---------------------------------------------------- ------------------------------------------------------- ----------------
  ![](media/image1.png){width="1.4972222222222222in"   **HMSA Plan\                                            **2004**
  height="0.9006944444444445in"}                       **[http://www.hmsa.com/portal/fedplan87/]{.underline}   

  ---------------------------------------------------- ------------------------------------------------------- ----------------

**A Health Maintenance Organization**

![](media/image2.png){width="1.5013888888888889in"
height="1.5319444444444446in"} **with a point of service product**

**Serving:** All of Hawaii

**Enrollment in this Plan is limited. You must live in our**

**Geographic service area to enroll. See page
[9](#Section_1_Service_Area) for requirements.**

![](media/image3.jpeg){width="0.8069444444444445in"
height="0.8069444444444445in"}

*This Plan has "Full" Accreditation from*

*NCQA. See the 2004 Guide for more*

*information on accreditation.*

**Enrollment codes for this Plan:**

**871 Self Only**

**872 Self and Family**

![](media/image4.png){width="1.1277777777777778in"
height="0.8027777777777778in"}

**RI 73-010**

![](media/image6.png){width="4.84375in" height="1.1354166666666667in"}

Dear Federal Employees Health Benefits Program Participant:

I am pleased to present this 2004 Federal Employees Health Benefits
(FEHB) Program plan brochure. The brochure describes the benefits this
plan offers you for 2004. Because benefits vary from year to year, you
should review your plan's brochure every Open Season -- especially
Section 2, which explains how the plan changed.

It takes a lot of information to help a consumer make wise healthcare
decisions. The information in this brochure, our FEHB Guide, and our
web-based resources, make it easier than ever to get information about
plans, to compare benefits and to read customer service satisfaction
ratings for the national and local plans that may be of interest. Just
click on [www.opm.gov/insure](http://www.opm.gov/insure)!

The FEHB Program continues to be an enviable national model that offers
exceptional choice, and uses private-sector competition to keep costs
reasonable, ensure high-quality care, and spur innovation. The Program,
which began in 1960, is sound and has stood the test of time. It enjoys
one of the highest levels of customer satisfaction of any healthcare
program in the country.

I continue to take aggressive steps to keep the FEHB Program on the
cutting edge of employer-sponsored health benefits. We demand
cost-effective quality care from our FEHB carriers and we have
encouraged Federal agencies and departments to pay the full FEHB health
benefit premium for their employees called to active duty in the Reserve
and National Guard so they can continue FEHB coverage for themselves and
their families. Our carriers have also responded to my request to help
our members to be prepared by making additional supplies of medications
available for emergencies as well as call-up situations and you can help
by getting an Emergency Preparedness Guide at [www.opm.gov]{.underline}.
OPM's *HealthierFeds* campaign is another way the carriers are working
with us to ensure Federal employees and retirees are informed on healthy
living and best-treatment strategies. You can help to contain healthcare
costs and keep premiums down by living a healthy life style.

Open Season is your opportunity to review your choices and to become an
educated consumer to meet your healthcare needs. Use this brochure, the
FEHB Guide, and the web resources to make your choice an informed one.
Finally, if you know someone interested in Federal employment, refer
them to [www.usajobs.opm.gov]{.underline}.

> Sincerely,
>
> ![](media/image7.png){width="2.5833333333333335in"
> height="0.7291666666666666in"}
>
> Kay Coles James
>
> Director

![](media/image8.png){width="1.195138888888889in"
height="1.0354166666666667in"} ![](media/image9.png)

# [Notice of the Office of Personnel Management's]{.underline}

# [Privacy Practices]{.underline}

### This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

By law, the United States Office of Personnel Management (OPM), which
administers the Federal Employees Health Benefits (FEHB) Program, is
required to protect the privacy of your personal medical information.
OPM is also required to give you this notice to tell you how OPM may use
and give out ("disclose") your personal medical information held by OPM.

OPM **will** use and give out your personal medical information:

-   To you or someone who has the legal right to act for you (your
    personal representative),

-   To the Secretary of the Department of Health and Human Services, if
    necessary, to make sure your privacy is protected,

-   To law enforcement officials when investigating and/or prosecuting
    alleged or civil or criminal actions, and

-   Where required by law.

OPM **has the right** to use and give out your personal medical
information to administer the FEHB Program. For example:

-   To communicate with your FEHB health plan when you or someone you
    have authorized to act on your behalf asks for our assistance
    regarding a benefit or customer service issue.

-   To review, make a decision, or litigate your disputed claim.

-   For OPM and the General Accounting Office when conducting audits.

OPM **may** use or give out your personal medical information for the
following purposes under limited circumstances:

-   For Government health care oversight activities (such as fraud and
    abuse investigations),

-   For research studies that meet all privacy law requirements (such as
    for medical research or education), and

-   To avoid a serious and imminent threat to health or safety.

By law, OPM must have your written permission (an "authorization") to
use or give out your personal medical information for any purpose that
is not set out in this notice. You may take back ("revoke") your written
permission at any time, except if OPM has already acted based on your
permission.

By law, you **have the right** to:

-   See and get a copy of your personal medical information held by OPM.

-   Amend any of your personal medical information created by OPM if you
    believe that it is wrong or if information is missing, and OPM
    agrees.  If OPM disagrees, you may have a statement of your
    disagreement added to your personal medical information.

-   Get a listing of those getting your personal medical information
    from OPM in the past 6 years. The listing will not cover your
    personal medical information that was given to you or your personal
    representative, any information that you authorized OPM to release,
    or that was given out for law enforcement purposes or to pay for
    your health care or a disputed claim.

-   Ask OPM to communicate with you in a different manner or at a
    different place (for example, by sending materials to a P.O. Box
    instead of your home address).

-   Ask OPM to limit how your personal medical information is used or
    given out. However, OPM may not be able to agree to your request if
    the information is used to conduct operations in the manner
    described above.

-   Get a separate paper copy of this notice.

For more information on exercising your rights set out in this notice,
look at [www.opm.gov/insure](http://www.opm.gov/insure on the web.You)
on the Web. You may also call 202-606-0191 and ask for OPM's FEHB
Program privacy official for this purpose.

If you believe OPM has violated your privacy rights set out in this
notice, you may file a complaint with OPM at the following address:

Privacy Complaints

United States Office of Personnel Management

P.O. Box 707

Washington, DC 20004-0707

Filing a complaint will not affect your benefits under the FEHB Program.
You also may file a complaint with the Secretary of the United States
Department of Health and Human Services.

By law, OPM is required to follow the terms in this privacy notice. OPM
has the right to change the way your personal medical information is
used and given out. If OPM makes any changes, you will get a new notice
by mail within 60 days of the change.

The privacy practices listed in this notice are effective April 14,
2003.

  -----------------------------------------------------------------------
  Table of Contents
  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

Introduction [5](#Introduction)

Plain Language [5](#Plain_Language)

Stop Health Care Fraud! [5](#Inspector_General_Advisory)

Preventing medical mistakes [6](#Preventing_Medical_Mistakes)

Section 1. Facts about this HMO plan [8](#Section_1_Facts)

We also have Point-of-service product (POS) benefits
[8](#Section_2_We_also_have_POS)

How we pay providers [8](#Section_1_How_We_Pay_Providers)

Your Rights [9](#Section_1_Your_Rights)

Service Area [9](#Section_1_Service_Area)

Section 2. How we change for 2004 [10](#how_we_change)

Program-wide changes [10](#Section_2_Program_Wide_Changes)

Changes to this Plan .[10](#Section_2_Changes_to_this_Plan)

Section 3. How you get care [12](#Section_3_How_You_Get_Care)

Identification cards [12](#Section_3_Identification_Cards)

Where you get covered care [12](#Section_3_Where_You_Get_Covered_Care)

• Plan providers [12](#Section_3_Plan_Providers)

• Plan facilities [12](#Section_3_Plan_Facilities)

What you must do to get covered care
[12](#Section_3_What_You_Are_Encouraged_To_Do)

• Primary care [12](#Section_3_Primary_Care)

• Specialty care [13](#Section_3_Specialty_Care)

• Hospital care [13](#Section_3_Hospital_Care)

Circumstances beyond our control [14](#Section_3_Circumstances_Beyond)

Services requiring our prior approval
[14](#Section_3_Services_Requiring_Approval)

Section 4. Your costs for covered services
[15](#Section_4_Your_Costs_For_Covered_Service)

-   Copayments [15](#Section_4_Copayments)

```{=html}
<!-- -->
```
-   Deductible [15](#Section_4_Deductible)

```{=html}
<!-- -->
```
-   Coinsurance [15](#Section_4_Coinsurance)

Your catastrophic protection out-of-pocket maximum
[15](#Section_4_Your_Out_Of_Pocket_Maximum)

Section 5. Benefits [16](#Section_5_Benefits)

Overview [16](#Section_5_Benefits)

(a) Medical services and supplies provided by physicians and other
    health care professionals
    [17](#Section_5_Medical_Services_And_Supplies)

(b) Surgical and anesthesia services provided by physicians and other
    health care professionals [29](#Section_5_Surgical_And_Anesthesia)

(c) Services provided by a hospital or other facility, and ambulance
    services [33](#Section_5_Hospital)

(d) Emergency services/accidents
    [36](#section-5-d.-emergency-servicesaccidents)

(e) Mental health and substance abuse benefits
    [39](#Section_5_Mental_Health)

(f) Prescription drug benefits [41](#Section_5_Prescription_Drug)

  -----------------------------------------------------------------------
  Table of Contents *(continued)*
  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

(g) Special features [46](#Section_5_Special_Features)

> • Integrated Case Management
> [46](#Section_5_Integrated_Case_Management)

• Drug Benefits Management Program
[46](#Section_5_Drug_Benefits_Management)

• Routine care associated with clinical trials
[46](#Section_5_Drug_Benefits_Management)

(h) Dental benefits [47](#Section_5_Dental)

(i) Point-of-service (POS) benefits [49](#Section_5_Point_Of_Service)

(j) Non-FEHB benefits available to Plan members
    [52](#Section_5_Non_FEHB)

Section 6. General exclusions \-- things we don\'t cover
[54](#Section_6_General_Exclusions)

Section 7. Filing a claim for covered services
[55](#Section_7_Filing_A_Claim)

Section 8. The disputed claims process [57](#Section_8_Disputed_Claims)

Section 9. Coordinating benefits with other coverage
[59](#Section_9_Coordinating_Benefits)

When you have other health coverage
[59](#Section_9_When_You_Have_Other_Health)

-   What is Medicare? [59](#Section_9_What_Is_Medicare)

-   Should I enroll in Medicare? [59](#medicare_should_I)

-   Medicare + Choice [62](#Section_9_Medicare_Managed_Care_Plan)

```{=html}
<!-- -->
```
-   TRICARE and CHAMPVA [62](#Section_9_Tricare_ChampVA)

```{=html}
<!-- -->
```
-   Worker's Compensation [63](#Section_9_Other_Government_Agencies)

```{=html}
<!-- -->
```
-   Medicaid [63](#Section_9_When_Others_Are_Responsible)

-   Other Government agencies [63](#Section_9_Other_Government_Agencies)

-   When others are responsible for injuries
    [63](#Section_9_When_Others_Are_Responsible)

Section 10. Definitions of terms we use in this brochure
[64](#Section_10_Definitions)

Section 11. FEHB facts [66](#Section_10_FEHB_Facts)

Coverage information [66](#Section_10_FEHB_Facts)

-   No pre-existing condition limitation
    [66](#Section_11_No_Preexisting_Condition)

-   Where you can get information about enrolling in the FEHB Program
    [66](#Section_11_Where_You_Get_Info_About_FEHB)

-   Types of coverage available for you and your family
    [66](#Section_11_Types_Of_Coverage)

-   Children's Equity Act [67](#children_equity)

-   When benefits and premiums start
    [67](#Section_11_When_Benefits_Start)

-   When you retire [67](#Section_11_When_You_Retire)

When you lose benefits [68](#Section_11_When_You_Lose_Benefits)

-   When FEHB coverage ends [68](#Section_11_When_FEHB_Coverage_Ends)

-   Spouse equity coverage [68](#Section_11_Spouse_Equity_Coverage)

-   Temporary Continuation of Coverage (TCC) [68](#Section_11_TCC)

-   Converting to individual coverage
    [68](#Section_11_Converting_To_Individual)

-   Getting a Certificate of Group Health Plan Coverage
    [69](#Section_11_Getting_A_Certificate)

Two new Federal Programs complement FEHB benefits
[70](#Two_new_programs)

  -----------------------------------------------------------------------
  Table of Contents *(continued)*
  -----------------------------------------------------------------------

  -----------------------------------------------------------------------

-   The Federal Flexible Spending Account Program - *FSAFEDS*
    [70](#FSAFEDS)

-   The Federal Long Term Care Insurance Program [73](#Long_term_care)

Index [74](#Index)

Summary of benefits [80](#summary_2004)

Rates Back cover

  -----------------------------------------------------------------------
  Introduction[]{#Introduction .anchor}

  -----------------------------------------------------------------------

> This brochure describes the benefits of Hawaii Medical Service
> Association (HMSA), an independent licensee of the Blue Cross and Blue
> Shield Association under our contract (CS 1058) with the United States
> Office of Personnel Management, as authorized by the Federal Employees
> Health Benefits law. The address for HMSA administrative offices is:
>
> Hawaii Medical Service Association
>
> 818 Keeaumoku Street
>
> Honolulu, Hawaii 96814
>
> This brochure is the official statement of benefits. No oral statement
> can modify or otherwise affect the benefits, limitations, and
> exclusions of this brochure. It is your responsibility to be informed
> about your health benefits.
>
> If you are enrolled in this Plan, you are entitled to the benefits
> described in this brochure. If you are enrolled in Self and Family
> coverage, each eligible family member is also entitled to these
> benefits. You do not have a right to benefits that were available
> before January 1, 2004, unless those benefits are also shown in this
> brochure.
>
> OPM negotiates benefits and rates with each plan annually. Benefit
> changes are effective January 1, 2004, and changes are summarized on
> page [10](#Section_2_Changes_to_this_Plan). Rates are shown at the end
> of this brochure.

  -----------------------------------------------------------------------
  Plain Language[]{#Plain_Language .anchor}

  -----------------------------------------------------------------------

> All FEHB brochures are written in plain language to make them
> responsive, accessible, and understandable to the public. For
> instance,

-   Except for necessary technical terms, we use common words. For
    instance, "you" means the enrollee or family member; \"we\" means
    HMSA*.*

-   We limit acronyms to ones you know. FEHB is the Federal Employees
    Health Benefits Program. OPM is the United States Office of
    Personnel Management. If we use others, we tell you what they mean
    first.

-   Our brochure and other FEHB plans\' brochures have the same format
    and similar descriptions to help you compare plans.

> If you have comments or suggestions about how to improve the structure
> of this brochure, let OPM know. Visit OPM\'s \"Rate Us\" feedback area
> at [www.opm.gov/insure](http://www.opm.gov/reitre) or e-mail OPM at
> <fehbwebcomments@opm.gov>. You may also write to OPM at the United
> States Office of Personnel Management, Insurance Services Program,
> Program Planning & Evaluation Group, 1900 E Street, NW Washington, DC
> 20415-3650.

  -----------------------------------------------------------------------
  []{#Inspector_General_Advisory .anchor}Stop Health Care Fraud!

  -----------------------------------------------------------------------

> Fraud increases the cost of health care for everyone and increases
> your Federal Employees Health Benefits (FEHB) Program premium.
>
> OPM\'s Office of the Inspector General investigates all allegations of
> fraud, waste, and abuse in the FEHB Program regardless of the agency
> that employs you or from which you retired.
>
> **[Protect Yourself From Fraud]{.underline}** - Here are some things
> you can do to prevent fraud:

-   Be wary of giving your plan identification (ID) number over the
    telephone or to people you do not know, except to your doctor, other
    provider, or authorized plan or OPM representative.

```{=html}
<!-- -->
```
-   Let only the appropriate medical professionals review your medical
    record or recommend services.

> Continued on next page

  -----------------------------------------------------------------------
  **Stop Health Care Fraud!** *(continued)*

  -----------------------------------------------------------------------

-   Avoid using health care providers who say that an item or service is
    not usually covered, but they know how to bill us to get it paid.

-   Carefully review explanations of benefits (EOBs) that you receive
    from us.

-   Do not ask your doctor to make false entries on certificates, bills
    or records in order to get us to pay for an item or service.

-   If you suspect that a provider has charged you for services you did
    not receive, billed you twice for the same service, or
    misrepresented any information, do the following:

```{=html}
<!-- -->
```
-   Call the provider and ask for an explanation. There may be an error.

-   If the provider does not resolve the matter, call us at 808/948-5166
    and explain the situation.

-   If we do not resolve the issue:

```{=html}
<!-- -->
```
-   Do not maintain as a family member on your policy:

-   Your former spouse after a divorce decree or annulment is final
    (even if a court order stipulates otherwise); or

-   Your child over age 22 (unless he/she is disabled and incapable of
    self support).

```{=html}
<!-- -->
```
-   If you have any questions about the eligibility of a dependent,
    check with your personnel office if you are employed, with your
    retirement office (such as OPM) if you are retired, or with the
    National Finance Center if you are enrolled under Temporary
    Continuation of Coverage.

```{=html}
<!-- -->
```
-   You can be prosecuted for fraud and your agency may take action
    against you if you falsify a claim to obtain FEHB benefits or try to
    obtain services for someone who is not an eligible family member or
    who is no longer enrolled in the Plan.

  -----------------------------------------------------------------------
  []{#Preventing_Medical_Mistakes .anchor}Preventing Medical Mistakes

  -----------------------------------------------------------------------

An influential report from the Institute of Medicine estimates that up
to 98,000 Americans die every year from medical mistakes in hospitals
alone. That\'s about 3,230 preventable deaths in the FEHB Program a
year. While death is the most tragic outcome, medical mistakes cause
other problems such as permanent disabilities, extended hospital stays,
longer recoveries, and even additional treatments. By asking questions,
learning more and understanding your risks, you can improve the safety
of your own health care, and that of your family members. Take these
simple steps:

1.  **Ask questions if you have doubts or concerns.**

-   Ask questions and make sure you understand the answers.

-   Choose a doctor with whom you feel comfortable talking.

-   Take a relative or friend with you to help you ask questions and
    understand answers.

1.  **Keep and bring a list of all the medicines you take.**

-   Give your doctor and pharmacist a list of all the medicines that you
    take, including non-prescription medicines.

-   Tell them about any drug allergies you have.

-   Ask about side effects and what to avoid while taking the medicine.

-   Read the label when you get your medicine, including all warnings.

-   Make sure your medicine is what the doctor ordered and know how to
    use it.

-   Ask the pharmacist about your medicine if it looks different than
    you expected.

    Continued on next page

  -----------------------------------------------------------------------
  Preventing Medical Mistakes *(continued)*

  -----------------------------------------------------------------------

2.  **Get the results of any test or procedure.**

-   Ask when and how you will get the results of test or procedures.

-   Don't assume the results are fine if you do not get them when
    expected, be it in person, by phone, or by mail.

-   Call your doctor and ask for your results.

-   Ask what the results mean for your care.

3.  **Talk to your doctor about which hospital is best for your health
    needs.**

-   Ask your doctor about which hospital has the best care and results
    for your condition if you have more than one hospital to choose from
    to get the health care you need.

-   Be sure you understand the instructions you get about follow-up care
    when you leave the hospital.

4.  **Make sure you understand what will happen if you need surgery.**

-   Make sure you, your doctor, and your surgeon all agree on exactly
    what will be done during the operation.

-   Ask your doctor, "Who will manage my care when I am in the
    hospital?"

-   Ask your surgeon:

    Exactly what will you be doing?

    About how long will it take?

    What will happen after surgery?

    How can I expect to feel during recovery?

-   Tell the surgeon, anesthesiologist, and nurses about any allergies,
    bad reaction to anesthesia, and any medications you are taking.

    Want more information on patient safety?

```{=html}
<!-- -->
```
-   [www.ahrq.gov/consumer/pathqpack.htm](http://www.ahrq.gov/consumer/pathqpack.htm).
    The Agency for Healthcare Research and Quality makes available a
    wide-ranging list of topics not only to inform consumers about
    patient safety but to help choose quality healthcare providers and
    improve the quality of care you receive.

-   [www.npsf.org](http://www.npsf.org/). The National Patient Safety
    Foundation has information on how to ensure safer healthcare for you
    and your family.

-   [www.talkaboutrx.org/consumer.html](http://www.talkaboutrx.org/consumer.html).
    The National Council on Patient Information and Education is
    dedicated to improving communication about the safe, appropriate use
    of medicines.

-   [www.leapfroggroup.org](http://www.leapfroggroup.org/). The Leapfrog
    Group is active in promoting safe practices in hospital care.

-   [www.ahqa.org](http://www.ahqa.org/). The American Health Quality
    Association represents organizations and healthcare professionals
    working to improve patient safety.

-   [www.quic.gov/report](http://www.quic.gov/report). Find out what
    federal agencies are doing to identify threats to patient safety and
    help prevent mistakes in the nation's healthcare delivery system.

  -----------------------------------------------------------------------
  **Section 1. Facts about this HMO Plan**[]{#Section_1_Facts .anchor}

  -----------------------------------------------------------------------

> This Plan is a health maintenance organization (HMO). We require you
> to see specific physicians, hospitals, and other providers that
> contract with us. These Plan providers coordinate your health care
> services. The Plan is solely responsible for the selection of these
> providers in your area. Contact the Plan for a copy of their most
> recent provider directory.
>
> HMOs emphasize preventive care such as routine office visits, physical
> exams, well-baby care, and immunizations, in addition to treatment for
> illness and injury. Our providers follow generally accepted medical
> practice when prescribing any course of treatment.
>
> When you receive services from Plan providers, you will not have to
> submit claim forms or pay bills. You only pay the copayments,
> coinsurance, and deductibles described in this brochure. When you
> receive emergency services from non-Plan providers, you may have to
> submit claim forms.
>
> **You should join an HMO because you prefer the Plan's benefits, not
> because a particular provider is available. You cannot change plans
> because a provider leaves our Plan. We cannot guarantee that any one
> physician, hospital, or other provider will be available and/or remain
> under contract with us.**
>
> **We also have Point-of-Service (POS)
> benefits**[]{#Section_2_We_also_have_POS .anchor}
>
> Our HMO offers Point-of-Service (POS) benefits. This means you can
> receive covered services from a participating provider without a
> referral, or from a non-participating provider. These out-of-network
> benefits have higher out-of-pocket costs than our in-network benefits.
>
> How we pay providers[]{#Section_1_How_We_Pay_Providers .anchor}
>
> We have over 3,500 Plan doctors, dentists, and other health care
> providers in Hawaii who agree to keep their charges for covered
> services below our eligible charge guidelines. When you go to a Plan
> provider, you are assured that your copayments or coinsurance will not
> be more than the amount shown in this brochure.
>
> You may go to a non-Plan provider, however, the Plan pays a reduced
> benefit for certain services from non-Plan providers. In addition,
> because non-Plan providers are not under contract to limit their
> charges, you are responsible for any charges in excess of eligible
> charges.
>
> When you need covered services outside the state of Hawaii, you are
> encouraged to contact the Blue Cross and/or Blue Shield Plan in the
> area where you need services for information regarding specific Plan
> providers in their area. Benefit payment for covered services received
> out-of-state are based on contracts negotiated between the
> out-of-state Blue Cross and/or Blue Shield Plans and their Plan
> providers.
>
> When out-of-state Blue Cross and/or Blue Shield Plan providers
> participate in the BlueCard Program, the amount you pay for covered
> services provided by these Plan providers is usually calculated on the
> lower of: 1) the actual billed charges for your covered services, or
> 2) the negotiated price that the on-site Blue Cross and/or Blue Shield
> Plan passes on to us.
>
> In some cases, this "negotiated price" is a simple discount. In other
> cases, the negotiated price may be an estimate. In calculating this
> estimated price, we may consider the following factors:

-   Expected settlements, withholds, any other contingent payment
    arrangements, and other non-claims transactions with Plan providers

-   An average expected savings

-   Prior price estimations

> A few states do not allow Blue Cross/or Blue Shield Plans to calculate
> your payment based on the methods outlined above. When you receive
> covered health care services in one of these states, your payment will
> be calculated according to the law of that state.
>
> *Continued on next page*

  -----------------------------------------------------------------------
  **Section 1. Facts about this HMO Plan** *(continued)*

  -----------------------------------------------------------------------

> In order to receive Plan Provider benefits for covered out-of-state
> services under this Plan, the services you receive must be rendered by
> a BlueCard PPO provider. Non-Plan provider benefits are applied for
> covered services rendered by non-PPO providers, even if they
> participate in other Blue Cross and/or Blue Shield programs.
>
> **Your Rights**[]{#Section_1_Your_Rights .anchor}
>
> OPM requires that all FEHB Plans provide certain information to their
> FEHB members. You may get information about us, our networks,
> providers, and facilities. OPM's FEHB Web site
> ([www.opm.gov/insure]{.underline}) lists the specific types of
> information that we must make available to you. Some of the required
> information is listed below.

