemic to stop elective surgeries. And this was due to lack of timely COVID testing and therefore results as a way to preserve our PPE and to be in line with state guidelines. And our inpatient admissions followed suit from patients not presenting as much as they would to the emergency room or other services. Our diagnostic imaging, as well as ER visits, you can also see here a decline in both of those services. When it came to diagnostic imaging, we made a decision to pause screening mammograms, DEXA scanning, as well as MRI. And this was clinical decisions to limit the spread of the infection, to limit patient exposure and employee exposure. And I mentioned some of the reasons why the decline in ER visits. Laboratory charges also saw a decline during the height of the pandemic. This was due to primary care clinicians making decisions to not order as many screening tests against the limit the spread of infection. It also had to do with physical exams on being paused during this time, which can be a driver of laboratory visits and charges. I do want to make mention though that the lab is really one of the unsung heroes in the response to the pandemic. It is where we house our COVID testing. Eventually it's where we house the BDMACs that allowed us to do in-house testing, which allowed us to resume elective surgeries at the right time so that we can do safe and timely testing of patients. It allows us to test our inpatient and other very urgent patients that need to get timely COVID results. Here you see our BMH medical group, which represents our 12 outpatient practices. And you can see here that visit volumes declined during the time of the pandemic. And this was due to a couple of reasons. One, we made the decision to consolidate our primary care practices. And we did that so that we could set up a respiratory clinic that allowed us to safely care for suspected outpatient COVID patients. It allowed us to preserve PPE. It allowed us to redeploy essential personnel to key areas in the hospital, such as primary care clinicians going to service hospitalists or ER clinicians, medical assistants and nurses going to serve as COVID testers or screeners. And while you see, yes, a decline in visit volume and the work that we use, you do see the rise of a new service that we had not previously used in our outpatient practices, which were the rise of telehealth visits. And we stood up a telehealth platform early in the pandemic to allow clinicians to lay eyes on their patients and to make some more care to patients. Here you see our contract labor. And this has been a really important initiative for us as a hospital to find ways to drive down the expense of contract labor. And that's important for many reasons. One, it's important to always find ways that we can reduce expenses where we can, but also so that we can hire and retain permanent staff. Staff who build connection and rapport with their patients and their team members and Jodi staff chief nursing officer on her team have done a really tremendous job in bringing down these costs. And they've done so through innovative programs and initiatives to retain top nursing talent as well as to support and bring on new nurses. Thank you. Turn it over to Andre. Through the pandemic, we've obviously incurred some additional costs. And this is a breakout of the costs that we've, we've seen through July. With the lion share being in wages and benefits, which a lot of that most of that is redeployment of our staff. As Ali said, we contracted the practices shut down some of the services. We had staff that we were able to redeploy into the rest of the organization as we were preparing for some of these other supplies, decontamination supplies, food, general supplies. These are additional supplies and services telehealth that we had to incur as we were ramping up the code. We also went ahead and put it put together separate test site for testing, as well as to respiratory sites. So we had to do some rentals of tents in a modular unit. That's all to about $900,000. Then we also had some capital costs in creating that code with you that Steve was talking about adding some additional equipment, conversion of some of our existing areas. That comes up to about 230,000. So in total through July, we've spent about 1.1 million is dedicated to expenses. This is a slide for our cash availability, our order of liquidity. Through July, we maintained our operating checking account roughly around $4 million. Below that, you can see all the stimulus payments that we received. We also participated in the Medicaid retainer program. We did receive the Medicare advance payment loan of $6.3 million. That's one that we're going to have to pay back. Steve alluded to, we had a $10 million line of credit plus our short-term investments. So for short-term liquidity, we have about $45 million available in total. Just one point. You see a $5 million stimulus check that we received in June, June 12th, right in the middle. You all see that? Yes? Yes, we all see it. All right. So I do want to point out that there were six hospitals designated and determined to be safety net hospitals between New Hampshire and Vermont, six of us. The two in Vermont was BMH as well as Rutland. And that's what generated that $5 million stimulus check for our two hospitals in Vermont. And that's based upon proportion of Medicare, Medicaid, low profitability. And what was the another factor? Charity care. And charity care. So that was really critical for us. Without that additional $5 million, we would not be in the position that we are, that we find ourselves today. Yeah, below that, we have our long-term investments, both for BMH and Southern Vermont, which is a parent company. And the $8.2 million for Ron Reid, that is dedicated towards the project that has been in the works for about three and a half, four years now. That's what Steve will talk about a little bit later. NPR, Fixed Perspective Payment Summary. And we're asking roughly 5.6 million, 5.6% change, budget to budget. There was an accounting change. We were asked to break out the expense for one care that we're paying as a member. Historically, we've lumped that against the revenues. So in FY 20, it was netted against the revenues in 21, we broke it out. So just because of that accounting change, it's about 0.5% of that 5.6 number. The COVID expenses account for just about 2% of the NPR increase and the remaining increases 3%. This is the income statement. The circle areas are those areas of some significant change. And some of the stuff that we just talked about, their fixed perspective payment 2020 budget to 21 budget. There's an increase there. We did see an increase in some of our revenues, but we also pulled out the expense piece from that 20 FY 20 budget number. Now go down a little bit lower right in the middle of the COVID stimulus money, the 11.8 million dollars of stimulus that we projected in here. That plays into the favorable bottom line. And the net operating income for 2019 actual 670,000. 