SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
Buffalo Mercy Hospital
 
Employer identification number

16-0756336
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . .
    3,118,969 227,821 2,891,148 0.820 %
b Medicaid (from Worksheet 3, column a) . . . . .     50,332,474 37,961,489 12,370,985 3.490 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .            
d Total Financial Assistance and Means-Tested Government Programs . . . . .     53,451,443 38,189,310 15,262,133 4.310 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     1,926,316   1,926,316 0.540 %
f Health professions education (from Worksheet 5) . . .     6,846,155 1,392,672 5,453,483 1.540 %
g Subsidized health services (from Worksheet 6) . . . .            
h Research (from Worksheet 7) .     749,047   749,047 0.210 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     281,295   281,295 0.080 %
j Total. Other Benefits . .     9,802,813 1,392,672 8,410,141 2.370 %
k Total. Add lines 7d and 7j .     63,254,256 39,581,982 23,672,274 6.680 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support     60,493   60,493 0.020 %
4 Environmental improvements            
5 Leadership development and
training for community members
    320,585   320,585 0.090 %
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     381,078   381,078 0.110 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
3,769,764
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
2,721,872
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
65,017,329
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
62,457,379
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
2,559,950
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

 

No
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?2
Name, address, primary website address, and state license number
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 Mercy Hospital of Buffalo
565 Abbott Road
Buffalo,NY14220
X X   X     X   Ambulatory Surgery - Multi Specialty, Audiology O/P, Cadriac Cathereization,  
2 Mercy Ambulatory Care Center
3669 Southwestern Blvd
Orchard Park,NY14127
X X   X     X   Clinical Laboratory Service, CT Scanner, Emeregency Department, Medical Sur  
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
Mercy Hospital of Buffalo
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A)
1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9....................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 13
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted................. 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities
in Part VI..................................
4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public?.............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply
as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs........... 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ................................ 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? .......... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 110.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 500.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?........ 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?........ 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual?.......................... 22 Yes  
If "Yes," explain in Section C.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
Mercy Hospital of Buffalo Part V, Section B, Line 1j: In addition to the IRS requirements Catholic Health complied with the NYS Department of Health Community Health Needs Assessment requirements, Community Service Plan.
Mercy Hospital of Buffalo Part V, Section B, Line 3: Catholic Health utilized a variety of sources to develop the health needs assessment to ensure the inclusion of persons who represent the broad interest of the community and have special expertise in, or knowledge of, public health issues and concerns: * Survey of community representatives was conducted to ascertain their perception of the County's health needs * Facilitated group discussions with community and public health experts* Focus group with Catholic Health's Emergency Department Task Force* Erie County Department of Health created community-wide health needs survey* Erie County Department of Health led community forum* Evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors. Group Interview Participants:Catholic CharitiesAlzheimer's AssociationBrylin Hospitals Harvest HouseSpectrum Human Services Buffalo State College Center for Community Health Center Health and Social ResearchErie County DOH Wellness InstituteAmerican Cancer Society P2 Collaborative of WNYHealthcare Community Consultant City of Buffalo communityPhysician representativeErie County Department of Health Community Meeting Participants:FDA Cancer Service Program of Erie CountyBuffalo State College Catholic HealthP2 Collaborative of WNYAmerican Cancer SocietyMonroe Plan UBMDWellness Institute EPICM.E.D.-V.A.R. Consulting KaleidaBuffalo Prenatal-Perinatal Network Erie County DOHUnited Way Prevention Focus