-   We are currently in compliance with state licensing requirements.

-   We are in our 65^th^ year of continuous service to the people of
    Hawaii.

-   We were founded in 1938 as a non-profit mutual benefit society.

> If you want more information about us, call 808/948-6499, or write to
> P.O. Box 860, Honolulu, HI 96808. You may also contact us by fax at
> 808/948-5567 or visit our Web site at
> [www.hmsa.com/portal/fedplan87/]{.underline}.
>
> **Service Area**[]{#Section_1_Service_Area .anchor}
>
> To enroll with us, you must live in our service area. This is where
> our providers practice. Our service area is the islands of Hawaii,
> Kauai, Maui, Oahu, Molokai and Lanai.
>
> If you or a covered family member move outside of our service area,
> you may remain in the Plan or you can enroll in another plan. If your
> dependents live out of the area (for example, if your child goes to
> college in another state), you may remain in the Plan or you can
> consider enrolling in a fee-for-service Plan or an HMO that has
> agreements with affiliates in other areas. If you or a family member
> move, you do not have to wait until Open Season to change plans.
> Contact your employing or retirement office.

  -----------------------------------------------------------------------
  **Section 2. How we change for 2004**[]{#how_we_change .anchor}

  -----------------------------------------------------------------------

> Do not rely on these change descriptions; this page is not an official
> statement of benefits. For that, go to Section 5 Benefits. Also, we
> edited and clarified language throughout the brochure; any language
> change not shown here is a clarification that does not change
> benefits.
>
> **Program-wide changes**[]{#Section_2_Program_Wide_Changes .anchor}

-   We added information regarding two new Federal Programs that
    complement FEHB benefits, the Federal Flexible Spending Account
    Program - *FSAFEDS* and the Federal Long Term Care Insurance
    Program. See page [70](#Two_new_programs).

-   We added information regarding preventing medical mistakes. See page
    [6](#Preventing_Medical_Mistakes).

-   We added information regarding enrolling in Medicare. See page
    [59](#medicare_should_I)

```{=html}
<!-- -->
```
-   We revised the Medicare Primary Payer Chart. See page
    [61](#medicare_primary_chart)

> **Changes to this Plan**[]{#Section_2_Changes_to_this_Plan .anchor}

-   Your share of the non-Postal premium will increase by 12% for Self
    Only or 12% for Self and Family.

-   The copayments for Plan physician services and outpatient laboratory
    services have been changed to \$15 copayment per visit for physician
    services and no member copayment for outpatient laboratory services.

-   Your copayments for some emergency care benefits have been changed:

```{=html}
<!-- -->
```
-   The copayments from Plan Emergency Room Facilities have been changed
    from 20% of eligible charges to a \$50 copayment.

-   The copayments for Plan physician services have been changed from
    20% of eligible charges to \$15 copayment per visit.

-   The copayments for Plan provider laboratory tests have been changed
    from 20% of eligible charges to no copayment.

```{=html}
<!-- -->
```
-   We clarified that if you are admitted as an inpatient following a
    visit to an emergency room, hospital inpatient benefits apply.

-   Your copayments for drug benefits have been changed:

```{=html}
<!-- -->
```
-   The copayments from Plan Pharmacies for Preferred Brand Name Drugs,
    Other Brand Insulin and Other Brand Diabetic Supplies have been
    changed from \$15 to \$20

-   The copayments from Plan Pharmacies for Other Brand Name Drugs have
    changed from 50% of eligible charges not less than \$15 to 50% of
    eligible charges not less than \$20

-   The copayments from Plan Pharmacies for Other Brand Name Diaphragms
    have changed from 50% of eligible charges not less than \$15 to 50%
    of eligible charges not less than \$10

-   The copayments from non-Plan Pharmacies for Preferred Brand Name
    Drugs and Other Brand Insulin have been changed from \$15 plus 20%
    of remaining eligible charge and any difference between the actual
    and eligible charge to \$20 plus 20% of remaining eligible charge
    and any difference between the actual and eligible charge

-   The copayments from non-Plan Pharmacies for Other Brand Name Drugs
    have changed from 50% of eligible charge not less than \$15 plus any
    difference between the actual and eligible charge to 50% of eligible
    charge not less than \$20 plus any difference between the actual and
    eligible charge

-   The copayments from non-Plan Pharmacies for Other Brand Diabetic
    Supplies have been changed from \$15 copayment plus any difference
    between the actual and eligible charge to \$20 copayment plus any
    difference between the actual and eligible charge

-   The copayments from non-Plan Pharmacies for Other Brand Name
    Diaphragms have changed from 50% of eligible charges not less than
    \$15 plus any difference between the actual and eligible charge to
    50% of eligible charges not less than \$10 plus any difference
    between the actual and eligible charge

```{=html}
<!-- -->
```
-   We added occupational therapy visits to the list of services
    requiring precertification. See Section 3 and Section 5(a)

-   We changed your copayment for HMSA's Smoking Cessation Program from
    \$25 to no copayment.

> Continued on next page

  -----------------------------------------------------------------------
  **Section 2. How we change for 2004** *(continued)*

  -----------------------------------------------------------------------

-   We changed the address for the mailing of disputed claims. See
    Section 8

-   We clarified the definition of homebound. See Section 5(a), Home
    health services. Homebound means that due to an illness or injury,
    you are unable to leave home or if you leave home, doing so requires
    a considerable and taxing effort.

-   We clarified information about third party liability under "When
    others are responsible for injuries". See Section 9

+---------------------+------------------------------------------------+
| **Section 3. How    |                                                |
| you get             |                                                |
| care**[]{#Section   |                                                |
| _3_How_You_Get_Care |                                                |
| .anchor}            |                                                |
+---------------------+------------------------------------------------+
| **Identification    | We will send you an identification (ID) card   |
| car                 | when you enroll. You should carry your ID card |
| ds**[]{#Section_3_I | with you at all times. You must show it        |
| dentification_Cards | whenever you receive services from a Plan      |
| .anchor}            | provider, or fill a prescription at a Plan     |
|                     | pharmacy. Until you receive your ID card, use  |
|                     | your copy of the Health Benefits Election      |
|                     | Form,\                                         |
|                     | SF-2809, your health benefits enrollment       |
|                     | confirmation (for annuitants), or your         |
|                     | Employee Express confirmation letter.          |
|                     |                                                |
|                     | If you do not receive your ID card within 30   |
|                     | days after the effective date of your          |
|                     | enrollment, or if you need replacement cards,  |
|                     | call us at 808/948-6499 or write to us at P.O. |
|                     | Box 860, Honolulu, HI 96808. You may also      |
|                     | request replacement cards through our Web site |
|                     | at                                             |
|                     | [www.hmsa.com/portal/fedplan87/]{.underline}.  |
+---------------------+------------------------------------------------+
| **Where you get     | You get care from "Plan providers" and "Plan   |
| covered             | facilities." You will only pay copayments      |
| care**[]            | and/or coinsurance, and you will not have to   |
| {#Section_3_Where_Y | file claims. If you use our Point-of-service   |
| ou_Get_Covered_Care | program, you can also get care from non-Plan   |
| .anchor}            | providers, but it will cost you more.          |
|                     |                                                |
|                     | We look at some or all the following criteria  |
|                     | to determine if a provider is recognized and   |
|                     | approved by us:                                |
|                     |                                                |
|                     | -   Is the provider accredited by a recognized |
|                     |     accrediting agency?                        |
|                     |                                                |
|                     | -   Is the provider appropriately licensed?    |
|                     |                                                |
|                     | -   Is the provider certified by the proper    |
|                     |     government authority?                      |
|                     |                                                |
|                     | ```{=html}                                     |
|                     | <!-- -->                                       |
|                     | ```                                            |
|                     | -   Are the services rendered within the       |
|                     |     lawful scope of the provider's respective  |
|                     |     licensure, certification, and /or          |
|                     |     accreditation?                             |
+---------------------+------------------------------------------------+
| -   **Plan          | Plan providers are physicians and other health |
|     p               | care professionals in our service area that we |
| roviders**[]{#Secti | contract with to provide covered services to   |
| on_3_Plan_Providers | our members. We credential Plan providers      |
|     .anchor}        | according to national standards.               |
|                     |                                                |
|                     | In order to receive Plan Provider benefits for |
|                     | covered out-of-state services under this Plan, |
|                     | the services must be provided by a BlueCard    |
|                     | PPO provider.                                  |
|                     |                                                |
|                     | We list Plan providers in a provider           |
|                     | directory, which we update periodically.       |
+---------------------+------------------------------------------------+
| -   **Non-Plan      | Non-Plan providers are physicians and other    |
|     providers**     | health care professionals who are not under    |
|                     | contract with this Plan.                       |
|                     |                                                |
|                     | For out-of-state services under this Plan,     |
|                     | non-Plan provider benefits are applied for     |
|                     | covered services rendered by non-Blue Cross    |
|                     | and/or Blue Shield programs.                   |
+---------------------+------------------------------------------------+
| -   **Plan          | Plan facilities are hospitals and other        |
|     fac             | facilities in our service area that we         |
| ilities**[]{#Sectio | contract with to provide covered services to   |
| n_3_Plan_Facilities | our members. We list these in the provider     |
|     .anchor}        | directory, which we update periodically.       |
+---------------------+------------------------------------------------+
| **What you**        | You are encouraged to coordinate your care     |
| []{#S               | with a primary care physician who will provide |
| ection_3_What_You_A | or arrange most of your health care.           |
| re_Encouraged_To_Do |                                                |
| .anchor}**must do   |                                                |
| to get co****vered  |                                                |
| care**              |                                                |
+---------------------+------------------------------------------------+
| -   **Primary       | Your primary care physician can be a family    |
|     care**[]{#Sec   | practitioner, internist                        |
| tion_3_Primary_Care | obstetrician/gynecologist or pediatrician.     |
|     .anchor}        | Your primary care physician will provide most  |
|                     | of your health care, or can refer you to see a |
|                     | specialist.                                    |
+---------------------+------------------------------------------------+

> *Continued on next page*

+---------------------+------------------------------------------------+
| Section 3. How you  |                                                |
| get care            |                                                |
| *(continued)*       |                                                |
+=====================+================================================+
| -   **Specialty     | You have direct access to Plan specialists     |
|     care**[]{#Secti | when needed. However, you may wish to          |
| on_3_Specialty_Care | coordinate your specialty care with your       |
|     .anchor}        | primary care physician, who can help you       |
|                     | arrange for the specialty care service you     |
|                     | will need.                                     |
|                     |                                                |
|                     | Here are other things you should know about    |
|                     | specialty care:                                |
|                     |                                                |
|                     | -   If you are seeing a specialist when you    |
|                     |     enroll in our Plan, you are encouraged to  |
|                     |     coordinate your specialty care with your   |
|                     |     primary care physician. If he or she       |
|                     |     decides to refer you to a different        |
|                     |     specialist, you may ask to see your        |
|                     |     current specialist.                        |
|                     |                                                |
|                     | ```{=html}                                     |
|                     | <!-- -->                                       |
|                     | ```                                            |
|                     | -   If you are seeing a specialist and your    |
|                     |     specialist leaves our Plan, talk to your   |
|                     |     primary care physician, who will arrange   |
|                     |     for you to see another specialist. If you  |
|                     |     decide to continue seeing your specialist, |
|                     |     you will pay a copayment/coinsurance plus  |
|                     |     the difference between the eligible charge |
|                     |     and the specialist billed charge.          |
|                     |                                                |
|                     | • If you have a chronic or disabling condition |
|                     | and lose access to your specialist because we: |
|                     |                                                |
|                     | -   terminate our contract with your           |
|                     |     specialist for other than cause; or        |
|                     |                                                |
|                     | -   drop out of the Federal Employees Health   |
|                     |     Benefits (FEHB) Program and you enroll in  |
|                     |     another FEHB Plan; or                      |
|                     |                                                |
|                     | -   reduce our service area and you enroll in  |
|                     |     another FEHB Plan,                         |
|                     |                                                |
|                     | you may be able to continue seeing your        |
|                     | specialist for up to 90 days after you receive |
|                     | notice of the change. Contact us or, if we     |
|                     | drop out of the Program, contact your new      |
|                     | plan.                                          |
|                     |                                                |
|                     | -   If you are in the second or third          |
|                     |     trimester of pregnancy and you lose access |
|                     |     to your specialist based on the above      |
|                     |     circumstances, you can continue to see     |
|                     |     your specialist until the end of your      |
|                     |     postpartum care, even if it is beyond the  |
|                     |     90 days.                                   |
+---------------------+------------------------------------------------+
| -   **Hospital      | Your Plan primary care physician or specialist |
|     care**[]{#Sect  | will make necessary hospital arrangements and  |
| ion_3_Hospital_Care | supervise your care. This includes admission   |
|     .anchor}        | to a skilled nursing or other type of          |
|                     | facility.                                      |
|                     |                                                |
|                     | If you changed from another FEHB plan to us,   |
|                     | your former plan will pay for the hospital     |
|                     | stay until:                                    |
|                     |                                                |
|                     | -   You are discharged, not merely moved to an |
|                     |     alternative care center; or                |
|                     |                                                |
|                     | -   The day your benefits from your former     |
|                     |     plan run out; or                           |
|                     |                                                |
|                     | -   The 92^nd^ day after you become a member   |
|                     |     of this Plan, whichever\                   |
|                     |     happens first.                             |
|                     |                                                |
|                     | These provisions apply only to the benefits of |
|                     | the hospitalized person. If your plan          |
|                     | terminates participation in the FEHB Program   |
|                     | in whole or in part, or if OPM orders an       |
|                     | enrollment change, this continuation of        |
|                     | coverage provision does not apply. In such     |
|                     | case, the hospitalized family member's         |
|                     | benefits under the new plan begin on the       |
|                     | effective date of enrollment.                  |
+---------------------+------------------------------------------------+

> *Continued on next page*

+---------------------+------------------------------------------------+
| Section 3. How you  |                                                |
| get care            |                                                |
| *(continued)*       |                                                |
+=====================+================================================+
| **Circumstances     | Under certain extraordinary circumstances,     |
| beyond our          | such as natural disasters, we may have to      |
| contr               | delay your services or we may be unable to     |
| ol**[]{#Section_3_C | provide them. In that case, we will make all   |
| ircumstances_Beyond | reasonable efforts to provide you with the     |
| .anchor}            | necessary care.                                |
+---------------------+------------------------------------------------+
| **Services          | Your primary care physician has authority to   |
| requiring our prior | refer you for most services. For certain       |
| approval**[]{       | services, however, you or your physician must  |
| #Section_3_Services | obtain approval from us. Before giving         |
| _Requiring_Approval | approval, we consider if the service is        |
| .anchor}            | covered, and follows generally accepted        |
|                     | medical practice.                              |
|                     |                                                |
|                     | We call this review and approval process       |
|                     | []{#Precertification .anchor}precertification. |
|                     | Precertification is a special approval process |
|                     | to ensure that certain medical treatments,     |
|                     | procedures, place of treatment or devices meet |
|                     | medical necessity criteria prior to the        |
|                     | services being rendered. If you are under the  |
|                     | care of:                                       |
|                     |                                                |
|                     | -   An HMSA participating physician or         |
|                     |     contracting physician, he or\              |
|                     |     she will :                                 |
|                     |                                                |
|                     | ```{=html}                                     |
|                     | <!-- -->                                       |
|                     | ```                                            |
|                     | -   obtain approval for you; and               |
|                     |                                                |
|                     | -   accept any penalties for failure to obtain |
|                     |     approval.                                  |
|                     |                                                |
|                     | ```{=html}                                     |
|                     | <!-- -->                                       |
|                     | ```                                            |
|                     | -   A BlueCard PPO, BlueCard Plan provider or  |
|                     |     a non-Plan provider, you are responsible   |
|                     |     for obtaining precertification. If you do  |
|                     |     not receive precertification and receive   |
|                     |     any of the services described in this      |
|                     |     Section, benefits may be denied.           |
|                     |                                                |
|                     | You or your physician must obtain              |
|                     | precertification for the following services\   |
|                     | such as:                                       |
|                     |                                                |
|                     | -   Autologous chondrocyte implants            |
|                     |                                                |
|                     | -   Custom durable medical equipment           |
|                     |                                                |
|                     | ```{=html}                                     |
|                     | <!-- -->                                       |
|                     | ```                                            |
|                     | -   Certain kinds of drugs listed in our       |
|                     |     Select Prescription Drug Formulary (see    |
|                     |     section 5(f) and 5(g) for more information |
|                     |                                                |
|                     | ```{=html}                                     |
|                     | <!-- -->                                       |
|                     | ```                                            |
|                     | -   Growth hormone therapy                     |
|                     |                                                |
|                     | -   In vitro fertilization                     |
|                     |                                                |
|                     | -   Integrated Case Management                 |
|                     |                                                |
|                     | -   Organ and tissue transplants listed in     |
|                     |     Section 5(b)                               |
|                     |                                                |
|                     | -   Physical Therapy and Occupational Therapy  |
|                     |     Visits                                     |
|                     |                                                |
|                     | ```{=html}                                     |
|                     | <!-- -->                                       |
|                     | ```                                            |
|                     | -   You must receive approval from HMSA for    |
|                     |     any outpatient physical therapy visits,    |
|                     |     occupational therapy visits, or a          |
|                     |     combination of both beyond the first 10    |
|                     |     visits.                                    |
|                     |                                                |
|                     | ```{=html}                                     |
|                     | <!-- -->                                       |
|                     | ```                                            |
|                     | -   Positron Emission Tomography (PET)         |
|                     |                                                |
|                     | -   Routine care associated with clinical      |
|                     |     trials listed in Section 5(g) of this      |
|                     |     brochure                                   |
|                     |                                                |
|                     | -   Stereotactic radiosurgery utilizing        |
|                     |     particle beams                             |
|                     |                                                |
|                     | -   Surgeries, therapies or procedures         |
|                     |     employing new technology                   |
|                     |                                                |
|                     | -   Surgery to correct morbid obesity          |
|                     |                                                |
|                     | -   Transplant evaluations, except for cornea  |
|                     |     and kidney transplant evaluations          |
|                     |                                                |
|                     | -   Wound VAC (Vacuum assisted closure of      |
|                     |     chronic wound)                             |
|                     |                                                |
|                     | This list of services requiring                |
|                     | precertification may change periodically. To   |
|                     | ensure your treatment or procedure is covered, |
|                     | call us at 808/948-6499.                       |
+---------------------+------------------------------------------------+

+---------------------+------------------------------------------------+
| Section 4. Your     |                                                |
| costs for covered   |                                                |
| services[]{#Se      |                                                |
| ction_4_Your_Costs_ |                                                |
| For_Covered_Service |                                                |
| .anchor}            |                                                |
+=====================+================================================+
| You must share the  | You are responsible for:                       |
| cost of some        |                                                |
| services.           |                                                |
+---------------------+------------------------------------------------+
| -                   | A copayment is a fixed amount of money you pay |
| **Copayments**[]{#S | to the provider, facility, pharmacy, etc.,     |
| ection_4_Copayments | when you receive services.                     |
|     .anchor}        |                                                |
|                     | Example: When you use your Plan pharmacy, you  |
|                     | pay a copayment of \$5 for generic drugs.      |
+---------------------+------------------------------------------------+
| -                   | We do not have a deductible.                   |
| **Deductible**[]{#S |                                                |
| ection_4_Deductible |                                                |
|     .anchor}        |                                                |
+---------------------+------------------------------------------------+
| -   **Eligible      | We calculate our payment and your              |
|     Charges**       | copayment/coinsurance based on eligible        |
|                     | charges. The eligible charge is the lower of   |
|                     | either the provider's actual charge or the     |
|                     | amount we established as the maximum allowable |
|                     | fee.                                           |
|                     |                                                |
|                     | Non-Plan providers are not under contract to   |
|                     | limit their charges to our eligible charges.   |
|                     | You are responsible for any charges in excess  |
|                     | of eligible charges.                           |
+---------------------+------------------------------------------------+
| -   **              | Coinsurance is the percentage of our eligible  |
| Coinsurance**[]{#Se | charge that you must pay for your care.        |
| ction_4_Coinsurance |                                                |
|     .anchor}        | Example: When you see your physician, you pay  |
|                     | a coinsurance of 20% per office visit.         |
+---------------------+------------------------------------------------+
| **Your catastrophic | After your coinsurance totals \$2,500 per      |
| protection          | person or \$7,500 per family enrollment in any |
| out-of-pocket**     | calendar year, you do not have to pay any more |
| []{#catastrophic    | for covered services. However,                 |
| .anchor}**maximum   | coinsurance/copayments for the following       |
| for coinsurance and | services do not count toward your catastrophic |
| copayments**[]      | protection out-of-pocket maximum, and you must |
| {#Section_4_Your_Ou | continue to pay coinsurance/copayments for     |
| t_Of_Pocket_Maximum | these services:                                |
| .anchor}            |                                                |
|                     | -   Dental Care                                |
|                     |                                                |
|                     | -   Prescription Drugs                         |
|                     |                                                |
|                     | -   Vision Care                                |
|                     |                                                |
|                     | Any payment from the difference of the actual  |
|                     | and eligible charge for non-Plan service does  |
|                     | not count toward meeting your catastrophic     |
|                     | protection out-of-pocket maximum.              |
|                     |                                                |
|                     | Be sure to keep accurate records of your       |
|                     | coinsurance/copayment. We will also keep       |
|                     | records of your coinsurance/copayment and      |
|                     | track your catastrophic protection\            |
|                     | out-of-pocket maximum.                         |
+---------------------+------------------------------------------------+

+-----------------------------------------------------------------------+
| **Section 5. Benefits -- OVERVIEW**[]{#Section_5_Benefits .anchor}    |
|                                                                       |
| ***(See page [10](#Section_2_Changes_to_this_Plan) for how our        |
| benefits changed this year and page [80](#summary_2004) for a         |
| benefits summary.)***                                                 |
+-----------------------------------------------------------------------+

> **Note**: This benefits section is divided into subsections. Please
> read the important things you should keep in mind at the beginning of
> each subsection. Also read the General Exclusions in Section 6; they
> apply to the benefits in the following subsections. To obtain claim
> forms, claims filing advice, or more information about our benefits,
> contact us at\
> 808/948-6499 or at our Web site at
> [www.hmsa.com/portal/fedplan87/]{.underline}*.*

(a) Medical services and supplies provided by physicians and other
    health care professionals
    [17](#Section_5_Medical_Services_And_Supplies)-[28](#Section_5_Medical_Services_End)