20's budgets for 75 and 21's budgets for 42. So all right around 0.5% margin, pretty thin margins. Balanchee missed the circle here. That should be two lines up that cash and investments of 25 million dollars. That includes all the stimulus money as well as the Medicare advance payment that's 6.3 million that we are going to have to pay back. And in December of 2019, we actually transferred almost the 8.2 million dollars from the run from the parent into the barrel account. So that shows up as additional cash that's restricted for the project. And if you go down to the circle towards the second circle is where our liabilities are. That's at 6.3 million dollars that we're going to have to pay back to Medicare for the Medicare advance payment. Our other operating and non operating revenue. There's no significant changes budget to budget. And as I just showed you the projections include roughly that 11.9 million dollars of grant funding through Medicare. The cares funding in the Medicaid retainer. Some of our expense drivers for next year. Wages contract medical specialists benefits primarily our health insurance. We've seen continued uptake on our health health insurance costs. Both of those combined accounts for 77% of our expense changes that are built in next year's budget. And as well as the code expenses. The change in the charge request 4.9% and kind of just went over with the code being roughly 2% of that. So I'll jump into discussion of the risks and some of this is obviously repeat from prior years. But I think all the hospitals are major risk is really any research of COVID-19 and in Vermont. Certainly recruitment and retention is is always an issue for us. Whether it's physicians or clinicians. We have low unemployment the loss of young talent in our in our area and certainly being your most southern hospital. We compete directly with those hospitals in both Massachusetts and New Hampshire. Another risk is you know we're we've been a strong supporter of one care. We will continue to be a strong supporter of one care and we participate in all three major contracts. But we have to list that as as a risk. But we do feel in our board feels that philosophically is where we need to move away from fee for service to value based payment. CMS proposed reductions are always on the table whether that's 340 be we have one more one more year left on our Medicare dependent hospital status. So that's always a question for us at BFH being the only Medicare dependent hospital. A risk but also a positive thing is we implemented a new general financial system. And you know I do want to thank the board and especially the staff for having some patients with us as we made that transition to multi view for our general financial system. And patients in terms of getting our financials to you on a timely basis. I think moving ahead though that that's no longer a risk. That's truly an opportunity. And then in general what I've talked about in the past is really having patients in terms of some of the major initiatives we take within our community that don't really yield the short term returns. We continue to support our homeless shelter with the vulnerable population nurse. We are contributed to rise her mind a strong focus on care coordination. One of the great programs we put together last year was establishing a dental program for those who can't afford it but especially those who are Medicaid that can't get into see any dentists in our area. We're in the process of recruiting actually our second dentist to serve that dental program a very unique program which is partnership with our local United Way. And then invented behavioral health therapists in primary care and finally our continued support and expansion to our community health team and our efforts working with the hub and spoke to lead also opportunities. We've had a great year believe it or not with recruitment. Ailey and her team in the medical staff here really worked hard and have attracted substantial new primary care clinicians. After two failed starts we do have a new orthopedic surgeon that will be starting Dr. Gallagher this month. And we've recruited two additional orthopedic PAs cardiology. We have a new cardiologist. Our cardiology program is actually through Dartmouth and Cheshire where we have a lot of clinical collaborations. The dentist as I mentioned before came on board to operationalize the dental program ophthalmology our independent ophthalmologist has expressed an interest this year to retire. And we work with him to recruit another independent ophthalmologist to join the medical staff young physician coming out of his fellowship at Mass Eye and Ear. We're very lucky and I think you saw I think Joe and Matt Scutney identified ophthalmology as one of the critical areas and we have been very successful in that again it's not an employment of an ophthalmologist. But we work very diligently with our current ophthalmologist to transition his practice to a new doctor. Hospitalists we recruited a new hospitalist as well as an APRN and we were without a diabetes management nurse and we have successfully recruited an individual to serve our very needed population. You know we when I talk about psychiatric and mental health care I always want to bring up that we are the fourth busiest hospital in terms of the emergency department treating mental health and psychiatric patients but we are certainly not the fourth biggest hospital in the state. So we have we really have a major need to collaborate closely with the retreat with ACRS and working with our community and we've been very instrumental in bringing up a sort of community treatment initiative here at the hospital working with the retreat and ACRS. So we continue to make investments in our emergency department as well as our treatment of mental health so to be as patients in our primary care practices. We continue our collaboration very strong collaboration over the last five years with both Dartmouth and Cheshire and Keen to again create a regional health care delivery system. Even though you know it's the part of it is obviously in New Hampshire we serve about 20% of our patients are from New Hampshire. So it's really critical that we we have that working relationship they've been great partners from a strategic standpoint and the most recent addition to that partnership as I mentioned above has been the addition of a cardiologist. So our cardiologist services actually provided through Cheshire collaboration. Telehealth Ailey mentioned our new platform for telehealth which was implemented quite recently and we just see major continued major growth in telemedicine. LGBT initiative was started several years ago. I've spoken about that in the past. We have added now racial diversity initiative. And that has kicked off over the last several months. And then continued support obviously of our dental clinic to serve the uninsured under insured and and Medicaid. So capital budget plans. We're back into making it a continuum invested our physical plan as well as our equipment. And this year it's about two point or for next year would be about $2.1 million. And then as I've communicated with Donna Jerry on the CON side. Our boiler plan has been completed as part of that laundry project you all approved. But we are with board approval. We are restarting the modernization project which is the new ORs and medical office building floors. September 7th. Just around the corner to start that we're restart that project. So that's really the formal presentation. From all of us at BMH. Thank you Steve. So, we're going to start our questioning by our link to the Brattleboro area, our member Robin lunch Robin. Hello. Thank you. Hi everyone. Well. I'm curious to know, or if you have any thoughts on why your implementation of telemedicine would have been. And these are my words not anybody else is more successful than Mount of Scott days. I'll let, I'll let Ailey talk about that or maybe Dr. Sheehan as well but who heads up the medical group but the two of you address that. Great. So, you know, we struggled just like everyone else did here in rural Vermont with connectivity and patients being able to easily connect and access telemedicine. And so we made a change. We started with one platform. And we made a change to blue stream kind of in the middle of when we implemented because we were struggling so much with patients being able to get out. So we recognize that saw this as an opportunity. We stood up a task force of key clinicians stakeholders and key staff using the