Mercy Hospital of Buffalo Part V, Section B, Line 4: Mercy Hospital was conducted with Sisters Hospital and Kenmore Mercy Hospital.
Mercy Hospital of Buffalo Part V, Section B, Line 7: Through the needs assessment, numerous areas were identified as important and clearly impact the health of the community. Catholic Health identified the "significant" needs as the New York State Department of Health Prevention Agenda priorities. Within the "priorities", Catholic Health will address numerous health needs. One priority area was prioritized lower and not addressed in the implementation plan: Promote a Healthy and Safe Environment. Contributing to this lower priority was lack of available funds and potential for less impact upon the community. Although, should opportunity arise, with resources available to effectively address this need, Catholic Health will reconsider for incorporation in the future.
Mercy Hospital of Buffalo Part V, Section B, Line 14g: Includes information in both English and Spanish on all signage and brochures for financial assistance.
Mercy Hospital of Buffalo Part V, Section B, Line 20d: Highest volume commercial payor rate.
Mercy Hospital of Buffalo Part V, Section B, Line 22: There are instances where the full charges on the account are equal to or less than the highest volume commercial payor rate.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?8
Name and address Type of Facility (describe)
1 East Aurora Medical Center
94 Olean St
East Aurora,NY14052
Extension Clinic: OT-O/P, PT-O/P, Speech-O/P, Radiology-O/P, Lab-O/P
2 Mercy Outpatient Clinic OBGyn
515 Abbott Rd
Buffalo,NY14220
Extension Clinic: Prenatal O/P, Primary Medical Care O/P
3 Mercy Comprehensive Care Center
397 Louisiana St
Buffalo,NY14202
Extension Clinic: Primary Care, Pediatric, Lab, Podiatry, Prenatal,Radiology
4 OLV Family Care Center
227 Ridge Rd
Lackawanna,NY14218
Extension Clinic: Prenatal O/P, Primary Medical Care O/P
5 Mercy Nursing Facility
55 Melroy Ave
Lackawanna,NY14218
Long Term Care, Lab-O/P, Radiology- Diagnostic O/P
6 Pace Health Center
55 Melroy Ave
Lackawanna,NY14218
Extension Clinic: OT-O/P, PT-O/P, Speech-O/P, Primary Care, Psychology O/P
7 Mercy Ambulatory Care Center
550 Orchard Park Rd
West Seneca,NY14224
CT, Lab-O/P, Primary Care, Radiology-O/P, OT-O/P, PT-O/P, Speech-O/P
8 Springville Primary Care Center
27 Franklin St
Springville,NY14141
Pediatric-O/P, Primary Medical Care-O/P
9
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Part I, Line 6a: Part 1, line 6a: Mercy Hospital Community Benefit Report is contained in a report prepared by the Catholic Health System.
Part I, Line 7: Costing is a full step down methodology of cost from non-revenue producing departments to revenue producing departments', with assignment of cost to individual charge items based on volume and charge amount. All patient accounts are cost with the same methodology regardless of patient type (inpatient, outpatient, emergency room, etc.) or insurance coverage (Medicare, Medicaid, private insurance, uninsured, etc.).
Part II, Community Building Activities: Mercy Hospital provided Community Building in the form of Community Support and Leadership Development which improved community leadership by promoting understanding of community healthcare needs and services at various events throughout the community.
Part III, Line 4: The amount in Part III line 2 is the actual bad debt expenses of $8,742,496 written down to cost, utilizing the Uninsured Ratio of Cost to Charges (RCC) obtained from the full step down methodology of cost described in Part 1, line 7. The amount in Part III line 3 is the estimate of bad debt from uninsured balance which is developed as follows: as policy is to write accounts to bad debt 120 days after discharge, the discharge date period of 10/1/2012 to 9/30/2013 was used to determine the population of uninsured accounts. The balance of these accounts was determined and the RCC was applied to develop the estimate in H Part III Line 3.As our determination of eligibility for the Healthcare Assistance Program (HAP) (Charity Care) is based solely on the presentation for care without insurance, which is now for each account, and use of a sophisticated estimator (PARO) of each guarantor's ability to pay an estimate of "the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy if sufficient information had been available to make a determination of their eligibility" is not relevant. The organization's financial statements do not include a footnote that describes bad debt expense, but the financial statements account for bad debt expenses in the statement of operations as actual expenses written off and an estimate of future write-offs less any recoveries.