+----------------------------+-----------------------------------------+
| -   Diagnostic and         | -   Speech therapy                      |
|     treatment services     |                                         |
|                            | -   Hearing services (testing,          |
| -   Lab, X-ray, and other  |     treatment, and supplies)            |
|     diagnostic tests       |                                         |
|                            | -   Vision services (testing,           |
| -   Preventive care, adult |     treatment, and supplies)            |
|                            |                                         |
| -   Preventive care,       | -   Foot care                           |
|     children               |                                         |
|                            | -   Orthopedic and prosthetic devices   |
| -   Maternity care         |                                         |
|                            | -   Durable medical equipment (DME)     |
| -   Family planning        |                                         |
|                            | -   Home health services                |
| -   Infertility services   |                                         |
|                            | -   Chiropractic                        |
| -   Allergy care           |                                         |
|                            | -   Alternative treatments              |
| -   Treatment therapies    |                                         |
|                            | -   Educational classes and programs    |
| -   Physical and           |                                         |
|     occupational therapies |                                         |
+----------------------------+-----------------------------------------+

(b) Surgical and anesthesia services provided by physicians and other
    health care professionals
    [29](#Section_5_Surgical_And_Anesthesia)-[32](#Section_5_Surgical_And_Anesthesia_End)

+----------------------------+-----------------------------------------+
| -   Surgical procedures    | -   Organ/tissue transplants            |
|                            |                                         |
| -   Reconstructive surgery | ```{=html}                              |
|                            | <!-- -->                                |
| ```{=html}                 | ```                                     |
| <!-- -->                   | -   Anesthesia                          |
| ```                        |                                         |
| -   Oral and maxillofacial |                                         |
|     surgery                |                                         |
+----------------------------+-----------------------------------------+

(c) Services provided by a hospital or other facility, and ambulance
    services [33](#Section_5_Hospital)-[35](#Section_5_Ambulance_End)

+----------------------------+-----------------------------------------+
| -   Inpatient hospital     | -   Extended care benefits/skilled      |
|                            |     nursing care facility benefits      |
| -   Outpatient hospital or |                                         |
|     ambulatory surgical    | -   Hospice care                        |
|     center                 |                                         |
|                            | -   Ambulance                           |
+----------------------------+-----------------------------------------+

(d) Emergency services/accidents
    [36](#section-5-d.-emergency-servicesaccidents)-[38](#Section_5_Emergency_End)

+----------------------------+-----------------------------------------+
| -   Medical emergency      | -   Ambulance                           |
+----------------------------+-----------------------------------------+

> \(e\) Mental health and substance abuse benefits
> [39](#Section_5_Mental_Health)-[40](#mental_health_end)

(f) Prescription drug benefits
    [41](#Section_5_Prescription_Drug)-[45](#Section_5_Prescription_Drug_End)

(g) Special features [46](#Section_5_Special_Features)

+----------------------------+-----------------------------------------+
| -   Integrated Case        | -   Routine Care Associated With        |
|     Management             |     Clinical Trials                     |
+----------------------------+-----------------------------------------+
| -   Drug Benefit           |                                         |
|     Management Program     |                                         |
+----------------------------+-----------------------------------------+

> \(h\) Dental benefits
> [47](#Section_5_Dental)-[48](#Section_5_Dental_End)
>
> \(i\) Point-of-service benefits (POS)
> [49](#Section_5_Point_Of_Service)-[50](#Section_5_Point_Of_Service_End)
>
> \(j\) Non-FEHB benefits available to Plan members
> [52](#Section_5_Non_FEHB)
>
> Summary of benefits [80](#summary_2004)

+---+---+-------------------------------------+----------------------+---+---+
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| \ |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
|   | * | **Here are some important things to |                      | * |   |
|   | * | keep in mind about these            |                      | * |   |
|   | I | benefits:**                         |                      | I |   |
|   | * |                                     |                      | * |   |
|   | * | -   Please remember that all        |                      | * |   |
|   |   |     benefits are subject to the     |                      |   |   |
|   | * |     definitions, limitations, and   |                      | * |   |
|   | * |     exclusions in this brochure and |                      | * |   |
|   | M |     are payable only when we        |                      | M |   |
|   | * |     determine they are medically    |                      | * |   |
|   | * |     necessary.                      |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * | -   We have no calendar year        |                      | * |   |
|   | * |     deductible.                     |                      | * |   |
|   | P |                                     |                      | P |   |
|   | * | ```{=html}                          |                      | * |   |
|   | * | <!-- -->                            |                      | * |   |
|   |   | ```                                 |                      |   |   |
|   | * | -   Be sure to read Section 4,      |                      | * |   |
|   | * |     *Your costs for covered         |                      | * |   |
|   | O |     services,* for valuable         |                      | O |   |
|   | * |     information about how cost      |                      | * |   |
|   | * |     sharing works. Also read        |                      | * |   |
|   |   |     Section 9 about coordinating    |                      |   |   |
|   | * |     benefits with other coverage,   |                      | * |   |
|   | * |     including with Medicare.        |                      | * |   |
|   | R |                                     |                      | R |   |
|   | * | -   Precertification is required    |                      | * |   |
|   | * |     for certain services, supplies, |                      | * |   |
|   |   |     and drugs. Please refer to the  |                      |   |   |
|   | * |     precertification information    |                      | * |   |
|   | * |     shown in Section 3 to be sure   |                      | * |   |
|   | T |     which services, supplies, and   |                      | T |   |
|   | * |     drugs require precertification. |                      | * |   |
|   | * |                                     |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   | A |                                     |                      | A |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   | N |                                     |                      | N |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   | T |                                     |                      | T |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
+---+---+-------------------------------------+----------------------+---+---+
| > |   |                                     | **You pay**          |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| B |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| # |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| > |   |                                     | > Plan Provider\     |   |   |
|   |   |                                     | > \$15 per visit     |   |   |
| P |   |                                     | >                    |   |   |
| r |   |                                     | > Non-Plan Provider\ |   |   |
| o |   |                                     | > 30% of eligible    |   |   |
| f |   |                                     | > charges and any    |   |   |
| e |   |                                     | > difference between |   |   |
| s |   |                                     | > our payment and    |   |   |
| s |   |                                     | > the actual charge  |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| ' |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| = |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
| < |   |                                     |                      |   |   |
| ! |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| k |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| = |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
| < |   |                                     |                      |   |   |
| ! |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| # |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| L |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| X |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| > |   |                                     | > Plan Provider\     |   |   |
|   |   |                                     | > Nothing            |   |   |
| T |   |                                     | >                    |   |   |
| e |   |                                     | > Non-Plan Provider\ |   |   |
| s |   |                                     | > 30% of eligible    |   |   |
| t |   |                                     | > charges and any    |   |   |
| s |   |                                     | > difference between |   |   |
| , |   |                                     | > our payment and    |   |   |
| > |   |                                     | > the actual charge  |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| : |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| B |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| = |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
| < |   |                                     |                      |   |   |
| ! |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| ` |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| U |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| P |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| P |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| - |   |                                     | > Plan Provider\     |   |   |
|   |   |                                     | > 20% of eligible    |   |   |
|   |   |                                     | > charges            |   |   |
|   |   |                                     | >                    |   |   |
| X |   |                                     | > Non-Plan Provider\ |   |   |
| - |   |                                     | > 30% of eligible    |   |   |
| r |   |                                     | > charges and any    |   |   |
| a |   |                                     | > difference between |   |   |
| y |   |                                     | > our payment and    |   |   |
| s |   |                                     | > the actual charge  |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| R |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| C |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| / |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| R |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| R |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| U |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| E |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| E |   |                                     |                      |   |   |
| E |   |                                     |                      |   |   |
| G |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| P |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+

+-----------------------------------------+---------------------------+---+
| ##### Preventive care, adult            | > **You pay**             |   |
+-----------------------------------------+---------------------------+---+
| > Routine screenings, limited to:       | > Nothing, if you receive |   |
|                                         | > services as a           |   |
| -   Total Blood                         | > HealthPass screening    |   |
|     Cholesterol[]{#cholesterol_tests    |                           |   |
|     .anchor} -- one per calendar year   |                           |   |
|                                         |                           |   |
| -   Colorectal Cancer Screening,        |                           |   |
|     including[]{#cholorectal_screening  |                           |   |
|     .anchor}                            |                           |   |
|                                         |                           |   |
| ```{=html}                              |                           |   |
| <!-- -->                                |                           |   |
| ```                                     |                           |   |
| -   Fecal occult blood test             |                           |   |
|     []{#fecal_occult_blood_test         |                           |   |
|     .anchor}-- one per calendar year,   |                           |   |
|     age 50 and above                    |                           |   |
|                                         |                           |   |
| -   Sigmoidoscopy, screening -- every   |                           |   |
|     3-5 years starting at age 50        |                           |   |
+-----------------------------------------+---------------------------+---+
| -   Routine Prostate Specific Antigen   | > Plan Provider\          |   |
|     (PSA) test -- one per calendar year | > Nothing                 |   |
|     for men age 50 and                  | >                         |   |
|     older[]{#prostate_screening         | > Non-Plan Provider\      |   |
|     .anchor}                            | > 30% of eligible charges |   |
|                                         | > and any difference      |   |
| -   Routine pap test -- one per         | > between our payment and |   |
|     calendar year[]{#routine_pap        | > the actual charge       |   |
|     .anchor}                            |                           |   |
|                                         |                           |   |
| ```{=html}                              |                           |   |
| <!-- -->                                |                           |   |
| ```                                     |                           |   |
| -   Routine mammogram -- covered for    |                           |   |
|     women age 35 and older, as          |                           |   |
|     follows:[]{#mammograms .anchor}     |                           |   |
|                                         |                           |   |
| ```{=html}                              |                           |   |
| <!-- -->                                |                           |   |
| ```                                     |                           |   |
| -   From age 35 through 39, one during  |                           |   |
|     this five year period               |                           |   |
|                                         |                           |   |
| -   From age 40 and older, one every    |                           |   |
|     calendar year                       |                           |   |
|                                         |                           |   |
| > Note: A woman of any age may receive  |                           |   |
| > the screening more often if she has a |                           |   |
| > history of breast cancer or if her    |                           |   |
| > mother or sister has a history of     |                           |   |
| > breast cancer                         |                           |   |
+-----------------------------------------+---------------------------+---+
| -   Complete Blood Count -- one per     | > Plan Provider\          |   |
|     calendar year                       | > Nothing                 |   |
|                                         | >                         |   |
| -   Fecal Occult Blood -- one every     | > Non-Plan Provider\      |   |
|     calendar year, age 50 and above     | > 30% of eligible charges |   |
|                                         | > and any difference      |   |
| -   Urinalysis -- one per calendar year | > between our payment and |   |
|                                         | > the actual charge       |   |
| -   Glucose screening -- one every 3    |                           |   |
|     years, age 45 and above             |                           |   |
|                                         |                           |   |
| -   Fasting lipoprotein profile (Total  |                           |   |
|     cholesterol, LDL, HDL, and          |                           |   |
|     triglycerides), once every 5 years  |                           |   |
|                                         |                           |   |
| -   Chlamydial infection screening      |                           |   |
+-----------------------------------------+---------------------------+---+
| -   Routine Chest X-ray -- one per      | > Plan Provider\          |   |
|     calendar year                       | > 20% of eligible charges |   |
|                                         | >                         |   |
| -   TB Tine Test -- one per calendar    | > Non-Plan Provider\      |   |
|     year                                | > 30% of eligible charges |   |
|                                         | > and any difference      |   |
| -   Sigmoidoscopy screening -- every 5  | > between our payment and |   |
|     years, age 50 and above             | > the actual charge       |   |
|                                         |                           |   |
| -   Colonoscopy[]{#Colonoscopy .anchor} |                           |   |
|     -- once every 10 years, age 50 and  |                           |   |
|     above                               |                           |   |
|                                         |                           |   |
| -   Double contrast barium enema (DCBE) |                           |   |
|     -- once every 5-10 years, age 50    |                           |   |
|     and above                           |                           |   |
+-----------------------------------------+---------------------------+---+
| -   Routine Physical                    | > Plan Provider**\        |   |
|     Exam[]{#physical_exam .anchor} --   | > **Nothing               |   |
|     one per calendar year               | >                         |   |
|                                         | > Non-Plan Provider\      |   |
| -   Well Woman Exam -- one per calendar | > 30% of eligible charges |   |
|     year                                | > and any difference      |   |
|                                         | > between our payment and |   |
|                                         | > the actual charge       |   |
+-----------------------------------------+---------------------------+---+

*Preventive care, adult -- continued on next page*

+-----------------------------------------+----------------------------+
| ###                                     | **You pay**                |
| ## Preventive care, adult *(continued)* |                            |
+-----------------------------------------+----------------------------+
| ##### *Not covere                       | > *All charges*            |
| d: Physical exams required for obtainin |                            |
| g or continuing employment or insurance |                            |
| , attending schools or camp, or travel* |                            |
+-----------------------------------------+----------------------------+
| > Immunizations are covered in accord   | > Plan Provider\           |
| > with guidelines set by the Advisory   | > 20% of eligible charges  |
| > Committee on Immunization Practices   | >                          |
| > (ACIP)[]{#immunizations .anchor}      | > Non-Plan Provider\       |
|                                         | > 30% of eligible charges  |
| -   Standard Immunizations              | > plus any difference      |
|                                         | > between the Plan's       |
| -   Immunizations for high risk         | > payment and the actual   |
|     conditions such as Hepatitis B      | > charges                  |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Travel Immunizations                |                            |
+-----------------------------------------+----------------------------+
| -   HealthPass                          | > Plan Provider\           |
|                                         | > Nothing                  |
| > You and any dependent defined below   | >                          |
| > are eligible for one routine physical | > Non-Plan Provider\       |
| > exam or HealthPass exam listed in     | > Not a benefit            |
| > this section per calendar year.       |                            |
| >                                       |                            |
| > HealthPass is a screening program     |                            |
| > that provides you with information    |                            |
| > about how to build a healthier life   |                            |
| > by looking at your current lifestyle, |                            |
| > health habits, and family medical     |                            |
| > history. For members age 14 to 17,    |                            |
| > HealthPass for Teens offers an        |                            |
| > interactive computer program,         |                            |
| > screenings and individual counseling. |                            |
+-----------------------------------------+----------------------------+
| > You are eligible to receive a health  |                            |
| > risk assessment through HealthPass.   |                            |
| > For more information, contact the     |                            |
| > Customer Service Department at        |                            |
| > 808/948-6499.                         |                            |
+-----------------------------------------+----------------------------+
| > After your assessment, we will work   |                            |
| > with you to develop a personal health |                            |
| > action plan. We can also recommend    |                            |
| > other health improvement activities   |                            |
| > and provide support to help you meet  |                            |
| > your health goals. Yearly visits will |                            |
| > enable you to measure your progress   |                            |
| > and alert you to any changes that     |                            |
| > might require additional actions to   |                            |
| > meet your health goals.               |                            |
+-----------------------------------------+----------------------------+
| > After you call the HealthPass office  |                            |
| > for an appointment, we\'ll send you a |                            |
| > health questionnaire. Your answers    |                            |
| > will be combined with the results     |                            |
| > from your annual screening, which     |                            |
| > includes:                             |                            |
|                                         |                            |
| -   Height and weight measurements      |                            |
|                                         |                            |
| -   Body fat analysis                   |                            |
|                                         |                            |
| -   Blood pressure measurement          |                            |
|                                         |                            |
| -   Blood []{#Blood_Cholesterol         |                            |
|     .anchor}cholesterol, HDL and        |                            |
|     glucose screening tests             |                            |
+-----------------------------------------+----------------------------+
| > If applicable, we may recommend that  |                            |
| > you attend programs to learn more     |                            |
| > about:                                |                            |
|                                         |                            |
| -   Nutrition                           |                            |
|                                         |                            |
| -   Smoking cessation                   |                            |
|                                         |                            |
| -   Weight management                   |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Exercise                            |                            |
+-----------------------------------------+----------------------------+

*Preventive care, adult -- continued on next page*

+-----------------------------------------+----------------------------+
| ###                                     | **You pay**                |
| ## Preventive care, adult *(continued)* |                            |
+-----------------------------------------+----------------------------+
| > If you have certain risk factors that | > Plan Provider\           |
| > become apparent during your initial   | > Nothing                  |
| > screening, you\'ll be eligible for    | >                          |
| > coverage for additional screenings.   | > Non-Plan Provider\       |
| > Examples include:                     | > Not a benefit            |
|                                         |                            |
| -   Health maintenance physical         |                            |
|     examination                         |                            |
|                                         |                            |
| -   Sigmoidoscopy                       |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Bone density testing for            |                            |
|     osteoporosis                        |                            |
|                                         |                            |
| -   []{#fecal_occult_blood_test_Prev    |                            |
|     .anchor}Fecal occult blood test.    |                            |
+-----------------------------------------+----------------------------+
| > The HealthPass program operates under |                            |
| > the direction of a physician who      |                            |
| > serves as the program\'s medical      |                            |
| > director. HealthPass health           |                            |
| > consultants are specially trained in  |                            |
| > preventive health, nutrition, and     |                            |
| > health promotion.                     |                            |
+-----------------------------------------+----------------------------+
| ##### Preventive care, children         |                            |
+-----------------------------------------+----------------------------+
| -   Childhood                           | Plan Provider\             |
|     []{#childhood_immunizations         | Nothing                    |
|     .anchor}immunizations recommended   |                            |
|     by the American Academy of          | Non-Plan Provider\         |
|     Pediatrics.                         | Any difference between our |
|                                         | eligible charge and the    |
|                                         | actual charge              |
+-----------------------------------------+----------------------------+
| Examinations, such as:                  | > Plan Optometrist\        |
|                                         | > \$7 per visit            |
| -   Eye exams through age 17 to         | >                          |
|     determine the need for vision       | > Plan Provider\           |
|     correction. See Vision services.    | > 20% of eligible charges  |
|                                         | >                          |
|                                         | > Non-Plan Provider\       |
|                                         | > 30% of eligible charges  |
|                                         | > and any difference       |
|                                         | > between our payment and  |
|                                         | > the actual charge        |
+-----------------------------------------+----------------------------+
| -   Ear exams through age 17 to         | Plan Provider\             |
|     determine the need for hearing      | Nothing                    |
|     correction.                         |                            |
|                                         | Non-Plan Provider\         |
| ```{=html}                              | 30% of eligible charges    |
| <!-- -->                                | plus any difference        |
| ```                                     | between the Plan's payment |
| -   Examinations through age 12         | and the actual charges     |
|     according to the following          |                            |
|     schedule:[]{#well_child .anchor}    |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Birth up to 24 months: eight visits |                            |
|     (one additional visit is covered    |                            |
|     when a newborn child is discharged  |                            |
|     within 48 hours of birth)           |                            |
|                                         |                            |
| -   Age two through twelve: one visit   |                            |
|     each calendar year                  |                            |
+-----------------------------------------+----------------------------+
| Laboratory tests through age 12:        | Plan Provider\             |
|                                         | 20% of eligible charge     |
| -   2 tuberculin tests (tine or skin    |                            |
|     sensitivity)                        | Non-Plan Provider\         |
|                                         | 30% of eligible charges    |
|                                         | plus any difference        |
|                                         | between the Plan's payment |
|                                         | and the actual charges     |
+-----------------------------------------+----------------------------+

*Preventive care, children -- continued on next page*

+-----------------------------------------+----------------------------+
| #####                                   | **You pay**                |
| Preventive care, children *(continued)* |                            |
+-----------------------------------------+----------------------------+
| Laboratory tests through age 12:        | Plan Provider\             |
|                                         | Nothing                    |
| -   3 blood tests (Hemoglobin or        |                            |
|     Hematocrit)                         | Non-Plan Provider\         |
|                                         | 30% of eligible charges    |
| ```{=html}                              | plus any difference        |
| <!-- -->                                | between the Plan's payment |
| ```                                     | and the actual charges     |
| -   3 urinalysis                        |                            |
+-----------------------------------------+----------------------------+
| ######## Maternity care                 |                            |
+-----------------------------------------+----------------------------+
| Complete maternity (obstetrical) care,  | > Plan Provider\           |
| such as:                                | > 20% of eligible charges  |
|                                         | >                          |
| -   Prenatal care                       | > Non-Plan Provider\       |
|                                         | > 30% of eligible charges  |
| ```{=html}                              | > plus any difference      |
| <!-- -->                                | > between the Plan's       |
| ```                                     | > payment and the actual   |
| -   []{#delivery .anchor}Delivery       | > charges                  |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Postnatal care                      |                            |
|                                         |                            |
| Note: Here are some things to keep in   |                            |
| mind:                                   |                            |
|                                         |                            |
| -   You do not need to precertify your  |                            |
|     normal delivery; see page           |                            |
|     [1                                  |                            |
| 7](#diagnostic-and-treatment-services), |                            |
|     Professional Service of Physicians, |                            |
|     and page [33](#inpatient-hospital), |                            |
|     Hospital Benefit, for other         |                            |
|     circumstances, such as extended     |                            |
|     stays for you or your baby          |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   You may remain in the hospital up   |                            |
|     to 48 hours after a regular         |                            |
|     delivery and 96 hours after a       |                            |
|     cesarean delivery. Your physician   |                            |
|     will extend your inpatient stay if  |                            |
|     medically necessary.                |                            |
+-----------------------------------------+----------------------------+
| -   We cover routine                    | > Plan Provider\           |
|     nursery[]{#Nursery_care .anchor}    | > 20% of eligible charges  |
|     care of the newborn child           | >                          |
|     []{#newborn_care .anchor}during the | > Non-Plan Provider\       |
|     covered portion of the mother's     | > 30% of eligible charges  |
|     maternity stay. We will cover other | > plus any difference      |
|     care of an infant who requires      | > between the Plan's       |
|     non-routine treatment only if we    | > payment and the actual   |
|     cover the infant under a Self and   | > charges                  |
|     Family enrollment.                  |                            |
|                                         |                            |
| -   We cover newborn circumcision under |                            |
|     the surgical procedures benefits.   |                            |
|     See Section 5(b) *Surgery           |                            |
|     benefits*.                          |                            |
|                                         |                            |
| -   We pay hospitalization and surgeon  |                            |
|     services (delivery) the same as for |                            |
|     illness and injury. See Section     |                            |
|     5(c) *Hospital benefits* and        |                            |
|     Section 5(b) *Surgery benefits.*    |                            |
+-----------------------------------------+----------------------------+
| > *Not covered: Routine sonograms to    | > *All charges*            |
| > determine fetal age, size\            |                            |
| > or sex*                               |                            |
+-----------------------------------------+----------------------------+