telehealth services. We talked to patients about where they were struggling. Through that information and data, we made a decision to move to blue strain health. And this is a platform that we've used for many years in the hospital for our interpretive services. And so we had some tried and true results with this program and they were sort of relatively new to the telehealth game. But given our relationship and the success that we had and patient and clinician feedback. We felt that it was important to make that move and it's been great and we've seen positive results. In addition to that, we did a lot of media and marketing campaigning on our website. We put online tutorials demonstrating our clinicians showing videos of conversing with patients. And showing patients real time tips and tricks for how to get on. We also engaged our staff. They do some of the work with patients to help them get connected ahead of their visit. I think Robin and I'll ask Dr. Sheen to weigh in on this. But I think one of the keys is this was a clinician driven initiative. Our clinicians really wanted to connect with their patients. Didn't want their patients to go without, you know, face to face visits. People were concerned about visiting the offices. We consolidated the practices, the primary care practices. So, but I think we got a huge amount of clinician engagement who really wanted to see a much more robust platform. I don't know. Yes, from the initial start of COVID, the need was recognized by the medical group and they started to form sort of their own organized groups meeting on a regular basis. And then it became very quickly formalized into the medical group leadership along with weekly meetings with all other clinicians that could join in. And so we were able to go through with many trials and errors. And also, in addition to that, develop some test sites so that before we implemented anything, we had the input of the test sites and also the other clinicians. So it was definitely driven by the clinicians at the image. Great. Well, that's wonderful. And I should just tell you so you're aware, we are not seeing you on camera, which is fine with me, but I just wanted to let you know in case you thought we were. No, no, no, no. No, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no, no. Here you go, hit that. Here you go. You see us now? No, yes. Hi, awesome. Thank you. I'm not even a millennial. It must be brown aboro people are just good with tech. Learning today. So I did have a question about the contracted labor and travelers. That's awesome that you're able to shift. Those those positions, I, and I noticed in your slide, you have the nurses broken out and then there's an other category and I wondered if you could just give us a flavor of what's in the other what positions are in the other category. So, I'll ask Jodi to jump on that because she, I, when I last year, when we talked about this, this is our biggest budget buster, our biggest and I think we're running 16 fte's of contracted RNs. Yeah, we all saw this throughout the state, but Jodi's an absolutely phenomenal job with her team to reduce that and I'll have her jump on that. So, for nursing for the past two years, we've had a focus effort on recruitment and retention, many things that go into that and gradually had a plan to phase them out. The timing was great because getting contract labor during COVID would have been very challenging. So we were right at the cost of eliminating nurse travelers and on July 20th, our last nurse traveler left. So, within the other category, we currently have two lab techs and an echo tech and we've tried to starting, you know, spring early summer apply the same methods. So revising job descriptions, you know, outreach to schools, offering temporary positions. And so we've had success with that. So we should have those three positions filled by October 1st. So we should be starting the fiscal year with no travelers. So I think it was mostly putting so much focus on nursing because that's where the need was. And then running that respiratory therapy or radiology and lab needed that same kind of focus attention. So we have done that our team with really good results. Do you want to comment on the nurse residency program? Sure. So we started a nurse residency program two years ago, a little bit on the fly, a little bit late in the game, but recognizing we really needed to address immediate needs, but also look to the future. So we put it together rather quickly in the spring and work to the schools. We had, I think between nine and 11 applicants, we had a small cohort of steps. We had to break them out. But immediately started working on nurse residency to point out to be prepared for this year. So what is the residency? The residency is for new grads with our ends. And the first year we hired to mix into our medical surgical unit. This year we started early. We posted the positions in January. We visited schools, word of mouth, got around and we had 28 very qualified applicants to the residency program. Wow. And so, and then COVID hit. So we were a little bit delayed, but my team did an amazing job and did multiple rounds of zoom interviews with everybody and we were able to bring them in house. July 20th. And we have four this year going to med surge. One to the emergency department, one to the operating room. They're not counted in staffing until. Until they apply for positions. So they are, they really are the future and historically in nursing, you know, we hire new graduates in and there's an open position. So we're constantly pushing to get their orientation finished for these nurse residents. They are having a very slow, slow, thoughtful, all of their preceptors have been specially trained to work with them. So by the time that they're done, they'll be applying into over position. How long is the residency? The residency is six months to a year and it's based in some for medical surgical at three months. They'll be taking their own assignment for specialty six months and then they're assigned a mentor. And I would say for our residency program right now, they are learning half clinical skills and half life and management skills. So time management and resiliency and, you know, implicit bias and all of those things. But it's really half and half and the feedback has been amazing from the staff, the preceptors and the nurse residents and right now I have to say we have minimal positions open. So we'll be looking at creative staffing models to look to the to look to the future with those residents, but it's very, it's a very different feeling to not have to be rust and really keep them and that's all on the retention site. So this year with recruitment, we're shifting to really retaining the nurses that we have focusing on education, shared governance, those sorts of things. Thank you. Shifting a little bit to some of the financial stuff. Can you, and I apologize if I missed this in the narrative or the other materials, but could you tell us what your Medicare and Medicaid reimbursement assumptions are? For 21, we assume the same reimbursement assumptions that were in 20s budget. So we didn't increase any, any reimbursement for Medicare and Medicaid. Okay. And can you tell me how, so for the account for the remaining of this calendar year, the feds have rolled back the sequestration for Medicare. Does that have much of a budget impact for you guys? Very minor. Two reasons. One major reason is we have, we're in one bear. So a lot of those would be running through the ACO. It's a small dollar amount overall for the remaining part. Great. Thank you. You mentioned that you're, that you're budgeting for a wage increase in 2021. And can you give us a sense of what that is? Well, we, you know, one of our biggest groups are the nurses and we have a contract. They're unionized. So that, that is part of the union contract. And then we, we have our across the board increase with the rest of the house. Are you looking for a percentage? Yes. Okay. What's our percentage? 