Part VI, Line 2: Catholic Health utilizes multiple methods to assess the health care needs of the commuities it serves, including:* Evaluations administered by the Catholic Health Community Education Department after each class, workshop, or program it sponsors;* Patient, resident and caregiver satisfaction surveys;* Physician and leadership participation in forums to define health needs of patient populations; and* Participation in regional planning initiatives.
Part VI, Line 3: Mercy Hospital informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the Catholic Health System Healthcare Assistance Program (HAP) policy. For example, Mercy Hospital has posters and brochures available which include contact information for the Financial Clearance staff in admissions areas, emergency rooms, primary care and outpatient rehabilitation clinics, Revenue Management Center (RMC) and other areas of the organization's facilities where eligible patients are likely to be present; provides information about financial assistance and HAP contact information to patients as part of the intake process; provides financial assistance and HAP contact information to inpatients either during or within 90 days of discharge of their hospital stay; patient bills include the following language: "The Catholic Health System has a Healthcare Assistance Program to assist those in need of financial assistance for qualified patients. If you would like to obtain additional information on the Healthcare Assistance Program, please call (716) 601-3600. Thank you.Our Customer Service area is our front end team to assist all patients in this process." Additionally, we discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, where applicable, and there is information about financial aid posted on the Catholic Health System website.
Part VI, Line 4: Catholic Health serves the eight counties of Western New York. The System's primary service area is Erie County which accounts for 90% of its inpatient admissions and 85% of ambulatory care visits. Erie County consists of a mix of urban, suburban and rural populations. It includes the City of Buffalo, New York State's second largest city, surrounded by a ring of older suburbs, which is followed by a ring of more newly developed suburbs, and then rural communities. The current population of Erie County is over nine hundred thousand, with about one-third living in Buffalo.Erie County has an average income significantly lower than and has a greater percentage of persons over the age of 55 than New York State and the United States. Erie County's population is projected to decreasebetween now and 2017, with the greatest decline expected in those ages 35-54, and the greatest increase projected in those 55 and over.Erie County is less racially and ethnically diverse than New York State or the rest of the country, and the Non-White populations are concentrated in and immediately around the City of Buffalo. All of the 11 zip codes in Erie County that have a Non-White population of 50% or more are in Buffalo.
Part VI, Line 5: One of the fundamental reasons for the creation of Catholic Health was to ensure the continued viability of faith-based health care to meet the needs of residents in Erie County and the surrounding communities. Integral to this effort is caring for the needs of those who are poor and disadvantaged. The services provided by Catholic Health organizations are provided in response to identified community needs, and reflect the System's emphasis on caring for the underserved. Catholic Health collaborates with other organizations to maximize its ability to provide needed services to the residents of our region.Each year, Catholic Health touches tens of thousands of community residents through community health education programs, health screenings, clinical and support services, and community support activities. Catholic Health will continue to meet community needs by providing charity care and Medicaid services, in addition to various other community benefit programs, including community health improvement, community benefit operations, health professions education, community building, as well as cash and in-kind contributions.
Part VI, Line 6: In 2013, Catholic Health (the System), including Kenmore Mercy Hospital, Mercy Hospital of Buffalo, Sisters of Charity Hospital, and Sisters of Charity Hospital - St. Joseph Campus, jointly conducted a Community Health Needs Assessment (CHNA) to better understand the health needs of the community they serve and to fulfill the requirements of both the Internal Revenue Service (IRS) and the New York State Department of Health (DOH). To ensure the assessment was comprehensive, input from the public and several community organizations was solicited. As part of this coordinated initiative, the System developed a three-year Implementation Strategy to address the health needs identified in the assessment.
Part VI, Line 7, Reports Filed With States NY
Schedule H (Form 990) 2013
Additional Data


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