+-----------------------------------------+----------------------------+
| ######## Family planning                | **You pay**                |
+-----------------------------------------+----------------------------+
| > A range of voluntary family planning  | > Plan Provider\           |
| > services, limited to:                 | > Nothing                  |
|                                         | >                          |
| -   Voluntary                           | > Non-Plan Provider\       |
|     st                                  | > 30% of eligible charges  |
| erilization[]{#sterilization_procedures | > and any difference       |
|     .anchor} (See Surgical procedures   | > between our payment and  |
|     Section 5(b))                       | > the actual charge        |
+-----------------------------------------+----------------------------+
| -   []{#contraceptive_devices_and_drugs | > Plan Provider\           |
|     .anchor}Surgically implanted        | > 20% of eligible charges  |
|     contraceptives                      | >                          |
|                                         | > Non-Plan Provider\       |
| -   Injectable contraceptive drugs      | > 30% of eligible charges  |
|     (such as Depo provera)              | > and any difference       |
|                                         | > between our payment and  |
| -   Intrauterine devices (IUDs)         | > the actual charge        |
|                                         |                            |
| -   Diaphragms/Cervical Caps            |                            |
|                                         |                            |
| > Note: Benefit payment for             |                            |
| > contraceptives is limited to one      |                            |
| > contraceptive method per period of    |                            |
| > effectiveness. We cover oral          |                            |
| > contraceptives under the prescription |                            |
| > drug benefits. See Section 5(f) for   |                            |
| > benefit level.                        |                            |
+-----------------------------------------+----------------------------+
| > *Not covered:*                        | > *All charges*            |
|                                         |                            |
| -   *Reversal of voluntary surgical     |                            |
|     sterilization*                      |                            |
|                                         |                            |
| -   *Genetic counseling*                |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   *Contraceptives such as condoms,    |                            |
|     foam, or creams which do not        |                            |
|     require a prescription*             |                            |
+-----------------------------------------+----------------------------+
| ######## Infertility services           | []{.mark}                  |
+-----------------------------------------+----------------------------+
| > Diagnosis and treatment of            | > Plan Provider\           |
| > infertility, limited to:              | > 20% of eligible charges  |
|                                         | >                          |
| -   Artificial insemination:            | > Non-Plan Provider\       |
|                                         | > 30% of eligible charges  |
| ```{=html}                              | > and any difference       |
| <!-- -->                                | > between our payment and  |
| ```                                     | > the actual charge        |
| -   *Intravaginal insemination (IVI)*   |                            |
|                                         |                            |
| -   *Intracervical insemination (ICI)*  |                            |
|                                         |                            |
| -   *Intrauterine insemination (IUI)*   |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   In Vitro Fertilization              |                            |
|                                         |                            |
| > Note: Coverage is limited to a one    |                            |
| > time only benefit for one outpatient  |                            |
| > in vitro procedure in accord with     |                            |
| > Hawaii law and criteria established   |                            |
| > by us                                 |                            |
+-----------------------------------------+----------------------------+
| > *Not covered:*                        | > *All charges*            |
|                                         |                            |
| -   *Assisted reproductive technology   |                            |
|     (ART) procedures, such as embryo    |                            |
|     transfer, gamete GIFT, and zygote   |                            |
|     ZIFT*                               |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   *Services and supplies related to   |                            |
|     excluded ART procedures except in   |                            |
|     vitro fertilization*                |                            |
|                                         |                            |
| -   *Cost of donor sperm*               |                            |
|                                         |                            |
| -   *Fertility drugs*                   |                            |
|                                         |                            |
| -   *Cost of donor egg*                 |                            |
+-----------------------------------------+----------------------------+

+-----------------------------------------+----------------------------+
| > **Allergy care**[]{#Allergy_tests     | **You pay**                |
| > .anchor}                              |                            |
+-----------------------------------------+----------------------------+
| -   Testing (one per calendar year) and | > Plan Provider\           |
|     treatment                           | > 20% of eligible charges  |
|                                         | >                          |
| ```{=html}                              | > Non-Plan Provider\       |
| <!-- -->                                | > 30% of eligible charges  |
| ```                                     | > and any difference       |
| -   Allergy injection                   | > between our payment and  |
|                                         | > the actual charge        |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Treatment materials                 |                            |
+-----------------------------------------+----------------------------+
| > Allergy serum                         | > Plan Provider\           |
|                                         | > Nothing                  |
|                                         | >                          |
|                                         | > Non-Plan Provider\       |
|                                         | > 30% of eligible charges  |
|                                         | > and any difference       |
|                                         | > between our payment and  |
|                                         | > the actual charge        |
+-----------------------------------------+----------------------------+
| > *Not covered: Provocative food        | > *All charges*            |
| > testing and sublingual allergy        |                            |
| > desensitization*                      |                            |
+-----------------------------------------+----------------------------+
| ######## Treatment therapies            |                            |
+-----------------------------------------+----------------------------+
| -   Chemotherapy and radiation therapy  | > Plan Provider\           |
|                                         | > 20% of eligible charges  |
| > Note: High dose chemotherapy in       | >                          |
| > association with autologous bone      | > Non-Plan Provider\       |
| > marrow transplants are limited to     | > 30% of eligible charges  |
| > those transplants listed under        | > and any difference       |
| > Organ/Tissue Transplants on page      | > between our payment and  |
| > [31](#Section_5_Organ_Transplants).   | > the actual charge        |
|                                         |                            |
| -   Respiratory and inhalation therapy  |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Dialysis -- hemodialysis and        |                            |
|     peritoneal dialysis                 |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Intravenous (IV)/Infusion Therapy   |                            |
|     -- Home IV and antibiotic therapy,  |                            |
|     self-administered injections,       |                            |
|     Outpatient injections and           |                            |
|     Intravenous nutrient solutions for  |                            |
|     primary diet.                       |                            |
+-----------------------------------------+----------------------------+
| -   []{#chemotherapy .anchor}Medical    | > Plan Provider\           |
|     foods and low-protein modified food | > 20% of eligible charges  |
|     products for the treatment of       | >                          |
|     inborn errors of metabolism in      | > Non-Plan Provider\       |
|     accord with Hawaii Law and Plan     | > 30% of eligible charges  |
|     guidelines                          | > and any difference       |
|                                         | > between our payment and  |
| -   Growth hormone therapy (GHT)        | > the actual charge        |
|                                         |                            |
| > Note: We will only cover GHT when we  |                            |
| > precertify the treatment. Call        |                            |
| > 808/948-6499 for more information on  |                            |
| > precertification. We will ask you to  |                            |
| > submit information that establishes   |                            |
| > that GHT is medically necessary. If   |                            |
| > you do not ask or if we determine GHT |                            |
| > is not medically necessary, we will   |                            |
| > not cover GHT or related services and |                            |
| > supplies. See services requiring our  |                            |
| > prior approval in Section 3.          |                            |
+-----------------------------------------+----------------------------+

+-----------------------------------------+----------------------------+
| > **Physical and occupational           | **You pay**                |
| > therapies**[]{#Section_5_PT_and_OT    |                            |
| > .anchor}                              |                            |
+-----------------------------------------+----------------------------+
| -   Short term therapy for the services | > Plan Provider\           |
|     of each of the following:           | > 20% of eligible charges  |
|                                         | >                          |
| ```{=html}                              | > Non-Plan Provider\       |
| <!-- -->                                | > 30% of eligible charges  |
| ```                                     | > and any difference       |
| -   Qualified physical therapists and   | > between our payment and  |
|                                         | > the actual charge        |
| -   Occupational therapists             |                            |
|                                         |                            |
| Note: We only cover therapy to restore  |                            |
| bodily function when there has been a   |                            |
| total or partial loss of bodily         |                            |
| function due to illness or injury. If   |                            |
| you require more than 10 visits of      |                            |
| outpatient physical therapy, outpatient |                            |
| occupational therapy, or a combination  |                            |
| of both, for an injury or illness, a    |                            |
| precertification request with a current |                            |
| progress evaluation and treatment plan  |                            |
| should be completed. If the requested   |                            |
| services extend beyond a 30-day period, |                            |
| an updated treatment plan is required   |                            |
| with documentation of your progress.    |                            |
| Plan providers obtain approval for you, |                            |
| non-Plan providers do not.              |                            |
+-----------------------------------------+----------------------------+
| -   Cardiac rehabilitation is covered   | > Plan Provider\           |
|     for up to 2 complete programs per   | > 20% of eligible charges  |
|     lifetime when:                      | >                          |
|                                         | > Non-Plan Provider\       |
| ```{=html}                              | > 30% of eligible charges  |
| <!-- -->                                | > and any difference       |
| ```                                     | > between our payment and  |
| -   You are referred by your doctor for | > the actual charge        |
|     cardiac rehabilitation within three | >                          |
|     months after coronary bypass        | > The Plan's payment is    |
|     surgery or diagnosis of acute       | > limited to \$300         |
|     myocardial infarction               |                            |
|                                         |                            |
| -   Each program consists of planned    |                            |
|     exercise to rehabilitate and        |                            |
|     strengthen the heart and education  |                            |
|     to provide information and          |                            |
|     motivation for behavior/lifestyle   |                            |
|     changes                             |                            |
|                                         |                            |
| -   Each treatment program must be      |                            |
|     completed within 180 days (no       |                            |
|     benefits are paid if the program is |                            |
|     not completed)                      |                            |
+-----------------------------------------+----------------------------+
| *Not covered:*                          | > *All charges*            |
|                                         |                            |
| -   *Long-term rehabilitative therapy*  |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   *Exercise programs*                 |                            |
+-----------------------------------------+----------------------------+
| > **Speech                              | **You Pay**                |
| >                                       |                            |
|  therapy**[]{#Section_5_Speech_Therapyl |                            |
| > .anchor}                              |                            |
+-----------------------------------------+----------------------------+
| > 25 visits per calendar year           | > Plan Provider\           |
|                                         | > 20% of eligible charges  |
|                                         | >                          |
|                                         | > Non-Plan Provider\       |
|                                         | > 30% of eligible charges  |
|                                         | > and any difference       |
|                                         | > between our payment and  |
|                                         | > the actual charge        |
+-----------------------------------------+----------------------------+
| > **Hearing services (testing,          |                            |
| > treatment, and                        |                            |
| > su                                    |                            |
| pplies)**[]{#Section_5_Hearing_Services |                            |
| > .anchor}                              |                            |
+-----------------------------------------+----------------------------+
| -   Diagnostic hearing test             | > Plan Provider\           |
|                                         | > 20% of eligible charges  |
| -   Hearing Aids -- one every five      | >                          |
|     years                               | > Non-Plan Provider\       |
|                                         | > 30% of eligible charges  |
| > Note: Hearing testing for children    | > and any difference       |
| > through age 17\                       | > between our payment and  |
| > (see Section 5(a) *Preventive care,   | > the actual charge        |
| > children.*)                           |                            |
+-----------------------------------------+----------------------------+
| > *Not covered:*                        | > *All charges*            |
|                                         |                            |
| -   *All other hearing testing*         |                            |
|                                         |                            |
| -   *Repair of hearing aids*            |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   *Hearing aid evaluation*            |                            |
+-----------------------------------------+----------------------------+

+-----------------------------------------+----------------------------+
| > **Vision services (testing,           | **You Pay**                |
| > treatment, and                        |                            |
| > s                                     |                            |
| upplies)**[]{#Section_5_Vision_Services |                            |
| > .anchor}                              |                            |
+-----------------------------------------+----------------------------+
| > []{#Eyeglasses_Covered                | > Plan Provider\           |
| > .anchor}Eyeglasses or contact lenses  | > 20% of eligible charges  |
| > for certain medical conditions such   | >                          |
| > as aphakia, cataract, and             | > Non-Plan Provider\       |
| > keratoconus.                          | > 30% of eligible charges  |
|                                         | > and any difference       |
|                                         | > between our payment and  |
|                                         | > the actual charge        |
+-----------------------------------------+----------------------------+
| -   Annual vision exam                  | > Plan Optometrist\        |
|                                         | > \$7 per visit            |
| -   Annual eye refractions              | >                          |
|                                         | > Plan Provider\           |
| > Note: For eye exams for children see  | > 20% of eligible charges  |
| > Section 5(a) *Preventive care,        | >                          |
| > children.*                            | > Non-Plan Provider\       |
|                                         | > 30% of eligible charges  |
|                                         | > and any difference       |
|                                         | > between our payment and  |
|                                         | > the actual charge        |
+-----------------------------------------+----------------------------+
| > *Not covered:*                        | > *All charges*            |
|                                         |                            |
| -   *Eyeglasses or contact lenses       |                            |
|     except as stated above*             |                            |
|                                         |                            |
| -   *Eye exercises and orthoptics*      |                            |
|                                         |                            |
| -   *Radial keratotomy and other        |                            |
|     refractive surgery*                 |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   *Contact lens fitting*              |                            |
+-----------------------------------------+----------------------------+
| ######## Foot care                      |                            |
+-----------------------------------------+----------------------------+
| > Routine foot care when you are under  | > Plan Provider\           |
| > active treatment for a metabolic or   | > 20% of eligible charge   |
| > peripheral vascular disease, such as  | >                          |
| > diabetes                              | > Non-Plan Provider\       |
| >                                       | > 30% of eligible charges  |
| > See Orthopedic and prosthetic devices | > and any difference       |
| > for information on podiatric shoe     | > between our payment and  |
| > inserts                               | > the actual charge        |
+-----------------------------------------+----------------------------+
| > *Not covered:*                        | > *All charges*            |
|                                         |                            |
| -   *Cutting, trimming, or removal of   |                            |
|     corns, calluses, or the free edge   |                            |
|     of toenails, and similar routine    |                            |
|     treatment of conditions of the      |                            |
|     foot, except as stated above*       |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   *Treatment of weak, strained or     |                            |
|     flat feet or bunions or spurs; and  |                            |
|     of any instability, imbalance or    |                            |
|     subluxation of the foot (unless the |                            |
|     treatment is by open cutting        |                            |
|     surgery)*                           |                            |
+-----------------------------------------+----------------------------+
| > **Orthopedic and prosthetic devices** |                            |
| >                                       |                            |
| []{#Section_5_Orthopedic_and_Prosthetic |                            |
| > .anchor}                              |                            |
+-----------------------------------------+----------------------------+
| -   Artificial limbs and eyes           | > Plan Provider\           |
|                                         | > 20% of eligible charges  |
| -   Externally worn breast prostheses   | >                          |
|     and surgical bras, including        | > Non-Plan Provider\       |
|     necessary replacements, following a | > 30% of eligible charges  |
|     mastectomy                          | > and any difference       |
|                                         | > between our payment and  |
| ```{=html}                              | > the actual charge        |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Prosthetic devices, such as         |                            |
|     artificial limbs and lenses         |                            |
|     following cataract removal          |                            |
+-----------------------------------------+----------------------------+

*Orthopedic and prosthetic devices -- continued on next page*

+-----------------------------------------+----------------------------+
| > **Orthopedic and prosthetic devices** | **You Pay**                |
| > *(continued)*                         |                            |
+-----------------------------------------+----------------------------+
| -   Orthopedic devices, such as braces  | > Plan Provider\           |
|                                         | > 20% of eligible charges  |
| -   Internal prosthetic devices such as | >                          |
|     artificial joints; pacemakers,      | > Non-Plan Provider\       |
|     cochlear implants, and surgically   | > 30% of eligible charges  |
|     implanted breast implant following  | > and any difference       |
|     mastectomy. Note: See Section 5(b)  | > between our payment and  |
|     for coverage of the surgery to      | > the actual charge        |
|     insert the device.                  |                            |
+-----------------------------------------+----------------------------+
| > *Not covered:*                        | > *All charges*            |
|                                         |                            |
| -   *Orthopedic and corrective shoes*   |                            |
|                                         |                            |
| -   *Podiatric shoes*                   |                            |
|                                         |                            |
| -   *Arch supports*                     |                            |
|                                         |                            |
| -   *Foot orthotics, except for         |                            |
|     specific diabetic conditions*       |                            |
|                                         |                            |
| -   *Heel pads and heel cups*           |                            |
|                                         |                            |
| -   *Lumbosacral supports*              |                            |
|                                         |                            |
| -   *Corsets, trusses, elastic          |                            |
|     stockings, support hose, and other  |                            |
|     supportive device*                  |                            |
|                                         |                            |
| -   *Bionic services and devices*       |                            |
+-----------------------------------------+----------------------------+
| #                                       |                            |
| ####### Durable medical equipment (DME) |                            |
+-----------------------------------------+----------------------------+
| > Rental or purchase, at our option,    | > Plan Provider\           |
| > including repair and adjustment, of   | > 20% of eligible charges  |
| > durable medical equipment prescribed  | >                          |
| > by your provider, such as oxygen and  | > Non-Plan Provider\       |
| > dialysis equipment. Under this        | > 30% of eligible charges  |
| > benefit, we also cover:               | > and any difference       |
|                                         | > between our payment and  |
| -   Hospital beds                       | > the actual charge        |
|                                         |                            |
| -   Wheelchairs[]{#wheelchair .anchor}  |                            |
|                                         |                            |
| -   Crutches[]{#crutches .anchor}       |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Walkers                             |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Blood glucose monitors              |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Insulin pumps                       |                            |
+-----------------------------------------+----------------------------+
| > *Not covered:*                        | > *All charges*            |
|                                         |                            |
| -   *Convenience items such as          |                            |
|     motorized wheel chairs*             |                            |
+-----------------------------------------+----------------------------+
| ######## Home health services           |                            |
+-----------------------------------------+----------------------------+
| -   Home health care ordered by a Plan  | > Plan Provider\           |
|     physician and provided by a         | > 20% of eligible charges  |
|     qualified home health agency for    | >                          |
|     the treatment of an illness or      | > Non-Plan Provider\       |
|     injury when you are homebound.      | > 30% of eligible charges  |
|     Homebound means that due to an      | > and any differences      |
|     illness or injury, you are unable   | > between our payment and  |
|     to leave home or if you leave home, | > the actual charge        |
|     doing so requires a considerable    |                            |
|     and taxing effort .                 |                            |
|                                         |                            |
| ```{=html}                              |                            |
| <!-- -->                                |                            |
| ```                                     |                            |
| -   Services provided for up to 150     |                            |
|     visits per calendar year            |                            |
|                                         |                            |
| > Note: If you need home health care    |                            |
| > services for more than 30 days, a     |                            |
| > physician must certify that there is  |                            |
| > further need for the services and     |                            |
| > provide a continuing plan of          |                            |
| > treatment at the end of each 30-day   |                            |
| > period of care.                       |                            |
+-----------------------------------------+----------------------------+

*Home health services -- continued on next page*

+-----------------------------------------+----------------------------+
| ####                                    | **You Pay**                |
| #### Home health services *(continued)* |                            |
+-----------------------------------------+----------------------------+
| > Not covered:                          | > *All charges*            |
|                                         |                            |
| -   *Nursing care requested by, or for  |                            |
|     the convenience of, the patient or  |                            |
|     the patient's family*               |                            |
|                                         |                            |
| -   *Home care primarily for personal   |                            |
|     assistance that does not include a  |                            |
|     medical component and is not        |                            |
|     diagnostic, therapeutic, or         |                            |
|     rehabilitative*                     |                            |
+-----------------------------------------+----------------------------+
| ######## Chiropractic                   |                            |
+-----------------------------------------+----------------------------+
| > *No Benefit*                          | > *All charges*            |
+-----------------------------------------+----------------------------+
| ######## Alternative treatments         |                            |
+-----------------------------------------+----------------------------+
| > *No Benefit*                          | > *All charges*            |
+-----------------------------------------+----------------------------+
| > *Not covered:*                        | > *All charges*            |
|                                         |                            |
| -   *Biofeedback and other forms of     |                            |
|     self-care or self-help training and |                            |
|     any related diagnostic testing*     |                            |
+-----------------------------------------+----------------------------+
| ##                                      |                            |
| ## **Educational classes and programs** |                            |
+-----------------------------------------+----------------------------+
| -   []{#smoking_cessation_QUIT_NOW      | > Nothing                  |
|     .anchor}Smoking Cessation -- Ready, |                            |
|     Set, Quit                           |                            |
|                                         |                            |
| #### A program for                      |                            |
| smokers who are ready to quit smoking.  |                            |
| For more information call 808/952-4400. |                            |
+-----------------------------------------+----------------------------+
| > Coverage is limited to:               | > Nothing                  |
|                                         |                            |
| -   Life Style Management -- Health     |                            |
|     Odyssey\                            |                            |
|     \                                   |                            |
|     HMSA's Health Odyssey programs      |                            |
|     provide a series of practical,      |                            |
|     fun-filled health education classes |                            |
|     to help you create a healthier,     |                            |
|     happier life.\                      |                            |
|     \                                   |                            |
|     Sessions are interactive and        |                            |
|     include a broad range of life style |                            |
|     topics such as goal setting,        |                            |
|     developing new habits, stress       |                            |
|     management, nutrition and fitness.  |                            |
|     Call your local HMSA Office for     |                            |
|     more information or to register for |                            |
|     Health Odyssey.                     |                            |
|                                         |                            |
| -   Disease Management\                 |                            |
|     \                                   |                            |
|     HMSA provides new and               |                            |
|     individualized programs to help you |                            |
|     better manage chronic illnesses.    |                            |
|     These programs allow you to take a  |                            |
|     much larger and more responsible    |                            |
|     role in controlling your illness.\  |                            |
|     \                                   |                            |
|     There are currently three disease   |                            |
|     management programs offered: Asthma |                            |
|     Care Connection, Diabetes Care      |                            |
|     Connection, and Cardiac Care        |                            |
|     Connection. To find out if these    |                            |
|     programs are right for you, talk    |                            |
|     with your primary care physician.   |                            |
+-----------------------------------------+----------------------------+

*Educational classes and programs -- continued on next page*

+-----------------------------------------+----------------------------+
| #### **Education                        | **You pay**                |
| al classes and programs** *(continued)* |                            |
+-----------------------------------------+----------------------------+
| > Prenatal Care Program\                | > Nothing                  |
| > The Good Pregnancy -- He Hapai Pono\  |                            |
| > \                                     |                            |
| > He Hapai Pono offers many ways to     |                            |
| > help you have a healthy pregnancy and |                            |
| > delivery. As soon as you become       |                            |
| > pregnant, you'll want to have your    |                            |
| > primary care physician register you   |                            |
| > in our program. You'll take an        |                            |
| > automated telephone survey and        |                            |
| > receive a personally tailored booklet |                            |
| > of information based on your          |                            |
| > responses. You'll also receive a copy |                            |
| > of the pregnancy best seller *What to |                            |
| > Expect When You're Expecting* and     |                            |
| > after delivery, we'll send you a copy |                            |
| > of *What to Expect the First Year* to |                            |
| > help you and your new baby get off to |                            |
| > a good start. To register call        |                            |
| > 888/400-2776 or visit the Web site at |                            |
| > [www.hmsa.com/myhealth]{.underline}.  |                            |
+-----------------------------------------+----------------------------+
| > *Not covered except as offered        | > *All                     |
| > through HMSA programs:*               | > charges*[]{#Sect         |
|                                         | ion_5_Medical_Services_End |
| -   *Weight reduction programs*         | > .anchor}                 |
|                                         |                            |
| -   *Smoking Cessation programs*        |                            |
|                                         |                            |
| -   *Nutrition Counseling*              |                            |
+-----------------------------------------+----------------------------+