4%. Yeah. The other thing we did during COVID is we also went to a $15 minimum wage and brought up everyone who was below that to the $15. So. That's great. I'm sure your community appreciated having that additional income. Okay. I may have missed a question because I've scribbled all over my questions with notes, but that's what I have. Thank you, Robin. Member Pelham, Tom. Thank you. And hello, Steve and Jody, I think it was probably about a year ago that I was down at your turf having a tour of the hospital. Say hello to patio Donald for me. I will. My first question is when, when we were going to the hospital. We did visit the birthing center. And I, as I recall, I didn't take great notes, but as I recall, because of the closing of the birthing center in Springfield. You had capacity that I think that I got the impression you felt was underutilized, and that this was just kind of a natural fit. And then, you know, in your presentation, there's this developing relationship or develop relationship with Dartmouth Hitchcock in the neonatal area and so I'm just wondering, you know, what, what the migration has been, you know, over the past year to to to the kind of the current situation. We're heading down to about 275 births, which had me concerned and with the closure of Springfield in the establishment of our OBGYN practice on the campus of Springfield, we actually picked up probably about 25 to 30 additional births. And that's what we've been running. I think this year will be a little bit over 300 births. Which is not a lot, but quite frankly, it's probably a lot in terms of the other Vermont hospitals are size. So we're hovering around that 300 birth level. Currently. Thank you. I, I, I, I think, I think Robin asked this question. No, I see my next question. And this question has to do with the provider tax. I could be wrong here. I didn't go and research the log in but I thought that the provider tax was something like 6% of the prior year net present revenue. Is that, is that your. Yes, that's correct. I'm seeing a nine and a half percent increase here in terms of 2021 over 2020. And I'm just wondering if that is a very low risk estimate, let's say. Based on 6% of the budget. That's because that your 20, 20 projected revenues are like 78 million and 6% at 6% a $5.5 million provider tax would be up around 91 92 million. 2020 net revenues Tom. I'm looking at both the 2020 budget. And the 2021 budget. And then looking at the actual projected for 2020 in the middle it's, I think it's 78 million bucks. 70. I mean, let me just flip it here. I can get right back to you. Yeah, I think we don't have 8 million. Yeah. Yeah, but it's plus the NPR is $78 million for the projection. Now in the 20 project projection. I think we ended up building it off the 21 budget amount. Can I ask a follow up question Tom? Sure. Is that typical that you accrue your provider tax estimates in your budget based on what you're budgeting for the next year, even though it's based on the previous year. See that again Kevin. So, as Tom pointed out, the 6% is based on the previous year. Yeah. Have you consistently applied the 6% to your current year so that you're literally accruing it to your financial statements. And then moving it from that accrual to an expense when you actually pay it or is this just a mistake. You want to weigh in? Yeah, Kevin, this is my grabbers. It's a mistake. I built a new budget model this year and I built it off the current year instead of the prior year. And as far as applying the 6% against the projected number, our current provider tax is actually being rolled forward from the same, basically the same calculation that we had for the state fiscal year prior year. So, our actual provider tax hasn't changed the amount we're paying currently. I don't know how Medicaid is going to actually handle that going into next year. Go ahead, Tom. Sorry to interrupt. No, glad you didn't. You're the chair. So, I'm looking at the paramix table and if you can just give some color to the 2% increases that are pretty steep, Medicare had a 25.5% increase and Medicaid had a 21.5% increase. Just what are, what's driving those? I mean, you've got rates and then you've got volume but they stand out to me. I'm not sure what you're looking at. Yeah, we're not sure what you're looking at right now. It's, it's in the adaptive budget data, which I presume you have. What were you saying the changes were Tom. 25% for Medicare and 21.5% for Medicaid. It's, and the table I'm looking at is the payer mix table. So, the Medicare increase 2020 budget over 2021 budget over 2020 is 7.6 million and the Medicaid is 2 million and those reflect a respectively 25.5% 21.5% over the 2020 budget. So, the, I mean, the basic question is, you know, what's your methodology in terms of that drives those increases. Tom Mike Rogers again. I knew those variances were in there, but basically we're having difficulty getting revenue by payer out of our, our center system in a consistent fashion. Last year's budget and this year's budget, I, it didn't make a heck of a lot of sense. So we did it on an overall basis and then had to spread it back to the payers. But there was I'd have no real good explanation other than the data that I get is inconsistent coming coming out of our base system. Thank you. And my, my last question is that just assume your, your, your commercial projection I think that you were down on your commercial projection. Yes, you were down a 1.4 million dollars. So let's assume for the moment that that you were off and that that 1.4 million dollars comes in. What would you, as, as added revenue, what would you would be your top priority for the use of that in terms of either applying it to an expense line item or letting it fall to the bottom line. Well, I think we let it fall to the bottom line. I mean, it's pretty slim margin as it is. Right answer, I guess, then. Thank you very much. And I'll pass it back to Kevin. Thank you, Tom. Next member, you suffered marine. Thanks. Just a couple of questions. First, just looking at what you received for COVID in 2020 that you don't need to pay back and it looks like when I look at your financial statements. The money that you're not paying back you put in the COVID stimulus grant and then the non operating revenue I believe is where you put the money that you'll be paying back. Is that right? No, all of it would be coming through our other revenue line. So the 11 million 11 million 11.8 million for the stimulus. We're all come through the revenue line. The money we have to pay back to 6.3 million for Medicare advanced payment. We did not bring through a revenue line because we're going to have to pay it back. It's in a liability. Okay, okay. So you didn't put it. So looking at that, it looks like in 20, if you hit your new projection that the amount you were down in NPR, which was about 10 million is more than offset by the COVID relief, which was about 11.8. And we're seeing that in the bottom line, improving from half a million on your net operating costs 2.4 million. Yeah. So the question really is, obviously we want the hospitals to get back to being whole with with what they're receiving from COVID. And it looks like you'll net about 2 million favorable. Yet in 2021, you're asking for a COVID increase to your rates that will contribute about 869,000 in the commercial rate piece. So just want to talk about, did you consider the increase that you were getting in 2020? Because most of the hospitals haven't been quite made whole. There's been a few that have been and those that have haven't really asked for a COVID related increase in 21. Let me go back to the projection itself. The projection was actually built off of an assumption that we would be hitting our budget for June, July, August, September. As Steve stated earlier in the presentation, we're looking right now at about 95% of our gross revenues. So I think the projection here is probably a little on the high side. So I think making BMH whole with those CARES funding, I think we're going to come pretty close to it being made whole by the end of the year. As far as getting those numbers into next year to pay for COVID expenses, we did not assume that. And then moving to 21 on your NPR. So you look to be going back to almost at 100% for, I guess, what are you assuming you're going to be back to on your baseline for 21? That's what the assumption was for 2021 budget is back to the 2020 100%. Okay, so if you were going to be back to 2020, that was like running at about that would have been running at about 88 million. And then if you add the incremental that you were getting from commercial requested is 2 million. So that would get you to 90 million. And you were requesting 92.8. So can you talk a little bit about the difference between the additional 2.7 million that's above your current one rate? And that also wouldn't account for any movement between payers where you're actually losing some on commercial. I think one of we built in some just some significant assumptions that would be back to 100% part of that the way we built the budget for revenues. We took our year to date February numbers and added in the main number of actually took the February and ran out the rest of the year's budget and added it to it. In February, we were actually running ahead of budget on our gross revenues. So that would actually see a budget for next year a little bit higher than our 2020 budget. Okay, I think you were running on NPR, weren't you running about half a percent above through through that. So that would be another. Another half a million maybe I would just caution looking at where your NPR is coming out because obviously your expenses are increasing from a budget of 91.4 in 20 to 96.1. And if you missed that top line, the ability to cut your expenses may not be there. So, you know, I know it's tough to forecast exactly, but it just seemed a little bit what we're seeing other the other hospitals, which most of them aren't thinking they'll get back to 100% unfortunately. So I guess my final question is a large portion of your expense increase I think was you had commented was because the benefits were trending upward for 20. And that accounted for 24% of your total increase in some of the in the expense line and can you just talk to that a little bit about the assumptions and has that changed at all with COVID because I would imagine now 20 is probably running a little favorable. But what do you see as for the benefits. This year we've run really hot on our self-insured health insurance program. We've had probably six to eight very high cost claims this year. And we were concerned about budgeting appropriately for that for next year. Luckily, we're part of the needed group for for negotiating with our third party payers for for health insurance. So we do have some stop loss opportunities there but I like it's kind of interesting as I was listening to Joe's presentation. We're just the opposite. We've had we've had some very serious health care cost increases on our own employees. You do have some stop loss that's helping you. I'm sorry. You do have some stop loss insurance that's helping you. Yeah. Yeah. Okay, great. That's all I had. Thank you. Thank you, Marine. Next is member homes. Jessica. Great. Thank you. Thanks for the presentation. And again, I've been trying to remember to say this every hospital team, but thank you for all the efforts you guys have undertaken to protect your essential workers and serve your community in these in these crises I know what the Herculean efforts have been I've heard about them and I probably only know the tip of the iceberg of what you had to do. So, I just want to say I appreciate that very much. I'm actually very proud to be living in Vermont, because of all that everybody has done. So, one, I guess some of my questions have already been answered, which is great, going last. One thing that hasn't come up yet is the decision to close the or to divest of the pediatric practice. And I was wondering if you could speak more about that the narrative it mentioned physician recruitment in space requirements for distancing as reasons for that decision and you know I know how important we all know how important primary care is and I'm wondering how is that what was the decision and then how has it impacted access in the community to pediatric. Good luck with Kevin and I think Lori and Patrick and one of our last calls. This goes back. We started a discussion with our two we have two pediatric groups or had two pediatric groups in our, in our market we had a private group about primary care, which part of which is a part of health partners. And then we had our own employee group of clinicians back in the fall. It was very clear that one of our pediatricians was looking at retirement in this July. We had had a lot of concerns related to being able to recruit new pediatricians to the area, which is very difficult. Another compounding situation was the pediatricians really wanted to cut back on their coverage of the nursery for OB. And what we started doing at that point is negotiating with Dartmouth Hitchcock to do neonatal coverage of our birthing center. What we ended up having with COVID hit as we were having all these discussions was our pediatric practice because of the lack of space in the office that they were practicing in that pediatric practice was consolidated from a facility standpoint with brown or primary care, which had a much larger office on our campus in one of our medical office buildings. So not only did we have a retirement in this past July, but also one of the pediatricians was for health reasons was not able to see patients on the campus. And that left us with two clinicians, one pediatrician, one nurse practitioner, both relatively part-time 0.75. It was clear that they did not want to, and the office was not never going to be able to serve moving forward their patients because there was no way to socially distance, not just the patients, but the staff. So we had a situation where, how are you going to operate a practice with a significant drop in provider FTEs. So in collaboration with Brown-Aborre Primary Care, we worked with that group, one of our, the pediatrician ended up actually going into Brown-Aborre Primary Care and joining them. The nurse practitioner ended up going up to Grace Cottage. So that's an issue. I mean, is there a wait list? Does, you know, how does that work in the area? So let me, we had about 1900, I think that was the number correct, 1900 patients in our employee practice that we spent the last several months on communicating and having them make a choice of where they want to go. The vast majority have gone to Brown-Aborre Primary Care because Brown-Aborre Primary Care now has additional capacity with the one pediatrician that was left in our group that had joined them. So the vast majority went with BPC. I think at the last count, we had 65 kids going up to Grace Cottage, and then another tranche of probably about 70 patients or so, maybe a little less, going with our family practice group. So, you know, it was a, it's a very difficult situation to be in, but one that, you know, was really exacerbated by, and as I shared with Kevin in some of my comments, retirement, the inability to see patients. We had this huge issue