+---+---+-------------------------------------+----------------------+---+---+
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| \ |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
|   | * | > **Here are some important things  |                      | * |   |
|   | * | > to keep in mind about these       |                      | * |   |
|   | I | > benefits:**                       |                      | I |   |
|   | * |                                     |                      | * |   |
|   | * | -   Please remember that all        |                      | * |   |
|   |   |     benefits are subject to the     |                      |   |   |
|   | * |     definitions, limitations, and   |                      | * |   |
|   | * |     exclusions in this brochure and |                      | * |   |
|   | M |     are payable only when we        |                      | M |   |
|   | * |     determine they are medically    |                      | * |   |
|   | * |     necessary.                      |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * | ```{=html}                          |                      | * |   |
|   | * | <!-- -->                            |                      | * |   |
|   | P | ```                                 |                      | P |   |
|   | * | -   We have no calendar year        |                      | * |   |
|   | * |     deductible.                     |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * | ```{=html}                          |                      | * |   |
|   | * | <!-- -->                            |                      | * |   |
|   | O | ```                                 |                      | O |   |
|   | * | -   Be sure to read Section 4,      |                      | * |   |
|   | * |     *Your costs for covered         |                      | * |   |
|   |   |     services,* for valuable         |                      |   |   |
|   | * |     information about how cost      |                      | * |   |
|   | * |     sharing works. Also read        |                      | * |   |
|   | R |     Section 9 about coordinating    |                      | R |   |
|   | * |     benefits with other coverage,   |                      | * |   |
|   | * |     including with Medicare.        |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * | -   The amounts listed below are    |                      | * |   |
|   | * |     for the charges billed by a     |                      | * |   |
|   | T |     physician or other health care  |                      | T |   |
|   | * |     professional for your surgical  |                      | * |   |
|   | * |     care. Look in Section 5(c) for  |                      | * |   |
|   |   |     charges associated with the     |                      |   |   |
|   | * |     facility. (i.e. hospital,       |                      | * |   |
|   | * |     surgical center, etc.).         |                      | * |   |
|   | A |                                     |                      | A |   |
|   | * | ```{=html}                          |                      | * |   |
|   | * | <!-- -->                            |                      | * |   |
|   |   | ```                                 |                      |   |   |
|   | * | -   YOU MUST GET PRECERTIFICATION   |                      | * |   |
|   | * |     FOR SOME SURGICAL PROCEDURES.   |                      | * |   |
|   | N |     Please refer to the             |                      | N |   |
|   | * |     precertification information    |                      | * |   |
|   | * |     shown in Section 3 to be sure   |                      | * |   |
|   |   |     which services require          |                      |   |   |
|   | * |     precertification and identify   |                      | * |   |
|   | * |     which surgeries require         |                      | * |   |
|   | T |     precertification.               |                      | T |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
+---+---+-------------------------------------+----------------------+---+---+
| > |   |                                     | **You pay**          |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| B |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| > |   |                                     | > Plan Provider\     |   |   |
|   |   |                                     | > (cutting) Nothing\ |   |   |
| * |   |                                     | > (non-cutting) 20%  |   |   |
| * |   |                                     | > of eligible        |   |   |
| C |   |                                     | > charges            |   |   |
| u |   |                                     | >                    |   |   |
| t |   |                                     | > Non-Plan Provider\ |   |   |
| t |   |                                     | > (cutting and       |   |   |
| i |   |                                     | > non-cutting)\      |   |   |
| n |   |                                     | > 30% of eligible    |   |   |
| g |   |                                     | > charges and any    |   |   |
| > |   |                                     | > difference between |   |   |
|   |   |                                     | > our payment and    |   |   |
| S |   |                                     | > the actual charge  |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| : |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| P |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| Y |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| C |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| & |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| : |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| O |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| P |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| T |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| z |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| C |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| j |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| j |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| j |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| E |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| C |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| E |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| B |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
| B |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| R |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| C |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| \ |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| R |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| \ |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| 1 |   |                                     |                      |   |   |
| 0 |   |                                     |                      |   |   |
| 0 |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| 1 |   |                                     |                      |   |   |
| 0 |   |                                     |                      |   |   |
| 0 |   |                                     |                      |   |   |
| % |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| ; |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| 1 |   |                                     |                      |   |   |
| 8 |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| O |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+

*Surgical procedures - continued on next page*

+------------------------------------------+---------------------------+
| > **Surgical Procedures** *(continued)*  | > **You pay**             |
+------------------------------------------+---------------------------+
| > **Cutting and Non-cutting surgical**   | > Plan Provider\          |
| > procedures (continued)                 | > (cutting) Nothing\      |
|                                          | > (non-cutting) 20% of    |
| -   Voluntary sterilization (e.g., Tubal | > eligible charges        |
|     ligation, Vasectomy)                 | >                         |
|                                          | > Non-Plan Provider\      |
| -   Treatment of burns                   | > (cutting and            |
|                                          | > non-cutting)\           |
| -   Newborn Circumcision                 | > 30% of eligible charges |
|                                          | > and any difference      |
|                                          | > between our payment and |
|                                          | > the actual charge       |
+------------------------------------------+---------------------------+
| > *Not covered:*                         | > *All charges*           |
|                                          |                           |
| -   *Reversal of voluntary               |                           |
|     sterilization*                       |                           |
|                                          |                           |
| -   *Routine treatment of conditions of  |                           |
|     the foot; see Foot care*             |                           |
+------------------------------------------+---------------------------+
| > **Reconstructive surgery**             |                           |
| > []{#Section_5_Reconstructive_Surgery   |                           |
| > .anchor}                               |                           |
+------------------------------------------+---------------------------+
| -   Surgery to correct a functional      | > Plan Provider\          |
|     defect                               | > (cutting) Nothing\      |
|                                          | > (non-cutting) 20% of    |
| ```{=html}                               | > eligible charges        |
| <!-- -->                                 | >                         |
| ```                                      | > Non-Plan Provider\      |
| -   Surgery to correct a condition       | > (cutting and            |
|     caused by injury or illness if:      | > non-cutting)\           |
|                                          | > 30% of eligible charges |
| ```{=html}                               | > and any difference      |
| <!-- -->                                 | > between our payment and |
| ```                                      | > the actual charge       |
| -   the condition produced a major       |                           |
|     effect on the member's appearance    |                           |
|     and                                  |                           |
|                                          |                           |
| -   the condition can reasonably be      |                           |
|     expected to be corrected by such     |                           |
|     surgery                              |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Surgery to correct a condition that  |                           |
|     existed at or from birth and is a    |                           |
|     significant deviation from the       |                           |
|     common form or norm. Examples of     |                           |
|     congenital                           |                           |
|                                          |                           |
|   []{#correction_of_congenital_anomalies |                           |
|     .anchor}anomalies are: protruding    |                           |
|     ear deformities, cleft lip, cleft    |                           |
|     palate, birth marks, webbed fingers  |                           |
|     and webbed toes.                     |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   All stages of breast reconstruction  |                           |
|     surgery following a mastectomy, such |                           |
|     as:                                  |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   surgery to produce a symmetrical     |                           |
|     appearance of breasts                |                           |
|                                          |                           |
| -   treatment of any physical            |                           |
|     complications, such as lymphedemas   |                           |
|                                          |                           |
| -   breast prostheses and surgical bras  |                           |
|     and replacements (see Prosthetic     |                           |
|     devices)                             |                           |
|                                          |                           |
| > Note: If you need a mastectomy, you    |                           |
| > may choose to have the procedure       |                           |
| > performed on an inpatient basis and    |                           |
| > remain in the hospital up to 48 hours  |                           |
| > after the procedure                    |                           |
+------------------------------------------+---------------------------+
| > *Not covered:*                         | > *All charges*           |
|                                          |                           |
| -   *Cosmetic surgery -- any surgical    |                           |
|     procedure (or any portion of a       |                           |
|     procedure) performed primarily to    |                           |
|     improve physical appearance through  |                           |
|     change in bodily form, except repair |                           |
|     of accidental injury*                |                           |
|                                          |                           |
| -   *Surgeries related to sex            |                           |
|     transformation*                      |                           |
+------------------------------------------+---------------------------+

+------------------------------------------+---------------------------+
| > **Oral and maxillofacial surgery**     | > **You pay**             |
| > []{#Section_5_Oral_And_Maxillofacial   |                           |
| > .anchor}                               |                           |
+------------------------------------------+---------------------------+
| > Oral surgical procedures, limited to:  | > Plan Provider\          |
|                                          | > (cutting) Nothing\      |
| -   Reduction of fractures of the jaws   | > (non-cutting) 20% of    |
|     or facial bones                      | > eligible charges        |
|                                          | >                         |
| -   Surgical correction of cleft lip or  | > Non-Plan Provider       |
|     cleft palate                         | > (cutting and            |
|                                          | > non-cutting)\           |
| -   Removal of stones from salivary      | > 30% of eligible charges |
|     ducts                                | > and any difference      |
|                                          | > between our payment and |
| -   Excision of leukoplakia or           | > the actual charge       |
|     malignancies                         |                           |
|                                          |                           |
| -   Excision of cysts and incision of    |                           |
|     abscesses when done as independent   |                           |
|     procedures                           |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Other surgical procedures that do    |                           |
|     not involve the teeth or their       |                           |
|     supporting structures                |                           |
+------------------------------------------+---------------------------+
| > *Not covered:*                         | > *All charges*           |
|                                          |                           |
| -   *Oral implants and transplants*      |                           |
|                                          |                           |
| -   *Procedures that involve the teeth   |                           |
|     or their supporting structures (such |                           |
|     as the periodontal membrane,         |                           |
|     gingiva, and alveolar bone)*         |                           |
|                                          |                           |
| -   *Dental surgeries generally done by  |                           |
|     dentists and not physicians*         |                           |
|                                          |                           |
| -   *Services, drugs or supplies for     |                           |
|     nondental treatment of               |                           |
|     temporomandibular joint (TMJ)        |                           |
|     syndrome*                            |                           |
+------------------------------------------+---------------------------+
| > **Organ/tissue                         |                           |
| > tran                                   |                           |
| splants**[]{#Section_5_Organ_Transplants |                           |
| > .anchor}                               |                           |
+------------------------------------------+---------------------------+
| > Limited to:                            | > Plan Provider\          |
|                                          | > (cutting) Nothing\      |
| -   Cornea                               | > (non-cutting) 20% of    |
|                                          | > eligible charges        |
| -   Heart                                | >                         |
|                                          | > Non-Plan Provider\      |
| -   Heart/lung                           | > (cutting and            |
|                                          | > non-cutting)\           |
| -   Kidney                               | > 30% of eligible charges |
|                                          | > and any difference      |
| -   Kidney/Pancreas                      | > between our payment and |
|                                          | > the actual charge       |
| -   Liver                                |                           |
|                                          |                           |
| -   Lung: Single -- Double               |                           |
|                                          |                           |
| -   Allogeneic (donor) bone marrow       |                           |
|     tran                                 |                           |
| splants[]{#Allogenetic_donor_bone_marrow |                           |
|     .anchor}                             |                           |
|                                          |                           |
| -   Autologous bone marrow transplants   |                           |
|     (autologous stem cell and peripheral |                           |
|     stem cell support) for the following |                           |
|     conditions: acute lymphocytic or     |                           |
|     non-lymphocytic leukemia; advanced   |                           |
|     Hodgkin\'s lymphoma; advanced        |                           |
|     non-Hodgkin\'s lymphoma; advanced    |                           |
|     neuroblastoma; breast cancer;        |                           |
|     multiple myeloma; epithelial ovarian |                           |
|     cancer; and testicular, mediastinal, |                           |
|     retroperitoneal and ovarian germ     |                           |
|     cell tumors                          |                           |
|                                          |                           |
| -   Autologous tandem transplants for    |                           |
|     testicular or other germ cell tumors |                           |
|                                          |                           |
| -   Treatment for breast cancer,         |                           |
|     multiple myeloma, and epithlial      |                           |
|     ovarian cancer must be provided in a |                           |
|     National Cancer Institute - or       |                           |
|     National Institutes of Health -      |                           |
|     approved clinical trial at a         |                           |
|     Plan-designated center of excellence |                           |
|     and approved by the Plan's medical   |                           |
|     director in accordance with the      |                           |
|     Plan's protocols                     |                           |
|                                          |                           |
| -   Intestinal transplants (small        |                           |
|     intestine) and the small intestine   |                           |
|     with the liver or small intestine    |                           |
|     with multiple organs such as the     |                           |
|     liver, stomach and pancreas          |                           |
|                                          |                           |
| > Note: We cover related medical and     |                           |
| > hospital expenses of the donor when we |                           |
| > cover the recipient                    |                           |
+------------------------------------------+---------------------------+

Organ/tissue transplants- continued on next page

+------------------------------------------+---------------------------+
| > **Organ/tissue transplants**           | > **You pay**             |
| > *(continued)*                          |                           |
+------------------------------------------+---------------------------+
| > This coverage is secondary and the     | > Plan Provider\          |
| > living donor's coverage is primary     | > (cutting) Nothing\      |
| > when:                                  | > (non-cutting) 20% of    |
|                                          | > eligible charges        |
| -   You are the recipient of an organ    | >                         |
|     from a living donor, and             | > Non-Plan Provider\      |
|                                          | > (cutting and            |
| -   The donor's health coverage provides | > non-cutting)\           |
|     benefits for organs donated by a     | > 30% of eligible charges |
|     living donor                         | > and any difference      |
|                                          | > between our payment and |
| > Transplant evaluations:                | > the actual charge       |
|                                          |                           |
| -   Must receive our approval (with the  |                           |
|     exception of corneal and kidney      |                           |
|     transplant evaluations)              |                           |
|                                          |                           |
| -   Means those procedures, including    |                           |
|     laboratory and diagnostic tests,     |                           |
|     consultations, and psychological     |                           |
|     evaluations, which a hospital or     |                           |
|     facility uses in evaluating a        |                           |
|     potential transplant candidate       |                           |
|                                          |                           |
| > Transplants (with the exception of     |                           |
| > corneal and kidney) must:              |                           |
|                                          |                           |
| -   Receive our approval. Without our    |                           |
|     approval for specific transplants,   |                           |
|     benefits are not available.          |                           |
|                                          |                           |
| -   Be received from a facility that:    |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   is under contract with us for that   |                           |
|     type of transplant; and              |                           |
|                                          |                           |
| -   accepts you as a transplant          |                           |
|     candidate.                           |                           |
|                                          |                           |
| -   This restriction does not apply to   |                           |
|     intestinal transplants.              |                           |
|                                          |                           |
| > ***Please refer to the                 |                           |
| > precertification information shown     |                           |
| > in***                                  |                           |
| >                                        |                           |
| > ***Section 3***                        |                           |
+------------------------------------------+---------------------------+
| > *Not covered:*                         | > *All charges*           |
|                                          |                           |
| -   *Donor screening tests and donor     |                           |
|     search expenses, except those        |                           |
|     performed for the actual donor*      |                           |
|                                          |                           |
| -   *Implants of artificial organs*      |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   *Transplants not listed as covered*  |                           |
|                                          |                           |
| -   *Non-human organs*                   |                           |
+------------------------------------------+---------------------------+
| > **Anesthesia** []{#Anesthesia .anchor} |                           |
+------------------------------------------+---------------------------+
| > Professional services provided in:     | > Plan Provider\          |
|                                          | > 20% of eligible charges |
| -   Hospital (inpatient)                 | >                         |
|                                          | > Non-Plan Provider\      |
| ```{=html}                               | > 30% of eligible charges |
| <!-- -->                                 | > and any difference      |
| ```                                      | > between our payment and |
| -   Hospital outpatient department       | > the actual charge       |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Skilled nursing facility             |                           |
|                                          |                           |
| -   Ambulatory surgical center           |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Office                               |                           |
+------------------------------------------+---------------------------+
| > Professional services include:         | > []{#Section_5_Su        |
|                                          | rgical_And_Anesthesia_End |
| -   General anesthesia                   | > .anchor}                |
|                                          |                           |
| -   Regional anesthesia                  |                           |
|                                          |                           |
| -   Monitored anesthesia when you meet   |                           |
|     the Plan's high-risk criteria        |                           |
+------------------------------------------+---------------------------+

+---+---+-------------------------------------+----------------------+---+---+---+
| * |   |                                     |                      |   |   |   |
| * |   |                                     |                      |   |   |   |
| S |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| 5 |   |                                     |                      |   |   |   |
| ( |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| ) |   |                                     |                      |   |   |   |
| . |   |                                     |                      |   |   |   |
| S |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| f |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
| \ |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| * |   |                                     |                      |   |   |   |
| * |   |                                     |                      |   |   |   |
| [ |   |                                     |                      |   |   |   |
| ] |   |                                     |                      |   |   |   |
| { |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| S |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| _ |   |                                     |                      |   |   |   |
| 5 |   |                                     |                      |   |   |   |
| _ |   |                                     |                      |   |   |   |
| H |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| . |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| } |   |                                     |                      |   |   |   |
+---+---+-------------------------------------+----------------------+---+---+---+
|   | * | > **Here are some important things  |                      | * |   |   |
|   | * | > to remember about these           |                      | * |   |   |
|   | I | > benefits:**                       |                      | I |   |   |
|   | * |                                     |                      | * |   |   |
|   | * | -   Please remember that all        |                      | * |   |   |
|   |   |     benefits are subject to the     |                      |   |   |   |
|   | * |     definitions, limitations, and   |                      | * |   |   |
|   | * |     exclusions in this brochure and |                      | * |   |   |
|   | M |     are payable only when we        |                      | M |   |   |
|   | * |     determine they are medically    |                      | * |   |   |
|   | * |     necessary.                      |                      | * |   |   |
|   |   |                                     |                      |   |   |   |
|   | * | -   We have no calendar year        |                      | * |   |   |
|   | * |     deductible.                     |                      | * |   |   |
|   | P |                                     |                      | P |   |   |
|   | * | -   Be sure to read Section 4,      |                      | * |   |   |
|   | * |     *Your costs for covered         |                      | * |   |   |
|   |   |     services,* for valuable         |                      |   |   |   |
|   | * |     information about how cost      |                      | * |   |   |
|   | * |     sharing works. Also read        |                      | * |   |   |
|   | O |     Section 9 about coordinating    |                      | O |   |   |
|   | * |     benefits with other coverage,   |                      | * |   |   |
|   | * |     including with Medicare.        |                      | * |   |   |
|   |   |                                     |                      |   |   |   |
|   | * | -   The amounts listed below are    |                      | * |   |   |
|   | * |     for the charges billed by the   |                      | * |   |   |
|   | R |     facility (i.e., hospital or     |                      | R |   |   |
|   | * |     surgical center) or ambulance   |                      | * |   |   |
|   | * |     service for your surgery or     |                      | * |   |   |
|   |   |     care. Any costs associated with |                      |   |   |   |
|   | * |     the professional charge (i.e.,  |                      | * |   |   |
|   | * |     physicians, etc.) are covered   |                      | * |   |   |
|   | T |     in Sections 5(a) or (b).        |                      | T |   |   |
|   | * |                                     |                      | * |   |   |
|   | * |                                     |                      | * |   |   |
|   |   |                                     |                      |   |   |   |
|   | * |                                     |                      | * |   |   |
|   | * |                                     |                      | * |   |   |
|   | A |                                     |                      | A |   |   |
|   | * |                                     |                      | * |   |   |
|   | * |                                     |                      | * |   |   |
|   |   |                                     |                      |   |   |   |
|   | * |                                     |                      | * |   |   |
|   | * |                                     |                      | * |   |   |
|   | N |                                     |                      | N |   |   |
|   | * |                                     |                      | * |   |   |
|   | * |                                     |                      | * |   |   |
|   |   |                                     |                      |   |   |   |
|   | * |                                     |                      | * |   |   |
|   | * |                                     |                      | * |   |   |
|   | T |                                     |                      | T |   |   |
|   | * |                                     |                      | * |   |   |
|   | * |                                     |                      | * |   |   |
+---+---+-------------------------------------+----------------------+---+---+---+
| > |   |                                     | **You pay**          |   |   |   |
|   |   |                                     |                      |   |   |   |
| * |   |                                     |                      |   |   |   |
| * |   |                                     |                      |   |   |   |
| B |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| f |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| D |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| * |   |                                     |                      |   |   |   |
| * |   |                                     |                      |   |   |   |
+---+---+-------------------------------------+----------------------+---+---+---+
| # |   |                                     | ########             |   |   |   |
| # |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| I |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
+---+---+-------------------------------------+----------------------+---+---+---+
| > |   |                                     | > Plan Provider\     |   |   |   |
|   |   |                                     | > Nothing\           |   |   |   |
| R |   |                                     | > (based on          |   |   |   |
| o |   |                                     | > semiprivate room   |   |   |   |
| o |   |                                     | > rate)              |   |   |   |
| m |   |                                     | >                    |   |   |   |
| > |   |                                     | > Non-Plan Provider\ |   |   |   |
|   |   |                                     | > 30% of eligible    |   |   |   |
| a |   |                                     | > charges and any    |   |   |   |
| n |   |                                     | > difference between |   |   |   |
| d |   |                                     | > our payment and    |   |   |   |
| > |   |                                     | > the actual charge\ |   |   |   |
|   |   |                                     | > (based on          |   |   |   |
| b |   |                                     | > semiprivate room   |   |   |   |
| o |   |                                     | > rate)              |   |   |   |
| a |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| : |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| S |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| G |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| M |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| N |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| : |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| I |   |                                     |                      |   |   |   |
| f |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| w |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| w |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
+---+---+-------------------------------------+----------------------+---+---+---+
| > |   |                                     | > Plan Provider\     |   |   |   |
|   |   |                                     | > Nothing            |   |   |   |
| S |   |                                     |                      |   |   |   |
| p |   |                                     | ######## No          |   |   |   |
| e |   |                                     | n-Plan Provider 30%  |   |   |   |
| c |   |                                     | of eligible charges  |   |   |   |
| i |   |                                     | and any difference b |   |   |   |
| a |   |                                     | etween our payment a |   |   |   |
| l |   |                                     | nd the actual charge |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| > |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| : |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| I |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| C |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
+---+---+-------------------------------------+----------------------+---+---+---+
| # |   |                                     | > Plan Provider\     |   |   |   |
| # |   |                                     | > Nothing            |   |   |   |
| # |   |                                     | >                    |   |   |   |
| # |   |                                     | > Non-Plan Provider\ |   |   |   |
|   |   |                                     | > 30% of eligible    |   |   |   |
| O |   |                                     | > charges and any    |   |   |   |
| t |   |                                     | > difference between |   |   |   |
| h |   |                                     | > our payment and    |   |   |   |
| e |   |                                     | > the actual charge  |   |   |   |
| r |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| : |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| O |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| P |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| D |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| X |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| A |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| f |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| B |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| [ |   |                                     |                      |   |   |   |
| ] |   |                                     |                      |   |   |   |
| { |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| _ |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| _ |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| . |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| } |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| k |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| D |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| [ |   |                                     |                      |   |   |   |
| ] |   |                                     |                      |   |   |   |
| { |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| S |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| . |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| } |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
| [ |   |                                     |                      |   |   |   |
| ] |   |                                     |                      |   |   |   |
| { |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| . |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| } |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| M |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| q |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| [ |   |                                     |                      |   |   |   |
| ] |   |                                     |                      |   |   |   |
| { |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| x |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| . |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| } |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| x |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| A |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| g |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| [ |   |                                     |                      |   |   |   |
| ] |   |                                     |                      |   |   |   |
| { |   |                                     |                      |   |   |   |
| # |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| _ |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| . |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| } |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| - |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| M |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| q |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| , |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| n |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| c |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| v |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
| d |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| b |   |                                     |                      |   |   |   |
| y |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| p |   |                                     |                      |   |   |   |
| i |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| l |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| f |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| r |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| u |   |                                     |                      |   |   |   |
| s |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| a |   |                                     |                      |   |   |   |
| t |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
|   |   |                                     |                      |   |   |   |
| h |   |                                     |                      |   |   |   |
| o |   |                                     |                      |   |   |   |
| m |   |                                     |                      |   |   |   |
| e |   |                                     |                      |   |   |   |
+---+---+-------------------------------------+----------------------+---+---+---+

*Inpatient hospital - continued on next page*

+------------------------------------------+---------------------------+
| #                                        | ######## You pay          |
| ####### Inpatient hospital *(continued)* |                           |
+------------------------------------------+---------------------------+
| > *Not covered:*                         | > *All charges*           |
|                                          |                           |
| -   *Custodial care, rest cures,         |                           |
|     domiciliary or convalescent care*    |                           |
|                                          |                           |
| -   *Non-covered facilities, such as     |                           |
|     adult day care, intermediate care    |                           |
|     facilities, schools*                 |                           |
|                                          |                           |
| -   *Personal comfort items, such as     |                           |
|     telephone, television, barber        |                           |
|     services, guest meals and beds*      |                           |
|                                          |                           |
| -   *Private nursing care*               |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   *Additional charges for autologous   |                           |
|     blood*                               |                           |
+------------------------------------------+---------------------------+
| #### **Outpatient                        | ####                      |
| hospital or ambulatory surgical center** |                           |
+------------------------------------------+---------------------------+
| > Outpatient medical services provided   | > > Plan Provider\        |
| > by a hospital or ambulatory surgical   | > > 20% of eligible       |
| > center, such as:                       | > > charges               |
|                                          | >                         |
| -   Diagnostic laboratory tests, X-rays, | > Non-Plan Provider\      |
|     and pathology services               | > 30% of eligible charges |
|                                          | > and any difference      |
| -   Pre-surgical testing is covered but  | > between our payment and |
|     only when you meet our criteria      | > the actual charge       |
|                                          |                           |
| > []{#dressings .anchor}                 |                           |
+------------------------------------------+---------------------------+
| > Services associated with outpatient    | > > Plan Provider\        |
| > surgery and provided by a hospital or  | > > Nothing               |
| > ambulatory surgical center, such as:   | >                         |
|                                          | > Non-Plan Provider\      |
| -   Operating, recovery, and other       | > 30% of eligible charges |
|     treatment rooms                      | > and any difference      |
|                                          | > between our payment and |
| -   Prescribed drugs and medicines       | > the actual charge       |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Diagnostic laboratory tests, X-rays, |                           |
|     and pathology services               |                           |
|                                          |                           |
| -   Administration of blood, blood       |                           |
|     plasma, and other biologicals        |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Blood and blood plasma cost, blood   |                           |
|     processing, blood bank               |                           |
|     []{#blood_plasma .anchor}services    |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Dressings, []{#dressings_casts       |                           |
|     .anchor}casts, and sterile tray      |                           |
|     services                             |                           |
|                                          |                           |
| -   Medical supplies, including oxygen   |                           |
|                                          |                           |
| -   Anesthetics                          |                           |
|                                          |                           |
| -   Anesthesia services (Section 5(b))   |                           |
|                                          |                           |
| > Note: We cover hospital services and   |                           |
| > supplies related to dental procedures  |                           |
| > when necessitated by a non-dental      |                           |
| > physical impairment. We do not cover   |                           |
| > the dental procedures except those     |                           |
| > services that are described in the     |                           |
| > Dental Benefits section.               |                           |
+------------------------------------------+---------------------------+