of not being able to or not wanting to cover any longer the birthing center. So there was a lot of issues and just got extenuated with COVID in the office space, which was, you know, a huge issue. Got it. Okay, well, thank you. I appreciate the context there. I always worry about, you know, access. So I think, you know, and I think we have a more stable group now that in a larger pediatric group, and quite frankly, you don't have to employ everybody either. So this has been a group that's been in our community for a long time. And actually, we, we work with them to set up three of their exam rooms for potential COVID pediatric patients, which we would never be able to do in our, in our previous employee group's office space. Yeah. So a lot of work went in. Yeah, I appreciate that. I appreciate the context. But not a, not a decision that was taken lightly. No, I wouldn't think so. I didn't think so. You probably heard me ask, since you were on the call earlier, you probably heard me ask this question, but I am wondering how hospitals think about whether or not payment reform is keep or delivery reform is keeping pace with payment reform. And so I guess I would love to hear from you how you think are they running in parallel. And a similar corollary question kind of is what would a typical provider at the MH say how they've changed their delivery practice as a result of, you know, sort of being a part of an ACO being a part of payment reform what are they doing differently day to day on the ground. Because of the way we're changing how we're paying for healthcare. So I think I think someone else jump in on that. No, okay. So I'd ask alien Dr. Sheehan to to address that because either been huge strides is being part of the ACO in terms of delivery of care, especially around care coordination. And this is a medical staff and a medical group that has really adopted the tenants of moving to value based payments. I mean, let's face it, the clinicians that are employed are pretty much isolated from or insulated from, you know, the, the vulgarities of payments. Right. That's that's our job is the hospital, but from a philosophical standpoint, it is right in line with the vast majority of the physicians in this community. So I'll ask you guys to kind of comment on on that. I'm so glad that you asked this question. I heard the question asked about Stetny and I was hoping that I would get the opportunity to answer this question. Jackpot. It's exciting because we we see the impact here in our hospital every day. And if you ask clinicians here the question about how it's impacted them, they would say in a really positive way. You know, our in-care coordinators at every practice has made a huge difference. The data that we receive from one care has had an impact and I'll share a story. One, one area that one care helped us to identify a data gap was in the number of patients receiving colorectal cancer screenings. It highlighted for us that we had a problem that without that data, it would have taken us a much longer time to realize that this was an opportunity and a challenge in our community. So we took that data and we quickly put in place interventions to make a difference. We ran outreach reports. We started calling patients. And as you may know, colorectal cancer screenings is not generally patients' favorite mode of screening, but it's important and it saves lives. And it's one of those types of screening, but you can screen it and take care of the problem all at once. And so it's a really effective form of screening and treatment. And so we started counting the pavement on outreach and we worked with both our on the employed clinicians and the independent gastroenterologists here to make a difference. We started with the marketing campaign. We used one care status. We worked with the Vermont Department of Health. We worked with care coordinators to put in place interventions. And we've seen those efforts have an impact and that's just one story in a field of many. The care coordination tools that we have through a care manager through the work of our care coordinators primary care clinicians have allowed patients to have brought from services and efficient services that they would not have otherwise had. So, and then on the payment delivery, how we see that again, we can see relatively real time how these interventions are impacting our Medicaid spend our Medicare spend. And we can kind of use that as a litmus has to see is our structural delivery reform, having an impact on the payment reform the way we anticipated or not. So, from our perspective and the outpatient world, it's been very positive. And I would also like to say that the buy-in from the clinicians and I remember one particular all clinicians meeting that we had where it was the topic of conversation. And on a humorous note, one of the clinicians threatened to dress up as a colon and so he got a lot of buy-in from the individual clinicians. A lot of excitement was generated and it was a quite a bit of participation and getting that mainstreamed and getting it done. Great. Well, thank you. If you have any insights into why the experience seems to be so different across hospitals, I would love to understand that better. Whether it's buy-in of clinicians or the way in which the data can be used, it would be helpful to understand why there's such a varied experience. I think it really does have to come from the clinicians. It can come from just me or leadership here or from one care. It's really based upon their philosophy of how they want to practice medicine. And I think we have something very special here in this community and a very primary care driven medical community here as well. And that fits within the culture. Great. Okay. I appreciate that insight. My other question that I've been asking about is I'm trying to get an understanding, maybe it's the economist in me, I don't know, but of how hospitals are thinking about medical inflation. So you've heard me ask this question, maybe you can just share with me those three buckets I think of major expenses is compensation, which it sounds like your growth rate for next year is about 4% if I heard that accurately in that bucket. What percentage of your expenses does that typically cover? Is that the 75% that I heard or no? Maybe that's not right. That was the 77% of the actual increase in their expenses. Okay. The agent salaries about mid-60s. And then med surge supplies, what is the inflation that you're assuming? Just the price effect on the supplies there. It's kind of modulated here because we're part of the NIA group of hospitals. We have now joined with UVM for significant group purchasing arrangements. So I think we're going to see some lower medical supply expenses. But that's not really where the big dollars are. Big dollars are on drugs. Yes, I actually was hoping I was going to ask you about that too. So what would you maybe break down both for me? Yeah. Or you can follow up with me. That's fine. We didn't apply specifically on inflation. Yeah, we didn't apply specifically on inflation. I'm sorry, I can't hear you. Yeah, we didn't apply specific rates to each one of those. You know, the pharmaceuticals, it's like a whack-a-mole approach because, you know, one drug goes down, two of them go up. They're not going to lose money one way or the other. The med surge supplies, the surgical supplies that he said we're leveraging NIA and we're trying to keep that, you know, as low as possible. I think in general, right now, I think we're starting to see some competition out there at least with equipment. So, again, we're trying to leverage NIA to keep that as low as possible. You know, and one of the services that really has not been impacted by COVID oncology and we consider we continuously