+------------------------------------------+---------------------------+
| ######## Extended care benefit           | ######## You pay          |
| s/skilled nursing care facility benefits |                           |
+------------------------------------------+---------------------------+
| > Skilled nursing facility (SNF):        | > Plan Provider\          |
| >                                        | > Nothing (based on       |
| > A facility that provides continuous    | > semiprivate room)       |
| > skilled nursing services as ordered    | >                         |
| > and certified by your attending        | > Non-Plan Provider\      |
| > physician                              | > 30% of eligible charges |
| >                                        | > and any difference      |
| > Room and Board is covered, but only    | > between our payment and |
| > for semiprivate rooms when:            | > the actual charge       |
|                                          | > (based on semiprivate   |
| -   You are admitted by your physician   | > room rate)              |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Care is ordered and certified by     |                           |
|     your physician                       |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   We approve the confinement           |                           |
|                                          |                           |
| -   Confinement is not primarily for     |                           |
|     comfort, convenience, a rest cure,   |                           |
|     or domiciliary care                  |                           |
|                                          |                           |
| -   If days exceed 30 the attending      |                           |
|     physician must submit a report       |                           |
|     showing the need for additional days |                           |
|     at the end of each 30-day period     |                           |
|                                          |                           |
| -   The confinement is not longer than   |                           |
|     100 days in any one\                 |                           |
|     calendar year                        |                           |
|                                          |                           |
| > Services and supplies are covered,     |                           |
| > including routine surgical supplies,   |                           |
| > drugs, dressings, oxygen, antibiotics, |                           |
| > blood transfusion services, and        |                           |
| > diagnostic and therapy benefits        |                           |
+------------------------------------------+---------------------------+
| > Not covered: Custodial care, rest      | > *All charges*           |
| > cures, domiciliary or\                 |                           |
| > convalescent care                      |                           |
+------------------------------------------+---------------------------+
| #### **Hospice care**                    | ####                      |
+------------------------------------------+---------------------------+
| > A hospice program provides care        | > Plan Provider\          |
| > (generally in a home setting) for      | > Nothing                 |
| > patients who are terminally ill and    | >                         |
| > who have a life expectancy of six      | > Non-Plan Provider\      |
| > months or less                         | > Not a benefit           |
|                                          |                           |
| -   Inpatient residential room and board |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Referral visits                      |                           |
+------------------------------------------+---------------------------+
| > *Not covered:*                         | > *All charges*           |
|                                          |                           |
| -   *Independent nursing*                |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   *Homemaker services*                 |                           |
+------------------------------------------+---------------------------+
| ######## Ambulance                       | ########                  |
+------------------------------------------+---------------------------+
| > Ground professional ambulance service  | > Nothing[]               |
| > is covered when:                       | {#Section_5_Ambulance_End |
|                                          | > .anchor}                |
| -   Medically appropriate                |                           |
|                                          |                           |
| -   Services to treat your illness or    |                           |
|     injury are not available in the      |                           |
|     hospital or nursing facility where   |                           |
|     you are an inpatient                 |                           |
+------------------------------------------+---------------------------+

+---+---+-------------------------------------+-----------------------+---+---+---+
| # |   |                                     |                       |   |   |   |
| # |   |                                     |                       |   |   |   |
| # |   |                                     |                       |   |   |   |
| # |   |                                     |                       |   |   |   |
| # |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| S |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| 5 |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| ( |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| ) |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| E |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| / |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
+---+---+-------------------------------------+-----------------------+---+---+---+
|   | * | > Here are some important things to |                       | * | # |   |
|   | * | > keep in mind about these          |                       | * | # |   |
|   | I | > benefits:                         |                       | I | # |   |
|   | * |                                     |                       | * | # |   |
|   | * | -   Please remember that all        |                       | * | # |   |
|   |   |     benefits are subject to the     |                       |   |   |   |
|   | * |     definitions, limitations, and   |                       | * |   |   |
|   | * |     exclusions in this brochure and |                       | * |   |   |
|   | M |     are payable only when we        |                       | M |   |   |
|   | * |     determine they are medically    |                       | * |   |   |
|   | * |     necessary.                      |                       | * |   |   |
|   |   |                                     |                       |   |   |   |
|   | * | -   We have no calendar year        |                       | * |   |   |
|   | * |     deductible.                     |                       | * |   |   |
|   | P |                                     |                       | P |   |   |
|   | * | -   Be sure to read Section 4,      |                       | * |   |   |
|   | * |     *Your costs for covered         |                       | * |   |   |
|   |   |     services,* for valuable         |                       |   |   |   |
|   | * |     information about how cost      |                       | * |   |   |
|   | * |     sharing works. Also read        |                       | * |   |   |
|   | O |     Section 9 about coordinating    |                       | O |   |   |
|   | * |     benefits with other coverage,   |                       | * |   |   |
|   | * |     including with Medicare.        |                       | * |   |   |
|   |   |                                     |                       |   |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   | R |                                     |                       | R |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   |   |                                     |                       |   |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   | T |                                     |                       | T |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   |   |                                     |                       |   |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   | A |                                     |                       | A |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   |   |                                     |                       |   |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   | N |                                     |                       | N |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   |   |                                     |                       |   |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
|   | T |                                     |                       | T |   |   |
|   | * |                                     |                       | * |   |   |
|   | * |                                     |                       | * |   |   |
+---+---+-------------------------------------+-----------------------+---+---+---+
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| W |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| ? |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| A |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| x |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| j |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| j |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| q |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| S |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| ; |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| x |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| k |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| O |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| k |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| k |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| T |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| q |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| k |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
+---+---+-------------------------------------+-----------------------+---+---+---+
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| W |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| : |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| I |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| Y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| P |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| k |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| I |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| ( |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| 9 |   |                                     |                       |   |   |   |
| 1 |   |                                     |                       |   |   |   |
| 1 |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| ) |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| I |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| z |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
| P |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| P |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| P |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| , |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| E |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| : |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| E |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| S |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| A |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| P |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| " |   |                                     |                       |   |   |   |
| Y |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| P |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| " |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| b |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| P |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
| P |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
+---+---+-------------------------------------+-----------------------+---+---+---+
| > |   |                                     | **You pay**           |   |   |   |
|   |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| B |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| D |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
+---+---+-------------------------------------+-----------------------+---+---+---+
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| E |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| w |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| * |   |                                     |                       |   |   |   |
| [ |   |                                     |                       |   |   |   |
| ] |   |                                     |                       |   |   |   |
| { |   |                                     |                       |   |   |   |
| # |   |                                     |                       |   |   |   |
| S |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| _ |   |                                     |                       |   |   |   |
| 5 |   |                                     |                       |   |   |   |
| _ |   |                                     |                       |   |   |   |
| E |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| _ |   |                                     |                       |   |   |   |
| W |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| . |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| } |   |                                     |                       |   |   |   |
+---+---+-------------------------------------+-----------------------+---+---+---+
| > |   |                                     | > Plan Provider       |   |   |   |
|   |   |                                     | >                     |   |   |   |
| P |   |                                     | > \$15 per visit      |   |   |   |
| r |   |                                     | >                     |   |   |   |
| o |   |                                     | > Non-Plan Provider   |   |   |   |
| f |   |                                     | >                     |   |   |   |
| e |   |                                     | > 20% of eligible     |   |   |   |
| s |   |                                     | > charges             |   |   |   |
| s |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| v |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| > |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| I |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| ' |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| f |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| I |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| A |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| h |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| p |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| l |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| I |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
+---+---+-------------------------------------+-----------------------+---+---+---+
| - |   |                                     | > Plan Provider\      |   |   |   |
|   |   |                                     | > 20% of eligible     |   |   |   |
|   |   |                                     | > charges             |   |   |   |
|   |   |                                     | >                     |   |   |   |
| E |   |                                     | > Non-Plan Provider\  |   |   |   |
| m |   |                                     | > 20% of eligible     |   |   |   |
| e |   |                                     | > charges             |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| d |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| E |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| x |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| a |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| E |   |                                     |                       |   |   |   |
| m |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| s |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| e |   |                                     |                       |   |   |   |
| r |   |                                     |                       |   |   |   |
| y |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
|   |   |                                     |                       |   |   |   |
| ( |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| o |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| - |   |                                     |                       |   |   |   |
| c |   |                                     |                       |   |   |   |
| u |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| t |   |                                     |                       |   |   |   |
| i |   |                                     |                       |   |   |   |
| n |   |                                     |                       |   |   |   |
| g |   |                                     |                       |   |   |   |
| ) |   |                                     |                       |   |   |   |
+---+---+-------------------------------------+-----------------------+---+---+---+

*Emergency services/accidents - continued on next page*

+------------------------------------------+---------------------------+
| > **Emergency within our service area**  | > **You Pay**             |
| > *(continued)*                          |                           |
+------------------------------------------+---------------------------+
| -   Emergency laboratory tests           | > Plan Provider           |
|                                          | >                         |
| -   Emergency surgery (cutting)          | > Nothing                 |
|                                          | >                         |
|                                          | > Non-Plan Provider       |
|                                          | >                         |
|                                          | > 20% of eligible charges |
+------------------------------------------+---------------------------+
| -   Emergency room facility              | > Plan Provider\          |
|                                          | > \$50                    |
| > Note: If you are admitted as an        | >                         |
| > inpatient following a visit to the     | > Non-Plan Provider\      |
| > emergency room, hospital inpatient     | > 20% of eligible charges |
| > benefits apply and not emergency room  |                           |
| > benefits.                              |                           |
+------------------------------------------+---------------------------+
| > *Not covered: Elective care or         | > *All charges*           |
| > non-emergency care*                    |                           |
+------------------------------------------+---------------------------+
| ###                                      |                           |
| ##### Emergency outside our service area |                           |
+------------------------------------------+---------------------------+
|                                          |                           |
+------------------------------------------+---------------------------+
| > Professional emergency services of     | > Plan Provider           |
| > physicians                             | >                         |
|                                          | > \$15 per visit          |
| -   In physician's office                | >                         |
|                                          | > Non-Plan Provider       |
| -   In an urgent care center             | >                         |
|                                          | > 20% of eligible charges |
| -   As an outpatient or inpatient at a   |                           |
|     hospital                             |                           |
|                                          |                           |
| -   In an emergency room                 |                           |
+------------------------------------------+---------------------------+
| -   Emergency diagnostic tests           | > Plan Provider\          |
|                                          | > 20% of eligible charges |
| -   Emergency x-rays                     | >                         |
|                                          | > Non-Plan Provider\      |
| -   Emergency surgery (non-cutting)      | > 20% of eligible charges |
+------------------------------------------+---------------------------+
| -   Emergency laboratory tests           | > Plan Provider           |
|                                          | >                         |
| -   Emergency surgery (cutting)          | > Nothing                 |
|                                          | >                         |
|                                          | > Non-Plan Provider       |
|                                          | >                         |
|                                          | > 20% of eligible charges |
+------------------------------------------+---------------------------+
| -   Emergency room facility              | > Plan Provider\          |
|                                          | > \$50                    |
| > Note: If you are admitted as an        | >                         |
| > inpatient following a visit to the     | > Non-Plan Provider\      |
| > emergency room, hospital inpatient     | > 20% of eligible charges |
| > benefits apply and not emergency room  |                           |
| > benefits.                              |                           |
+------------------------------------------+---------------------------+
| > *Not covered: Elective care or         | > *All charges*           |
| > non-emergency care*                    |                           |
+------------------------------------------+---------------------------+

***Emergency services/accidents - continued on next page***

+------------------------------------------+---------------------------+
| > **Ambulance**[]{#Ambulance_1 .anchor}  | > **You Pay**             |
+------------------------------------------+---------------------------+
| > Professional ambulance service when    | > Nothing                 |
| > the following apply:                   |                           |
|                                          |                           |
| -   Transportation begins at the place   |                           |
|     where an injury or illness occurred  |                           |
|     or first required emergency care     |                           |
|                                          |                           |
| -   Transportation ends at the nearest   |                           |
|     facility equipped to furnish         |                           |
|     emergency treatment                  |                           |
|                                          |                           |
| -   Transportation is for the purpose of |                           |
|     emergency treatment                  |                           |
+------------------------------------------+---------------------------+
| > Air ambulance is limited to            | > Plan Provider\          |
| > intra-island or inter-island           | > 20% of eligible charges |
| > transportation within the state of     | >                         |
| > Hawaii.                                | > Non-Plan Provider\      |
| >                                        | > 30% of eligible charges |
| > See Section 5(c) for non-emergency     | > and any difference      |
| > service.                               | > between our payment and |
|                                          | > the actual              |
|                                          | > charge[]                |
|                                          | {#Section_5_Emergency_End |
|                                          | > .anchor}                |
+------------------------------------------+---------------------------+

+---+---+-------------------------------------+----------------------+---+---+
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| H |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
|   | * | > When you get our approval for     |                      | * | # |
|   | * | > services and follow a treatment   |                      | * | # |
|   | I | > plan we approve, cost-sharing and |                      | I | # |
|   | * | > limitations for Plan mental       |                      | * | # |
|   | * | > health and substance abuse        |                      | * | # |
|   |   | > benefits will be no greater than  |                      |   |   |
|   | * | > for similar benefits for other    |                      | * |   |
|   | * | > illnesses and conditions.         |                      | * |   |
|   | M | >                                   |                      | M |   |
|   | * | > **Here are some important things  |                      | * |   |
|   | * | > to keep in mind about these       |                      | * |   |
|   |   | > benefits:**                       |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * | -   Please remember that all        |                      | * |   |
|   | P |     benefits are subject to the     |                      | P |   |
|   | * |     definitions, limitations, and   |                      | * |   |
|   | * |     exclusions in this brochure and |                      | * |   |
|   |   |     are payable only when we        |                      |   |   |
|   | * |     determine they are medically    |                      | * |   |
|   | * |     necessary.                      |                      | * |   |
|   | O |                                     |                      | O |   |
|   | * | ```{=html}                          |                      | * |   |
|   | * | <!-- -->                            |                      | * |   |
|   |   | ```                                 |                      |   |   |
|   | * | -   Be sure to read Section 4,      |                      | * |   |
|   | * |     *Your costs for covered         |                      | * |   |
|   | R |     services,* for valuable         |                      | R |   |
|   | * |     information about how cost      |                      | * |   |
|   | * |     sharing works. Also read        |                      | * |   |
|   |   |     Section 9 about coordinating    |                      |   |   |
|   | * |     benefits with other coverage,   |                      | * |   |
|   | * |     including with Medicare.        |                      | * |   |
|   | T |                                     |                      | T |   |
|   | * | -   Behavioral Care Connection, a   |                      | * |   |
|   | * |     management program, will        |                      | * |   |
|   |   |     develop a treatment plan and    |                      |   |   |
|   | * |     provide care management in      |                      | * |   |
|   | * |     conjunction with your Plan      |                      | * |   |
|   | A |     provider.                       |                      | A |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   | N |                                     |                      | N |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   | T |                                     |                      | T |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
+---+---+-------------------------------------+----------------------+---+---+
| * |   |                                     | **You pay**          |   |   |
| * |   |                                     |                      |   |   |
| B |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| # |   |                                     | ###                  |   |   |
| # |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| > |   |                                     | > Your cost sharing  |   |   |
|   |   |                                     | > responsibilities   |   |   |
| A |   |                                     | > are no greater     |   |   |
| l |   |                                     | > than for other     |   |   |
| l |   |                                     | > illnesses or       |   |   |
| > |   |                                     | > conditions         |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| T |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| : |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| P |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| # |   |                                     | > Plan Provider\     |   |   |
| # |   |                                     | > \$15 per visit     |   |   |
|   |   |                                     | >                    |   |   |
| P |   |                                     | > Non-Plan Provider\ |   |   |
| r |   |                                     | > 30% of eligible    |   |   |
| o |   |                                     | > charges and any    |   |   |
| f |   |                                     | > difference between |   |   |
| e |   |                                     | > our payment and    |   |   |
| s |   |                                     | > the actual charge  |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| k |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| P |   |                                     |                      |   |   |
| R |   |                                     |                      |   |   |
| N |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| M |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| - |   |                                     | > Plan Provider\     |   |   |
|   |   |                                     | > 20% of eligible    |   |   |
|   |   |                                     | > charges            |   |   |
|   |   |                                     | >                    |   |   |
| D |   |                                     | > Non-Plan Provider\ |   |   |
| i |   |                                     | > 30% of eligible    |   |   |
| a |   |                                     | > charges and any    |   |   |
| g |   |                                     | > difference between |   |   |
| n |   |                                     | > our payment and    |   |   |
| o |   |                                     | > the actual charge  |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| - |   |                                     | > Plan Provider\     |   |   |
|   |   |                                     | > Nothing            |   |   |
|   |   |                                     | >                    |   |   |
|   |   |                                     | > Non-Plan Provider\ |   |   |
| L |   |                                     | > 30% of eligible    |   |   |
| a |   |                                     | > charges and any    |   |   |
| b |   |                                     | > difference between |   |   |
| o |   |                                     | > our payment and    |   |   |
| r |   |                                     | > the actual charge  |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+

*Mental Health and substance abuse -- continued on next page*

+------------------------------------------+---------------------------+
| ### **Mental health and                  | ### **You pay**           |
| substance abuse benefits** *(continued)* |                           |
+------------------------------------------+---------------------------+
| -   Inpatient services provided by a     | > Plan Provider\          |
|     hospital or other facility           | > Nothing                 |
|                                          | >                         |
| -   Inpatient services in approved       | > Non-Plan Provider\      |
|     alternative care settings such as    | > 30% of eligible charges |
|     partial hospitalization, residential | > and                     |
|     treatment, full-day hospitalization  | > an[]{#mental_health_end |
|                                          | > .anchor}y difference    |
|                                          | > between our payment and |
|                                          | > the actual charge       |
+------------------------------------------+---------------------------+

+------------------------------------------+---------------------------+
| ## No                                    | > *All charges*           |
| t covered: Services we have not approved |                           |
|                                          |                           |
| > *Note: OPM will base its review of     |                           |
| > disputes about treatment plans on the  |                           |
| > treatment plan's clinical              |                           |
| > appropriateness. OPM will generally    |                           |
| > not order us to pay or provide one     |                           |
| > clinically appropriate treatment plan  |                           |
| > in favor of another.*                  |                           |
+------------------------------------------+---------------------------+