see growth and unfortunately in oncology. But that's one of the areas that was interesting that because people needed to have their treatments even during this COVID timeframe. So that hasn't dropped, but I think every hospital you've seen is impacted by the relentless increase in oncology admixture drugs. Yeah. And what percentage of your expense budget is pharmacy though? I mean, I'm hearing about 10% from other hospitals. This is 5% to 6%. Yeah. The total expenses. And one of the other things we've done this year is we've created a 340B tech position that is going to help. The idea is to help manage the purchasing of our drugs, both 340B and non 340B to get the best pricing. Yeah. Okay, great. Well, maybe I know you couldn't pinpoint what that growth rate is for those two categories. Maybe you can follow up with our. I guess my last question is another thing to perhaps if you could follow up on, which is the HCA's question about the average commercial reimbursement and Medicare reimbursement. You mentioned that you couldn't calculate it because you didn't know if I individual payer. If you could just give us aggregate the average across all commercial payers to Medicare reimbursement and send that to the hospital budget team. That would be great. It's been really helpful to see what it is for other hospitals. So I'd love to be able to see it for the MH. Yeah, we'll do. Okay. Steve, could you address the seeming contradiction where. On the one hand, you say that you don't see a way to apply for the state CRF funds. But you've put in a request for the bifurcated COVID rate increase. I'll address that. Yeah, the state grant funds. Has a couple of different requirements with it. One of them. Is that we would actually need those additional funds to offset either expenses that we've already incurred or a decrease in our revenue. And our feeling is that with the cares funding that we got. As well as the Medicaid retainer funding that that for the most part offsets our. Drop in that revenues because of COVID. And we're going to be applying for FEMA funds, which is going to be offsetting majority of those expenses for COVID expenses. So one of the things that is the police that I understand with the state grant. Is if you actually get more money than what you need to offset, you're going to end up paying that back in the long run. That's at least have a cares. Act funding that we received through HHS has been worded to come back when they come back to an audit need to pay that back. So for the 1st round of the state grant funding, it was to fund expenses through June 15. It wasn't to get the funding for next year. The 2nd round, I believe is going to open up in September with an October due date. We set my current understanding. And there may be an opportunity to apply for it at that point, depending on what we can use the funds for. So I understand why you didn't apply for the state grant. So likewise, make your case on why you should get the COVID portion of the rate increase that you've asked for. The ongoing expenses that we're going to see through through next year. I mean, we've had add, you know, 15 plus. Screeners we've had ongoing expenses related to how we're going to prepare for COVID. Both staffing and other expenses stocking up on PPE. So. It's a different world for us. Okay. So, you know, again, going back to, you know, if we didn't have that 5 million that we got as a safety net hospital. We'd be scratching for everything right now. And our board felt that with, because we brought this to the board here that with that 5 million that others needed it more than we did at that point in time. But we are going to have continual ongoing expenses related to COVID without question. Well, Steve, I hope you're right that others need it more and those monies will be used. My fear is that there'll be money left on the table. And really the effects of COVID will be paid for on the backs of the commercial ratepayers in Vermont. That's, that's where I'm coming from on that line of questioning. My last question is since COVID hit. Have you seen any increase or decrease in either suicides or overdoses? No, it's interesting. Our ER was fairly quiet during the pandemic. But over the last several months or last month or so, we've seen a pretty substantial increase in psychiatric mental health needs as they come through the ER, both on the acuity and the level of violence. So I think we are without question, we are seeing a growth from that standpoint. Another thing too is, you know, the patients are staying longer, especially those are who require inpatient hospitalization that patients that are EE because they also have to be tested for COVID through state requirement. So, yeah, we have seen an increase without question. I know that you may not have had a chance to do as much research on it, but do you suspect that the recent surge is more related to a pent up delay? Or is it related to the fact that people are starting to feel the burdens of living in this new normal? So Dr. McGraw, our chief medical officer is very involved in the ER, actually the ER clinicians report to her. I'll let you can handle that one. So I think it's actually both. During COVID, we put together a team of folks to go and see and address medical and psychiatric issues for our homeless population that were housed in our local motels. And we did that as an effort to ensure that they didn't just have pent up on the dress need for not coming to the emergency department. We are seeing a little bit of a bolus from that, but it's very clear that we're also seeing this increase from just a burden of all the time spent with all of this additional angst that we have as a community. I would also say not just in the overdose world, but we're also seeing increase in substance use or substance misuse with respect to alcohol. And so that's becoming an increasing issue and, you know, meeting and looking for how could we make increased access for outpatient detox, for example. So we are definitely seeing it from all of those angles. Thank you, muted. Sorry about that. I didn't think you wanted to hear my dog continually bark. Trying to turn it on as much as possible. So at this point in the hearing, I'm going to turn the questioning over to the healthcare advocate. I think Mike, I'm going to ask two questions or three. And then I think Mike may have some additional questions. But first, I was wondering is the volatility and the kind of magnitude of the swings of your non operating budget from quarter to quarter. Is that due to the transfer of the monies between organizations connected to Ron Reed? Yeah, the seven, there's a $7 million amount. Yeah, December. And that's a transfer from between two organizations. And I think board member tell him what he asked you about this, the sheet and the GMCB staff analysis is on a page seven and so I had a question about the self a category. You're seeing an uptick in self pay, but unlike a lot of hospitals you're projecting a net loss on that and I was wondering if you could talk about that and maybe maybe it's due to some of the data issues that you mentioned earlier. I haven't seen that staff analysis myself, but I can speak to it somewhat in our in our payer report, we put the bad debt and free care all the self pay, even though if you were to look at all of it and break it all down, you could probably spread it across to the different payers. We've never we've never tried to do that because it's combination of both what was written off in the time plus what our estimates were to provide for the reserve. It's a it's a tricky analysis. Okay, so that's probably why he's shown a loss is because it's got all the bad debt and free care in it. Thank you that's that's really helpful and then, lastly, I wanted to touch on