+---+---+---+-------------------------------------------------------------+---+---+
| * |   |   |                                                             |   |   |
| * |   |   |                                                             |   |   |
| S |   |   |                                                             |   |   |
| e |   |   |                                                             |   |   |
| c |   |   |                                                             |   |   |
| t |   |   |                                                             |   |   |
| i |   |   |                                                             |   |   |
| o |   |   |                                                             |   |   |
| n |   |   |                                                             |   |   |
| 5 |   |   |                                                             |   |   |
| ( |   |   |                                                             |   |   |
| f |   |   |                                                             |   |   |
| ) |   |   |                                                             |   |   |
| . |   |   |                                                             |   |   |
| P |   |   |                                                             |   |   |
| r |   |   |                                                             |   |   |
| e |   |   |                                                             |   |   |
| s |   |   |                                                             |   |   |
| c |   |   |                                                             |   |   |
| r |   |   |                                                             |   |   |
| i |   |   |                                                             |   |   |
| p |   |   |                                                             |   |   |
| t |   |   |                                                             |   |   |
| i |   |   |                                                             |   |   |
| o |   |   |                                                             |   |   |
| n |   |   |                                                             |   |   |
| d |   |   |                                                             |   |   |
| r |   |   |                                                             |   |   |
| u |   |   |                                                             |   |   |
| g |   |   |                                                             |   |   |
| b |   |   |                                                             |   |   |
| e |   |   |                                                             |   |   |
| n |   |   |                                                             |   |   |
| e |   |   |                                                             |   |   |
| f |   |   |                                                             |   |   |
| i |   |   |                                                             |   |   |
| t |   |   |                                                             |   |   |
| s |   |   |                                                             |   |   |
| * |   |   |                                                             |   |   |
| * |   |   |                                                             |   |   |
| [ |   |   |                                                             |   |   |
| ] |   |   |                                                             |   |   |
| { |   |   |                                                             |   |   |
| # |   |   |                                                             |   |   |
| S |   |   |                                                             |   |   |
| e |   |   |                                                             |   |   |
| c |   |   |                                                             |   |   |
| t |   |   |                                                             |   |   |
| i |   |   |                                                             |   |   |
| o |   |   |                                                             |   |   |
| n |   |   |                                                             |   |   |
| _ |   |   |                                                             |   |   |
| 5 |   |   |                                                             |   |   |
| _ |   |   |                                                             |   |   |
| P |   |   |                                                             |   |   |
| r |   |   |                                                             |   |   |
| e |   |   |                                                             |   |   |
| s |   |   |                                                             |   |   |
| c |   |   |                                                             |   |   |
| r |   |   |                                                             |   |   |
| i |   |   |                                                             |   |   |
| p |   |   |                                                             |   |   |
| t |   |   |                                                             |   |   |
| i |   |   |                                                             |   |   |
| o |   |   |                                                             |   |   |
| n |   |   |                                                             |   |   |
| _ |   |   |                                                             |   |   |
| D |   |   |                                                             |   |   |
| r |   |   |                                                             |   |   |
| u |   |   |                                                             |   |   |
| g |   |   |                                                             |   |   |
| . |   |   |                                                             |   |   |
| a |   |   |                                                             |   |   |
| n |   |   |                                                             |   |   |
| c |   |   |                                                             |   |   |
| h |   |   |                                                             |   |   |
| o |   |   |                                                             |   |   |
| r |   |   |                                                             |   |   |
| } |   |   |                                                             |   |   |
+---+---+---+-------------------------------------------------------------+---+---+
|   | * |   | **Here are some important things to keep in mind about      | * |   |
|   | * |   | these benefits:**                                           | * |   |
|   | I |   |                                                             | I |   |
|   | * |   | -   We cover prescribed drugs and medications, as described | * |   |
|   | * |   |     in the chart beginning on page                          | * |   |
|   |   |   |     [43](#Section_5_Drug_Copays).                           |   |   |
|   | * |   |                                                             | * |   |
|   | * |   | -   Your provider must obtain precertification for certain  | * |   |
|   | M |   |     drugs.                                                  | M |   |
|   | * |   |                                                             | * |   |
|   | * |   | -   All benefits are subject to the definitions,            | * |   |
|   |   |   |     limitations and exclusions in this brochure and are     |   |   |
|   | * |   |     payable only when we determine they are medically       | * |   |
|   | * |   |     necessary.                                              | * |   |
|   | P |   |                                                             | P |   |
|   | * |   | -   We have no calendar year deductible.                    | * |   |
|   | * |   |                                                             | * |   |
|   |   |   | ```{=html}                                                  |   |   |
|   | * |   | <!-- -->                                                    | * |   |
|   | * |   | ```                                                         | * |   |
|   | O |   | -   Be sure to read Section 4, *Your costs for covered      | O |   |
|   | * |   |     services,* for valuable information about how cost      | * |   |
|   | * |   |     sharing works. Also read Section 9 about coordinating   | * |   |
|   |   |   |     benefits with other coverage, including with Medicare.  |   |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   | R |   |                                                             | R |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   |   |   |                                                             |   |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   | T |   |                                                             | T |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   |   |   |                                                             |   |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   | A |   |                                                             | A |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   |   |   |                                                             |   |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   | N |   |                                                             | N |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   |   |   |                                                             |   |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
|   | T |   |                                                             | T |   |
|   | * |   |                                                             | * |   |
|   | * |   |                                                             | * |   |
+---+---+---+-------------------------------------------------------------+---+---+
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | T |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | T |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | : |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | W |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | A |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | W |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | Y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | W |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | { |                                                             |   |   |
|   |   | = |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | } |                                                             |   |   |
|   |   | < |                                                             |   |   |
|   |   | ! |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | W |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | O |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | H |                                                             |   |   |
|   |   | M |                                                             |   |   |
|   |   | S |                                                             |   |   |
|   |   | A |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | S |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | k |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | O |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | : |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | { |                                                             |   |   |
|   |   | = |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | } |                                                             |   |   |
|   |   | < |                                                             |   |   |
|   |   | ! |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | G |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | A |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | ( |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | ) |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | { |                                                             |   |   |
|   |   | = |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | } |                                                             |   |   |
|   |   | < |                                                             |   |   |
|   |   | ! |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | A |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | B |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | N |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | H |                                                             |   |   |
|   |   | M |                                                             |   |   |
|   |   | S |                                                             |   |   |
|   |   | A |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | S |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | F |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | { |                                                             |   |   |
|   |   | = |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | } |                                                             |   |   |
|   |   | < |                                                             |   |   |
|   |   | ! |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | O |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | B |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | A |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | B |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | N |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | H |                                                             |   |   |
|   |   | M |                                                             |   |   |
|   |   | S |                                                             |   |   |
|   |   | A |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | S |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | F |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | W |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | I |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | T |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | ' |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | T |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   | * |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | { |                                                             |   |   |
|   |   | = |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | } |                                                             |   |   |
|   |   | < |                                                             |   |   |
|   |   | ! |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | P |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | x |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | 3 |                                                             |   |   |
|   |   | 0 |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | F |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | x |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | 3 |                                                             |   |   |
|   |   | 0 |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | k |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | 3 |                                                             |   |   |
|   |   | 0 |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | q |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | 2 |                                                             |   |   |
|   |   | 8 |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | q |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | k |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | Y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | 3 |                                                             |   |   |
|   |   | 0 |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | { |                                                             |   |   |
|   |   | = |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | } |                                                             |   |   |
|   |   | < |                                                             |   |   |
|   |   | ! |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | R |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | A |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | q |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | q |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | I |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | D |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | W |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | , |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | Y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | T |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | w |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | { |                                                             |   |   |
|   |   | = |                                                             |   |   |
|   |   | h |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | } |                                                             |   |   |
|   |   | < |                                                             |   |   |
|   |   | ! |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | > |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | ` |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | M |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | M |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | g |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | b |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | y |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | m |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | . |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | F |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | f |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | n |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | p |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | o |                                                             |   |   |
|   |   | v |                                                             |   |   |
|   |   | i |                                                             |   |   |
|   |   | d |                                                             |   |   |
|   |   | e |                                                             |   |   |
|   |   | r |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | c |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   | l |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | u |                                                             |   |   |
|   |   | s |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | a |                                                             |   |   |
|   |   | t |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   |   |                                                             |   |   |
|   |   | 8 |                                                             |   |   |
|   |   | 0 |                                                             |   |   |
|   |   | 8 |                                                             |   |   |
|   |   | / |                                                             |   |   |
|   |   | 9 |                                                             |   |   |
|   |   | 4 |                                                             |   |   |
|   |   | 8 |                                                             |   |   |
|   |   | - |                                                             |   |   |
|   |   | 6 |                                                             |   |   |
|   |   | 4 |                                                             |   |   |
|   |   | 9 |                                                             |   |   |
|   |   | 9 |                                                             |   |   |
|   |   | . |                                                             |   |   |
+---+---+---+-------------------------------------------------------------+---+---+

*Prescription drug benefits -- continued on next page*

+---+--------------------------------------------------------------------+
| * |                                                                    |
| * |                                                                    |
| S |                                                                    |
| e |                                                                    |
| c |                                                                    |
| t |                                                                    |
| i |                                                                    |
| o |                                                                    |
| n |                                                                    |
| 5 |                                                                    |
| ( |                                                                    |
| f |                                                                    |
| ) |                                                                    |
| . |                                                                    |
| P |                                                                    |
| r |                                                                    |
| e |                                                                    |
| s |                                                                    |
| c |                                                                    |
| r |                                                                    |
| i |                                                                    |
| p |                                                                    |
| t |                                                                    |
| i |                                                                    |
| o |                                                                    |
| n |                                                                    |
| d |                                                                    |
| r |                                                                    |
| u |                                                                    |
| g |                                                                    |
| b |                                                                    |
| e |                                                                    |
| n |                                                                    |
| e |                                                                    |
| f |                                                                    |
| i |                                                                    |
| t |                                                                    |
| s |                                                                    |
| * |                                                                    |
| * |                                                                    |
| * |                                                                    |
| ( |                                                                    |
| c |                                                                    |
| o |                                                                    |
| n |                                                                    |
| t |                                                                    |
| i |                                                                    |
| n |                                                                    |
| u |                                                                    |
| e |                                                                    |
| d |                                                                    |
| ) |                                                                    |
| * |                                                                    |
+---+--------------------------------------------------------------------+
|   | -   Mail order prescription drugs prescribed by a doctor and       |
|   |     obtained through a Plan mail order pharmacy will be dispensed  |
|   |     with a maximum limit of a 90-day supply or fraction thereof.   |
|   |     For example, if your physician prescribes a 90-day supply of a |
|   |     drug that is packaged in less than a 30-day quantity, such as  |
|   |     a 28-day quantity, the Plan mail order pharmacy will fill the  |
|   |     prescription by dispensing three packages of the drug. This    |
|   |     amounts to a 84 day quantity since each package contains a     |
|   |     28-day quantity. You will owe the mail order copayment for a   |
|   |     90-day supply.                                                 |
+---+--------------------------------------------------------------------+
|   | -   **Why use generic drugs?** Generic drugs on the formulary are  |
|   |     therapeutically equivalent to the brand name drugs and are     |
|   |     less expensive. You may reduce your out-of-pocket costs by     |
|   |     choosing to use a generic drug.                                |
|   |                                                                    |
|   | ```{=html}                                                         |
|   | <!-- -->                                                           |
|   | ```                                                                |
|   | -   **When you have to file a claim.** Refer to Section 7 *"Filing |
|   |     a claim for covered services".*                                |
|   |                                                                    |
|   | ```{=html}                                                         |
|   | <!-- -->                                                           |
|   | ```                                                                |
|   | -   **Drugs Benefit Management Program.** We have arranged with    |
|   |     Plan Pharmacies to assist in managing the usage of certain     |
|   |     kinds of drugs, including drugs listed in the HMSA Select      |
|   |     Prescription Drug Formulary.                                   |
|   |                                                                    |
|   | > We have identified certain kinds of drugs listed in the HMSA     |
|   | > Select Prescription Drug Formulary that require                  |
|   | > precertification. The criteria for precertification are that:    |
|   |                                                                    |
|   | -   The drug is being used as part of a treatment plan,            |
|   |                                                                    |
|   | -   There are no equally effective drug substitutes, and           |
|   |                                                                    |
|   | -   The drug meets the "medical necessity" criteria and other      |
|   |     criteria as established by us.                                 |
|   |                                                                    |
|   | > A list of these drugs in the HMSA Select Prescription Drug       |
|   | > Formulary has been distributed to all Participating Providers.   |
|   | >                                                                  |
|   | > Plan Pharmacists will dispense a maximum of a 30-day supply or   |
|   | > fraction thereof for first time prescriptions of maintenance     |
|   | > drugs. For subsequent refills, the Plan pharmacist may dispense  |
|   | > a maximum 90-day supply or fraction thereof after confirming     |
|   | > that:                                                            |
|   |                                                                    |
|   | -   You have tolerated the drug without adverse side effects that  |
|   |     may cause you to discontinue using the drug, and               |
|   |                                                                    |
|   | -   Your doctor has determined that the drug is effective.         |
+---+--------------------------------------------------------------------+

*Prescription drug benefits -- continued on next page*

+------------------------------------------+---------------------------+
| > **Benefit Description**                | > **You pay**             |
+------------------------------------------+---------------------------+
| > **Covered medications and supplies**   |                           |
| > []{#Section_5_Drug_Copays .anchor}     |                           |
+------------------------------------------+---------------------------+
| > We cover the following medications and |                           |
| > supplies prescribed by a licensed      |                           |
| > practitioner and obtained from a Plan  |                           |
| > or non-Plan Pharmacy or through our    |                           |
| > mail order program:                    |                           |
+------------------------------------------+---------------------------+
| -   Drugs and medications that by        | > **Generic:**            |
|     Federal law of the United States     | >                         |
|     require a physician's prescription   | > Plan Pharmacy - \$5     |
|     for their purchase, except those     | > copayment               |
|     listed as *Not covered*              | >                         |
|                                          | > Non-Plan Pharmacy - \$5 |
| -   Injectable drugs limited to:         | > plus 20% of remaining   |
|                                          | > eligible charge and any |
| ```{=html}                               | > difference between the  |
| <!-- -->                                 | > actual and eligible     |
| ```                                      | > charge                  |
| -   Imitrex                              | >                         |
|                                          | > **Preferred Brand:**    |
| -   Epinephrine emergency kit            | >                         |
|                                          | > Plan Pharmacy - \$20    |
| ```{=html}                               | > copayment               |
| <!-- -->                                 | >                         |
| ```                                      | > Non-Plan Pharmacy -     |
| -   Glucagon                             | > \$20 plus 20% of        |
|                                          | > remaining eligible      |
| > Note: Self administered injectable     | > charge and any          |
| > medication and intravenous fluids and  | > difference between the  |
| > medication for home use are covered    | > actual and eligible     |
| > under your medical coverage. See       | > charge                  |
| > Section 5(a) *Treatment therapies.*    | >                         |
|                                          | > **Other Brand:**        |
| -   Nicotine patches for the cessation   | >                         |
|     of smoking by prescription           | > Plan Pharmacy - 50% of  |
|     only[]{#smoking_cessation .anchor}   | > eligible charge not     |
|                                          | > less than \$20          |
| > Note: Limited to one treatment cycle   | >                         |
| > per calendar year, with a limit of 2   | > Non-Plan Pharmacy - 50% |
| > treatment cycles per lifetime          | > of eligible charge not  |
|                                          | > less than \$20 plus any |
| -   Drugs for sexual dysfunction         | > difference between the  |
|                                          | > actual and eligible     |
| > Benefits are limited to the following; | > charge                  |
|                                          |                           |
| -   Up to four doses every 30 days       |                           |
|                                          |                           |
| -   Up to three months dispensed at a    |                           |
|     time\                                |                           |
|     (Multiple copayments will apply)     |                           |
|                                          |                           |
| -   Retail pharmacy access only\         |                           |
|     (not available through mail order)   |                           |
|                                          |                           |
| -   Covered for gender approved by FDA   |                           |
|                                          |                           |
| -   Physician must certify in advance    |                           |
|     that the patient has impotence due   |                           |
|     to organic causes from vascular or   |                           |
|     neurological disease                 |                           |
|                                          |                           |
| ```{=html}                               |                           |
| <!-- -->                                 |                           |
| ```                                      |                           |
| -   Oral []{#oral_contraceptives         |                           |
|     .anchor}contraceptive                |                           |
+------------------------------------------+---------------------------+
| -   Internally implanted time-release    | > Plan Provider - 20% of  |
|     contraceptive drugs                  | > eligible charges        |
|                                          | >                         |
| -   Contraceptive drugs injected         | > Non-Plan Provider - 30% |
|     periodically and intrauterine        | > of eligible charges and |
|     devices                              | > any difference between  |
|                                          | > our payment and the     |
|                                          | > actual charge           |
+------------------------------------------+---------------------------+

*Covered medications and supplies -- continued on next page*

+------------------------------------------+---------------------------+
| > **Covered medications and supplies**   | > **You Pay**             |
| > *(continued)*                          |                           |
+------------------------------------------+---------------------------+
| -   Diaphragms                           | > **Preferred             |
|                                          | > Diaphragms**            |
|                                          | >                         |
|                                          | > Plan Pharmacy - \$10    |
|                                          | > copayment               |
|                                          | >                         |
|                                          | > Non-Plan Pharmacy -     |
|                                          | > \$10 copayment plus 20% |
|                                          | > of remaining eligible   |
|                                          | > charge and any          |
|                                          | > difference between the  |
|                                          | > actual and eligible     |
|                                          | > charge                  |
|                                          | >                         |
|                                          | > **Other Brand           |
|                                          | > Diaphragms**            |
|                                          | >                         |
|                                          | > Plan Pharmacy - 50% of  |
|                                          | > eligible charge not     |
|                                          | > less than \$10          |
|                                          | >                         |
|                                          | > Non-Plan Pharmacy - 50% |
|                                          | > of eligible charge not  |
|                                          | > less than \$10 plus any |
|                                          | > difference between the  |
|                                          | > actual and eligible     |
|                                          | > charge                  |
+------------------------------------------+---------------------------+
| -   Insulin[]{#insulin .anchor}          | > **Preferred Brand       |
|                                          | > Insulin:**              |
| > Note: When obtained by prescription,   | >                         |
| > with a copayment charge applied to     | > Plan Pharmacy - \$5     |
| > each 30-day supply or fraction thereof | > copayment               |
|                                          | >                         |
|                                          | > Non-Plan Pharmacy - \$5 |
|                                          | > plus 20% of eligible    |
|                                          | > charge and any          |
|                                          | > difference between the  |
|                                          | > actual and eligible     |
|                                          | > charge                  |
|                                          | >                         |
|                                          | > **Other Brand           |
|                                          | > Insulin:**              |
|                                          | >                         |
|                                          | > Plan Pharmacy - \$20    |
|                                          | > copayment               |
|                                          | >                         |
|                                          | > Non-Plan Pharmacy -     |
|                                          | > \$20 copayment plus 20% |
|                                          | > of eligible charge and  |
|                                          | > any difference between  |
|                                          | > the actual and eligible |
|                                          | > charge                  |
+------------------------------------------+---------------------------+
| > Diabetic Supplies include:             | > **Preferred Brand       |
|                                          | > Diabetic Supplies:**    |
| -   Insulin syringes[]{#syringes         | >                         |
|     .anchor}                             | > Plan Pharmacy - Nothing |
|                                          | >                         |
| -   Needles                              | > Non-Plan Pharmacy - Any |
|                                          | > difference between the  |
| -   Lancets                              | > actual and eligible     |
|                                          | > charge                  |
| -   Auto-lancet devices                  | >                         |
|                                          | > **Other Brand Diabetic  |
| -   Glucose test tablets and test tapes  | > Supplies:**             |
|                                          | >                         |
| -   Acetone test tablets                 | > Plan Pharmacy - \$20    |
|                                          | > copayment               |
|                                          | >                         |
|                                          | > Non-Plan Pharmacy -     |
|                                          | > \$20 copayment plus any |
|                                          | > difference between the  |
|                                          | > actual and eligible     |
|                                          | > charge                  |
+------------------------------------------+---------------------------+

*Covered medications and supplies -- continued on next page*

+------------------------------------------+---------------------------+
| > **Covered medications and supplies**   | > **You pay**             |
| > *(continued)*                          |                           |
+------------------------------------------+---------------------------+
| > Mail Order Drug                        | > \$10 Copayment          |
| >                                        | >                         |
| Program[]{#mail_order_prescription_drugs | > \$35 Copayment          |
| > .anchor}:                              | >                         |
|                                          | > \$60 Copayment          |
| -   Generic Drugs                        | >                         |
|                                          | > \$10 Copayment          |
| -   Preferred Brand Name Drugs           | >                         |
|                                          | > \$35 Copayment          |
| -   Other Brand Name Drugs               | >                         |
|                                          | > Nothing                 |
| -   Preferred Brand Name Insulin         | >                         |
|                                          | > \$35 Copayment          |
| -   Other Brand Insulin                  |                           |
|                                          |                           |
| -   Preferred Diabetic Supplies          |                           |
|                                          |                           |
| -   Other Brand Name Diabetic Supplies   |                           |
+------------------------------------------+---------------------------+
| *Not covered:*                           | > *All charges*           |
|                                          |                           |
| -   *Drugs and supplies for cosmetic     |                           |
|     purposes*                            |                           |
|                                          |                           |
| -   *Drugs to enhance athletic           |                           |
|     performance*                         |                           |
|                                          |                           |
| -   *Fertility drugs*                    |                           |
|                                          |                           |
| -   *Vitamins, nutrients and food        |                           |
|     supplements even if a physician      |                           |
|     prescribes or administers them*      |                           |
|                                          |                           |
| -   *Nonprescription medicines*          |                           |
|                                          |                           |
| -   *Medical supplies such as dressings  |                           |
|     and antiseptics*                     |                           |
|                                          |                           |
| -   *Smoking                             |                           |
|     ce                                   |                           |
| ssatio*[]{#smoking_cessation_not_covered |                           |
|     .anchor}*n drugs except for nicotine |                           |
|     patches and Zyban prescription drug* |                           |
|                                          |                           |
| -   *Drugs related to the diagnosis or   |                           |
|     treatment of                         |                           |
|     inferti                              |                           |
| lity*[]{#Section_5_Prescription_Drug_End |                           |
|     .anchor}                             |                           |
+------------------------------------------+---------------------------+

+------------------+---------------------------------------------------+
| Section 5 (g).   |                                                   |
| Special          |                                                   |
| featur           |                                                   |
| es[]{#Section_5_ |                                                   |
| Special_Features |                                                   |
| .anchor}         |                                                   |
+==================+===================================================+
| > **Feature**    | > **Description**                                 |
+------------------+---------------------------------------------------+
| > **Integrated   | > Integrated Case Management is a special program |
| > Case           | > for certain medical conditions that may require |
| > Mana           | > costly, long-term care. A hospital may not be   |
| gement**[]{#Sect | > the most appropriate setting for your           |
| ion_5_Integrated | > treatment. That's why your coverage provides    |
| _Case_Management | > you with the opportunity to receive alternative |
| > .anchor}       | > benefits to help meet health care needs         |
|                  | > resulting from extreme illness or injury        |
|                  | > (providing costs do not exceed inpatient        |
|                  | > facility costs). You, your physician, and the   |
|                  | > hospital can work with our case managers to     |
|                  | > identify and arrange alternative treatment      |
|                  | > plans to meet your special needs and to assist  |
|                  | > in preserving your health care benefits.        |
+------------------+---------------------------------------------------+
| > **Drug         | > We have arranged with Plan Pharmacies to assist |
| > Benefits       | > in managing the usage of certain kinds of       |
| > Management     | > drugs, including drugs listed in the HMSA       |
| >                | > Select Prescription Drug Formulary.             |
|  Program**[]{#Se | >                                                 |
| ction_5_Drug_Ben | > We have identified certain kinds of drugs       |
| efits_Management | > listed in the HMSA Select Prescription Drug     |
| > .anchor}       | > Formulary that require precertification. The    |
|                  | > criteria for precertification are that:         |
|                  |                                                   |
|                  | -   The drug is being used as part of a treatment |
|                  |     plan,                                         |
|                  |                                                   |
|                  | -   There are no equally effective drug           |
|                  |     substitutes, and                              |
|                  |                                                   |
|                  | -   The drug meets the "medical necessity"        |
|                  |     criteria and other criteria as established by |
|                  |     us.                                           |
|                  |                                                   |
|                  | > A list of these drugs in the HMSA Select        |
|                  | > Prescription Drug Formulary has been            |
|                  | > distributed to all Participating Providers.     |
|                  | >                                                 |
|                  | > Plan Pharmacists will dispense a maximum of a   |
|                  | > 30-day supply or fraction thereof for first     |
|                  | > time prescriptions of maintenance drugs. For    |
|                  | > subsequent refills, the Plan pharmacist may     |
|                  | > dispense a maximum 90-day supply or fraction    |
|                  | > thereof after confirming that:                  |
|                  |                                                   |
|                  | -   You have tolerated the drug without adverse   |
|                  |     side effects that may cause you to            |
|                  |     discontinue using the drug, and               |
|                  |                                                   |
|                  | -   Your doctor has determined that the drug is   |
|                  |     effective.                                    |
+------------------+---------------------------------------------------+
| > **Routine Care | > Routine care associated with clinical trials is |
| > Associated     | > covered in accord with criteria established by  |
| > With Clinical  | > us.                                             |
| > Trials**       | >                                                 |
|                  | > These services require precertification. Please |
|                  | > refer to the precertification information shown |
|                  | > in Section 3.                                   |
+------------------+---------------------------------------------------+