a question that board member lunch had about telehealth you guys have obviously made some pretty admirable strides and in offering that how much do you think the, your continued progress in telehealth and telehealth adoption is, will be, what will that look like if reimbursement for telehealth changes or goes back to pre coven status. It's now incorporated into the workings of clinicians in their practice. I don't think it's going to go away. I do think that we are reached the point of being becoming very comfortable with it. In my estimation, I believe that there is greater access to care because of it, because you have homebound people that can actually, you know, if they're able to get on to correspond with their provider this way. When it comes to the amount that's being used right now, I think that it's been fairly stable within the individual practices. I don't see a huge increase because I do see physicians and clinicians who want to be in touch with their patients. So they are slowly returning to the practices with a lot of modification to keep in mind patient safety. So there's systems in place for that. You know, you don't feel like that will change if you get less money for those visits. We weren't now. I think that's a separate. I think that's we'll have to manage it. But we're not going to put the gene back in the bottle. Yeah. Another patient convenience because of everything else is concerned with patients coming into the offices. I think one of the compounding issues is licensure. So we see 20% of our patients are from New Hampshire. All of our physicians have to be licensed in New Hampshire. Some are coming out of Massachusetts because we're right on the board. So that to me is a bigger concern. And that leads to reimbursement because unless you're licensed, you might not be able to get reimbursement from those plans that are based in Massachusetts or New Hampshire. So it's kind of convoluted, but I don't think we're ever going to go back. I don't think the doctors or the patients ultimately want to go back. I only asked because it's interesting to think about how we move forward with it with the connectivity and reimbursement issues and licensing. Mike, do you have any questions? Yeah, I think I'll just ask one. Steve, it was interesting to it was thanks for mentioning your LGBTQ initiative and your recognition of the work that needs to be done on racial inequities. I heard from a member of your community that there was some discussion or thought about advancements of that are moving towards a clinic. Yeah. And I just love to invite you to speak a little bit about what that work means to you and what you think the work in front of you, you have to. Yeah, I think our goal was, you know, we linked up with the Fenway Institute in Boston several years ago. And I think the first was to make sure we have an organization that welcomes the LGBTQ plus community as well as racial diversity. So we did a lot of education, a lot of work with Fenway. And now I think we're ready to now go into the clinical space. And there is going to be a proposal that goes in front of medical group leadership to establish one of our family practice sites as a LGBTQ plus clinic operation. So that will be for this year. We felt that family medicine would probably be the right location. We have a lot of very interested clinicians in this space and we're pretty excited about now making that transition to actually for clinical services. Yeah. And anything about the racial inequities work in front of you. I'll turn that either back to Kat or Jody because they've been very much involved in typing in its infancy but, you know, looking at the same model that we've used or the same approach that we've used for LGBTQ plus community but Kat, do you want to make sure there's a group among our staff who had been meeting informally actually around these issues and thinking about how to move forward with this for I would say over a year. And we with that really thinking about how do we move forward in line with the way that we have moved forward with the LGBTQ work. And looking at involved in consultants to help us do that work recognizing that we need to get our own house in order internally and structurally. We can really move and be very public in that way. One of the differences I would say is that we are looking at the data a little bit more closely certainly COVID is really pressing that and so looking at the data around COVID and the race racial inequity data. I think that we're moving forward in line with LGBTQ as a whole as taking the more commonplace than are with the LGBTQ work. Thank you. Good to see you, Mike. Yes, good to see you. Thank you, Mike. At this point we're going to open it up to public comment on the Brattleville Memorial budget. Is there any member of the public who wishes to comment? Kevin, I do. This is Jeff Tiemann. Thank you, thank you, Mr. Chairman. I just, I just wanted to say a quick note of thank you to Steve Gordon, who not only serves as president of Brattleboro Memorial Hospital, but also as chair of the Hospital Association and who was a thoughtful leader throughout the pandemic, both in Brattleboro and among his peers in state government and the other hospitals. I'll just say, I saw up close and personal, Steve really helped the provider community and the Hospital Association and me personally navigate those tough times of March and April and he's still doing that. And I'm grateful for his leadership and partnership. And similarly, on another note of gratitude, sitting behind him is Dr. Kat McGraw, who leads the VOS Group of Chief Medical Officers. Throughout this time, Kat has also been a smart leader and a quick thinker and an excellent convener of a challenging group of physician leaders. Overall, she's an amazing person that both the hospital and Vermont are fortunate to have on their side. Thanks. Great points, Jeff. I see a hand raised by Eva. Yes, can folks hear me? Yes. Awesome, yes. My name is Eva Westheimer and I am the programs and volunteer coordinator with Out in the Open. And I just wanted to echo Mike's support for questioning around the proposed LGBTQ Health Clinic and say that from Out in the Open's perspective as somebody, as a community organization that has been working with the LGBTQ Council at BMH, it's been a pleasure to be working with folks on that proposed clinic and saying that from our community perspective, folks in our community are really excited about this clinic being pushed forward within the hospital and know that it'll really greatly serve our community. Thank you, Eva. Yeah, thank you all so much. Is there other public comment? Is there any other public comment? Seeing none, I just want to share the love that you've been receiving and say that we're all grateful for the good work that everybody's doing down in Burrata borough and keep it up. Thank you back to actually running your hospital, Steve. I want to thank you and the rest of the board and your staff for all the support over the last year and especially during this very difficult period of time and your understanding as we work our way through this, the team effort. Have a great rest of the day. Okay, you too. Thank you. Bye-bye. I guess we don't have to move to adjourn and vote to adjourn, so. I know, I was waiting for that too. Well, we could do it. There's three of us here. We still have a quorum, so. I was wondering, I guess we don't have to. I'm not sure. I move to adjourn. You guys should adjourn. Okay, good. All those in favor? Aye. Kevin, jump up quick. Aye. I'm going to send you guys an email. I know why. I'll send it to you right now. Do you want to send it during the board meeting? Okay, well, I'm sure people are still on, so. Yeah, so I'll send it to you right now. Okay. Bye. Bye. Bye.