+---+---+-------------------------------------+----------------------+---+---+
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
|   | * | > **Here are some important things  |                      | * |   |
|   | * | > to keep in mind about these       |                      | * |   |
|   | I | > benefits:**                       |                      | I |   |
|   | * |                                     |                      | * |   |
|   | * | -   Please remember that all        |                      | * |   |
|   |   |     benefits are subject to the     |                      |   |   |
|   | * |     definitions, limitations, and   |                      | * |   |
|   | * |     exclusions in this brochure and |                      | * |   |
|   | M |     are payable only when we        |                      | M |   |
|   | * |     determine they are medically    |                      | * |   |
|   | * |     necessary.                      |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * | -   We have no calendar year        |                      | * |   |
|   | * |     deductible*.*                   |                      | * |   |
|   | P |                                     |                      | P |   |
|   | * | -   We cover hospitalization for    |                      | * |   |
|   | * |     dental procedures only when a   |                      | * |   |
|   |   |     nondental physical impairment   |                      |   |   |
|   | * |     exists which makes              |                      | * |   |
|   | * |     hospitalization necessary to    |                      | * |   |
|   | O |     safeguard the health of the     |                      | O |   |
|   | * |     patient. See Section 5 (c) for  |                      | * |   |
|   | * |     inpatient hospital benefits. We |                      | * |   |
|   |   |     do not cover the dental         |                      |   |   |
|   | * |     procedure unless it is          |                      | * |   |
|   | * |     described below.                |                      | * |   |
|   | R |                                     |                      | R |   |
|   | * | -   Be sure to read Section 4,      |                      | * |   |
|   | * |     *Your costs for covered         |                      | * |   |
|   |   |     services,* for valuable         |                      |   |   |
|   | * |     information about how cost      |                      | * |   |
|   | * |     sharing works. Also read        |                      | * |   |
|   | T |     Section 9 about coordinating    |                      | T |   |
|   | * |     benefits with other coverage,   |                      | * |   |
|   | * |     including with Medicare.        |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   | A |                                     |                      | A |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   | N |                                     |                      | N |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   |   |                                     |                      |   |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
|   | T |                                     |                      | T |   |
|   | * |                                     |                      | * |   |
|   | * |                                     |                      | * |   |
+---+---+-------------------------------------+----------------------+---+---+
| # |   |                                     | > **You pay**        |   |   |
| # |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| j |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| > |   |                                     | > Plan Provider\     |   |   |
|   |   |                                     | > Nothing            |   |   |
| W |   |                                     | >                    |   |   |
| e |   |                                     | > Non-Plan Provider\ |   |   |
| > |   |                                     | > 30% of eligible    |   |   |
|   |   |                                     | > charges and any    |   |   |
| c |   |                                     | > difference between |   |   |
| o |   |                                     | > our payment and    |   |   |
| v |   |                                     | > the actual charge  |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| T |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| > |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| j |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| B |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| # |   |                                     | **You pay**          |   |   |
| # |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| P |   |                                     | > Plan Provider\     |   |   |
| r |   |                                     | > Nothing            |   |   |
| e |   |                                     | >                    |   |   |
| v |   |                                     | > Non-Plan Provider\ |   |   |
| e |   |                                     | > 30% of eligible    |   |   |
| n |   |                                     | > charges and any    |   |   |
| t |   |                                     | > difference between |   |   |
| i |   |                                     | > our payment and    |   |   |
| v |   |                                     | > the actual charge  |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| / |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| S |   |                                     | > Plan Provider\     |   |   |
| t |   |                                     | > 30% of eligible    |   |   |
| a |   |                                     | > charges            |   |   |
| n |   |                                     | >                    |   |   |
| d |   |                                     | > Non-Plan Provider\ |   |   |
| a |   |                                     | > 50% of eligible    |   |   |
| r |   |                                     | > charges and any    |   |   |
| d |   |                                     | > difference between |   |   |
| D |   |                                     | > our payment and    |   |   |
| e |   |                                     | > the actual charge  |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| X |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| 2 |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| \ |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| F |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| E |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| R |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| T |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| D |   |                                     | > Plan Provider\     |   |   |
| e |   |                                     | > 30% of eligible    |   |   |
| n |   |                                     | > charges            |   |   |
| t |   |                                     | >                    |   |   |
| a |   |                                     | > Non-Plan Provider\ |   |   |
| l |   |                                     | > 50% of eligible    |   |   |
| S |   |                                     | > charges and any    |   |   |
| u |   |                                     | > difference between |   |   |
| r |   |                                     | > our payment and    |   |   |
| g |   |                                     | > the actual charge  |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| E |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| # |   |                                     | **You pay**          |   |   |
| # |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| O |   |                                     | > Plan Provider or   |   |   |
| c |   |                                     | > non-Plan Provider\ |   |   |
| c |   |                                     | > 50% of eligible    |   |   |
| l |   |                                     | > charges, plus any  |   |   |
| u |   |                                     | > difference between |   |   |
| s |   |                                     | > our payment and    |   |   |
| a |   |                                     | > the actual charge  |   |   |
| l |   |                                     | >                    |   |   |
| S |   |                                     | > Note: Maximum Plan |   |   |
| p |   |                                     | > payment not to     |   |   |
| l |   |                                     | > exceed \$125       |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| \ |   |                                     |                      |   |   |
| \ |   |                                     |                      |   |   |
| W |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| P |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| C |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| j |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| j |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| T |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| k |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| T |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| I |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| j |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| T |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| T |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| 1 |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+
| * |   |                                     | > *All charges*      |   |   |
| N |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| : |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| A |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| w |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| x |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| u |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| , |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| f |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| y |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| b |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| - |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| O |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| g |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| ( |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| m |   |                                     |                      |   |   |
| p |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| ) |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| v |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| s |   |                                     |                      |   |   |
| * |   |                                     |                      |   |   |
| [ |   |                                     |                      |   |   |
| ] |   |                                     |                      |   |   |
| { |   |                                     |                      |   |   |
| # |   |                                     |                      |   |   |
| S |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| i |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| 5 |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| D |   |                                     |                      |   |   |
| e |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| t |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| l |   |                                     |                      |   |   |
| _ |   |                                     |                      |   |   |
| E |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| d |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
|   |   |                                     |                      |   |   |
| . |   |                                     |                      |   |   |
| a |   |                                     |                      |   |   |
| n |   |                                     |                      |   |   |
| c |   |                                     |                      |   |   |
| h |   |                                     |                      |   |   |
| o |   |                                     |                      |   |   |
| r |   |                                     |                      |   |   |
| } |   |                                     |                      |   |   |
+---+---+-------------------------------------+----------------------+---+---+

  -----------------------------------------------------------------------
  **Section 5 (i). Point-of-service
  benefits**[]{#Section_5_Point_Of_Service .anchor}

  -----------------------------------------------------------------------

> **[Point-of-service (POS) Benefits]{.underline}**

##### Facts about this Plan\'s POS option

> At your option, you may choose to obtain benefits covered by this Plan
> from non-Plan doctors and hospitals whenever you need care. When you
> obtain covered non-emergency medical treatment from a non-Plan doctor,
> you are subject to a higher copayment/coinsurance.
>
> Non-Plan providers are physicians and other health care professionals
> who are not under contract with this Plan.
>
> For out-of-state services under this Plan, non-Plan provider benefits
> are applied for covered services rendered by non-Blue Cross and/or
> Blue Shield programs.

# [What is covered and not covered]{.underline}

-   Medical services and supplies (Section 5(a))

-   Surgical and anesthesia services (Section 5(b))

-   Services provided by a hospital or other facility, and ambulance
    service (Section 5(c))

-   Emergency services/accidents (Section 5(d))

-   Mental health and substance abuse benefits (Section 5(e))

-   Prescription drug benefits (Section 5(f))

-   Dental benefits (Section 5(h))

> Please refer to the general exclusions listed in Section 6 for
> additional information.

# Precertification

> You or your physician must obtain precertification for the services
> listed in Section 3. A non-Plan provider may not necessarily obtain a
> precertification on your behalf. You are responsible for ensuring that
> the services are precertified. Services may not be covered if you do
> not obtain precertification. If you need more information, call us at
> 808/948-6499.
>
> You may receive services from a non-Plan provider without a referral.
> Non-Plan provider services have higher out-of-pocket cost. Please
> refer to the non-Plan provider benefits in Section 5.

# Your cost for covered services from non-Plan providers

> There is no calendar year deductible for non-Plan provider services.
>
> We calculate our payment and your copayment/coinsurance based on
> eligible charges. The eligible charge is the lower of either the
> provider's actual charge or the amount we established as the maximum
> allowable fee.
>
> Non-Plan providers are not under contract to limit their charges to
> our eligible charges. You are responsible for any charges in excess of
> eligible charges.
>
> Coinsurance is the percentage of our eligible charge that you must pay
> for your care. After your coinsurance totals \$2,500 per person or
> \$7,500 per family enrollment in any calendar year, you are no longer
> responsible for coinsurance/copayments. However, when you receive
> services from a non-Plan provider, you are also responsible for any
> charges in excess of the eligible charge. In addition
> coinsurance/copayments for the following services do not count toward
> your out-of-pocket maximum, and you must continue to pay
> coinsurance/copayments for these services:

-   Dental Care

-   Prescription Drugs

-   Vision Care

> Any payment from the difference of the actual and eligible charge for
> non-Plan service does not count toward meeting your out-of-pocket
> maximum.
>
> *Continued on next page*
>
> *(Continued)*
>
> Be sure to keep accurate records of your coinsurance/copayment. We
> will also keep records of your coinsurance/copayment and track your
> out-of-pocket maximum.

# Hospital/extended care

> Your coinsurance for services from a non-Plan facility is 30% of the
> eligible charges and any difference between our payment and the actual
> charge (based on semiprivate room rate). See Section 5(c). The
> facility's charge does not include any charges for physician's
> services. Benefits for physician's services will depend on whether the
> physician is a Plan provider or non-Plan provider and will be paid
> according to the benefits listed in Section 5(a). We cannot guarantee
> that a participating hospital will have participating physicians on
> staff. Benefits will be paid according to each individual provider and
> the type of service rendered by the provider.

# Emergency benefits

> Emergency care is covered within or outside our service area,
> regardless of whether a Plan provider or non-Plan provider is used.
> Your coinsurance for services from a non-Plan provider is 20% of the
> eligible charges. []{#Section_5_Point_Of_Service_End .anchor}See
> Section 5(d).

[]{#Section_5_Non_FEHB .anchor}

+-----------------------------------------------------------------------+
| > Section 6. General exclusions \-- things we don\'t                  |
| > cover[]{#Section_6_General_Exclusions .anchor}                      |
+-----------------------------------------------------------------------+

> The exclusions in this section apply to all benefits. **Although we
> may list a specific service as a benefit, we will not cover it unless
> your doctor determines it is medically necessary to prevent, diagnose,
> or treat your illness, disease, injury or condition** **and we agree,
> as discussed under *Services requiring our prior approval* on page
> [14](#Section_3_Services_Requiring_Approval).**
>
> We do not cover the following:

-   Services, drugs, or supplies you receive while you are not enrolled
    in this Plan;

```{=html}
<!-- -->
```
-   Services, drugs, or supplies that are not medically necessary;

-   Services, drugs, or supplies not required according to accepted
    standards of medical, dental, or psychiatric practice;

-   Experimental or investigational procedures, treatments, drugs or
    devices, except routine care associated with clinical trials. Please
    refer to the information shown in Section 3 (precertification) and
    Section 5(g);

-   Services, drugs, or supplies related to abortions, except when the
    life of the mother would be endangered if the fetus were carried to
    term or when the pregnancy is the result of an act of rape or
    incest;

-   Services, drugs, or supplies related to sex transformations;

-   Services, drugs, or supplies you receive from a provider or facility
    barred from the FEHB Program;

-   Professional services or supplies when furnished to you by a
    provider who is within your immediate family\
    (i.e., parent, child, or spouse);

-   Services when someone else has the legal obligation to pay for your
    care, and when, in the absence of this brochure,\
    you would not be charged; or

-   Services, drugs, or supplies you receive without charge while in
    active military service.

  -----------------------------------------------------------------------
  Section 7. Filing a claim for covered
  services[]{#Section_7_Filing_A_Claim .anchor}

  -----------------------------------------------------------------------

> When you see Plan physicians, receive services at Plan hospitals and
> facilities, or obtain your prescription drugs at Plan pharmacies, you
> will not have to file claims. Just present your identification card
> and pay your copayment, or coinsurance.
>
> ***If you need to file the claim, here is the process:***

+---------------------+-------------------+---------------------------+
| **Medical, Hospital | In most cases,    |                           |
| and Drug Benefits** | providers,        |                           |
|                     | facilities and    |                           |
|                     | pharmacies file   |                           |
|                     | claims for you.   |                           |
|                     | Physicians must   |                           |
|                     | file on the form  |                           |
|                     | HCFA-1500, Health |                           |
|                     | Insurance Claim   |                           |
|                     | Form, facilities  |                           |
|                     | must file on the  |                           |
|                     | UB-92 form,       |                           |
|                     | dental services   |                           |
|                     | must be on the    |                           |
|                     | American Dental   |                           |
|                     | Association (ADA) |                           |
|                     | form and          |                           |
|                     | pharmacies must   |                           |
|                     | file on the       |                           |
|                     | Universal Drug    |                           |
|                     | form. For claims  |                           |
|                     | questions and     |                           |
|                     | assistance, call  |                           |
|                     | us at             |                           |
|                     | 808/948-6499.     |                           |
|                     |                   |                           |
|                     | When you must     |                           |
|                     | file a claim \--  |                           |
|                     | such as for       |                           |
|                     | services you      |                           |
|                     | receive outside   |                           |
|                     | of the Plan's     |                           |
|                     | service area \--  |                           |
|                     | submit it on one  |                           |
|                     | of the forms      |                           |
|                     | indicated above   |                           |
|                     | or a claim form   |                           |
|                     | that includes the |                           |
|                     | information shown |                           |
|                     | below. Bills and  |                           |
|                     | receipts should   |                           |
|                     | be itemized and   |                           |
|                     | show:             |                           |
|                     |                   |                           |
|                     | -   Covered       |                           |
|                     |     member's name |                           |
|                     |     and ID number |                           |
|                     |                   |                           |
|                     | -   Name and      |                           |
|                     |     address of    |                           |
|                     |     the physician |                           |
|                     |     or facility   |                           |
|                     |     that provided |                           |
|                     |     the service\  |                           |
|                     |     or supply     |                           |
|                     |                   |                           |
|                     | -   Dates you     |                           |
|                     |     received the  |                           |
|                     |     services or   |                           |
|                     |     supplies      |                           |
|                     |                   |                           |
|                     | -   Diagnosis     |                           |
|                     |                   |                           |
|                     | -   Type of each  |                           |
|                     |     service or    |                           |
|                     |     supply        |                           |
|                     |                   |                           |
|                     | -   The charge    |                           |
|                     |     for each      |                           |
|                     |     service or    |                           |
|                     |     supply        |                           |
|                     |                   |                           |
|                     | ```{=html}        |                           |
|                     | <!-- -->          |                           |
|                     | ```               |                           |
|                     | -   A copy of the |                           |
|                     |     explanation   |                           |
|                     |     of benefits,  |                           |
|                     |     payments, or  |                           |
|                     |     denial from   |                           |
|                     |     any primary   |                           |
|                     |     payer \--     |                           |
|                     |     such as the   |                           |
|                     |     Medicare      |                           |
|                     |     Summary       |                           |
|                     |     Notice (MSN)  |                           |
|                     |                   |                           |
|                     | ```{=html}        |                           |
|                     | <!-- -->          |                           |
|                     | ```               |                           |
|                     | -   Receipts, if  |                           |
|                     |     you paid for  |                           |
|                     |     your services |                           |
+---------------------+-------------------+---------------------------+
|                     | **Submit your     | **For Physician claims\   |
|                     | claims to:**      | HMSA-HCFA 1500 claims\    |
|                     |                   | P.O. Box 44500\           |
|                     |                   | Honolulu, Hawaii          |
|                     |                   | 96804-4500**              |
|                     |                   |                           |
|                     |                   | **For Facility claims\    |
|                     |                   | HMSA-UB92 claims\         |
|                     |                   | P.O. Box 32700\           |
|                     |                   | Honolulu, Hawaii          |
|                     |                   | 96803-2700\               |
|                     |                   | \                         |
|                     |                   | For Dental claims\        |
|                     |                   | HMSA-Dental claims\       |
|                     |                   | P.O. Box 13400\           |
|                     |                   | Honolulu, Hawaii          |
|                     |                   | 96801-3400\               |
|                     |                   | \                         |
|                     |                   | For Pharmacy claims\      |
|                     |                   | HMSA-Drug claims\         |
|                     |                   | P.O. Box 13400\           |
|                     |                   | Honolulu, Hawaii          |
|                     |                   | 96801-3400**              |
+---------------------+-------------------+---------------------------+

*Continued on next page*

  --------------------- -------------------------------------------------
  Section 7. Filing a   
  claim for covered     
  services              
  *(continued)*         

  **Deadline for filing All Plan and most non-Plan providers in the State
  your claim**          of Hawaii file claims for you. If your non-Plan
                        provider does not file the claim for you, you
                        must submit an itemized bill and receipt for the
                        services you received by December 31 of the year
                        after the year you received the service, unless
                        timely filing was prevented by administrative
                        operations of Government or legal incapacity,
                        provided the claim was submitted as soon as
                        reasonably possible. File a separate claim for
                        each covered family member and each provider. For
                        more information, please call us at 808/948-6499.

  **When we need more   Please reply promptly when we ask for additional
  information**         information. We may delay processing or deny your
                        claim if you do not respond.
  --------------------- -------------------------------------------------

  -----------------------------------------------------------------------
  Section 8. The disputed claims process[]{#Section_8_Disputed_Claims
  .anchor}

  -----------------------------------------------------------------------

> Follow this Federal Employees Health Benefits Program disputed claims
> process if you disagree with our decision on your claim or request for
> services, drugs, or supplies -- including a request for
> precertification:

+---+------------------------------------------------------------------+
| * | **Description**                                                  |
| * |                                                                  |
| S |                                                                  |
| t |                                                                  |
| e |                                                                  |
| p |                                                                  |
| * |                                                                  |
| * |                                                                  |
+---+------------------------------------------------------------------+
| * | Ask us in writing to reconsider our initial decision. You must:  |
| * |                                                                  |
| 1 | (a) Write to us within 6 months from the date of our decision;   |
| * |     and                                                          |
| * |                                                                  |
|   | (b) Send your request to us at: Hawaii Medical Service           |
|   |     Association, Attn: Appeals Coordinator, P.O. Box 1958,       |
|   |     Honolulu, Hawaii 96805-1958, and                             |
|   |                                                                  |
|   | (c) Include a statement about why you believe our initial        |
|   |     decision was wrong, based on specific benefit provisions in  |
|   |     this brochure; and                                           |
|   |                                                                  |
|   | (d) Include copies of documents that support your claim, such as |
|   |     physicians\' letters, operative reports, bills, medical      |
|   |     records, and explanation of benefits (EOB) forms.            |
+---+------------------------------------------------------------------+
| * | We have 30 days from the date we receive your request to:        |
| * |                                                                  |
| 2 | (a) Pay the claim (or, if applicable, arrange for the health     |
| * |     care provider to give you the care); or                      |
| * |                                                                  |
|   | (b) Write to you and maintain our denial \-- go to step 4; or    |
|   |                                                                  |
|   | (c) Ask you or your medical provider for more information. If we |
|   |     ask your provider, we will send you a copy of our            |
|   |     request---go to step 3.                                      |
+---+------------------------------------------------------------------+
| * | You or your provider must send the information so that we        |
| * | receive it within 60 days of our request. We will then decide    |
| 3 | within 30 more days.                                             |
| * |                                                                  |
| * | If we do not receive the information within 60 days, we will     |
|   | decide within 30 days of the date the information was due. We    |
|   | will base our decision on the information we already have.       |
|   |                                                                  |
|   | We will write to you with our decision.                          |
+---+------------------------------------------------------------------+
| * | If you do not agree with our decision, you may ask OPM to review |
| * | it.                                                              |
| 4 |                                                                  |
| * |                                                                  |
| * |                                                                  |
+---+------------------------------------------------------------------+
|   | You must write to OPM within:                                    |
|   |                                                                  |
|   | -   90 days after the date of our letter upholding our initial   |
|   |     decision; or                                                 |
|   |                                                                  |
|   | -   120 days after you first wrote to us \-- if we did not       |
|   |     answer that request in some way within 30 days; or           |
|   |                                                                  |
|   | -   120 days after we asked for additional information.          |
+---+------------------------------------------------------------------+
|   | Write to OPM at: United States Office of Personnel Management,   |
|   | Insurance Services Program, Health Insurance Group 2, 1900 E     |
|   | Street, NW, Washington, DC 20415-3620.                           |
+---+------------------------------------------------------------------+
|   | Send OPM the following information:                              |
|   |                                                                  |
|   | -   A statement about why you believe our decision was wrong,    |
|   |     based on specific benefit provisions in this brochure;       |
|   |                                                                  |
|   | -   Copies of documents that support your claim, such as         |
|   |     physicians\' letters, operative reports, bills, medical      |
|   |     records, and explanation of benefits (EOB) forms;            |
|   |                                                                  |
|   | -   Copies of all letters you sent to us about the claim;        |
|   |                                                                  |
|   | -   Copies of all letters we sent to you about the claim; and    |
|   |                                                                  |
|   | -   Your daytime phone number and the best time to call.         |
|   |                                                                  |
|   | Note: If you want OPM to review more than one claim, you must    |
|   | clearly identify which documents apply to\                       |
|   | which claim.                                                     |
+---+------------------------------------------------------------------+

####### *Continued on next page*

+---+------------------------------------------------------------------+
| S |                                                                  |
| e |                                                                  |
| c |                                                                  |
| t |                                                                  |
| i |                                                                  |
| o |                                                                  |
| n |                                                                  |
| 8 |                                                                  |
| . |                                                                  |
| T |                                                                  |
| h |                                                                  |
| e |                                                                  |
| d |                                                                  |
| i |                                                                  |
| s |                                                                  |
| p |                                                                  |
| u |                                                                  |
| t |                                                                  |
| e |                                                                  |
| d |                                                                  |
| c |                                                                  |
| l |                                                                  |
| a |                                                                  |
| i |                                                                  |
| m |                                                                  |
| s |                                                                  |
| p |                                                                  |
| r |                                                                  |
| o |                                                                  |
| c |                                                                  |
| e |                                                                  |
| s |                                                                  |
| s |                                                                  |
| * |                                                                  |
| ( |                                                                  |
| c |                                                                  |
| o |                                                                  |
| n |                                                                  |
| t |                                                                  |
| i |                                                                  |
| n |                                                                  |
| u |                                                                  |
| e |                                                                  |
| d |                                                                  |
| ) |                                                                  |
| * |                                                                  |
+---+------------------------------------------------------------------+
|   | Note: You are the only person who has a right to file a disputed |
|   | claim with OPM. Parties acting as your representative, such as   |
|   | medical providers, must include a copy of your specific written  |
|   | consent with the review request.                                 |
|   |                                                                  |
|   | Note: The above deadlines may be extended if you show that you   |
|   | were unable to meet the deadline because of reasons beyond your  |
|   | control.                                                         |
+---+------------------------------------------------------------------+
| * | OPM will review your disputed claim request and will use the     |
| * | information it collects from you and us to decide whether our    |
| 5 | decision is correct. OPM will send you a final decision within   |
| * | 60 days. There are no other administrative appeals.              |
| * |                                                                  |
+---+------------------------------------------------------------------+
|   | If you do not agree with OPM's decision, your only recourse is   |
|   | to sue. If you decide to sue, you must file the suit against OPM |
|   | in federal court by December 31 of the third year after the year |
|   | in which you received the disputed services, drugs or supplies   |
|   | or from the year in which you were denied precertification or    |
|   | prior approval. This is the only deadline that may not be        |
|   | extended.                                                        |
|   |                                                                  |
|   | OPM may disclose the information it collects during the review   |
|   | process to support their disputed claim decision. This           |
|   | information will become part of the court record.                |
+---+------------------------------------------------------------------+
|   | You may not sue until you have completed the disputed claims     |
|   | process. Further, federal law governs your lawsuit, benefits,    |
|   | and payment of benefits. The federal court will base its review  |
|   | on the record that was before OPM when OPM decided to uphold or  |
|   | overturn our decision. You may recover only the amount of        |
|   | benefits in dispute.                                             |
+---+------------------------------------------------------------------+

**Note: If you have a serious or life threatening condition** (one that
may cause permanent loss of bodily functions or death if not treated as
soon as possible), and

(a) We haven\'t responded yet to your initial request for care or
    precertification/prior approval, then call us at 808/948-6499 and we
    will expedite our review; or

(b) We denied your initial request for care or precertification/prior
    approval, then:

-   If we expedite our review and maintain our denial, we will inform
    OPM so that they can give your claim expedited treatment too, or

-   You may call OPM\'s Health Insurance Group 2 at 202/606-3818 between
    8 a.m. and 5 p.m. eastern time.

+-----------------------+----------------------------------------------+
| Section 9.            |                                              |
| Coordinating benefits |                                              |
| with other            |                                              |
| c                     |                                              |
| overage[]{#Section_9_ |                                              |
| Coordinating_Benefits |                                              |
| .anchor}              |                                              |
+-----------------------+----------------------------------------------+
| **When you have other | You must tell us if you or a covered family  |
| health coverage**     | member have coverage under another group     |
| []{#Section_9_When_   | health plan or have automobile insurance     |
| You_Have_Other_Health | that pays health care expenses without       |
| .anchor}              | regard to fault. This is called "double      |
|                       | coverage".                                   |
|                       |                                              |
|                       | When you have double coverage, one plan      |
|                       | normally pays its benefits in full as the    |
|                       | primary payer and the other plan pays a      |
|                       | reduced benefit as the secondary payer. We,  |
|                       | like other insurers, determine which         |
|                       | coverage is primary according to the         |
|                       | National Association of Insurance            |
|                       | Commissioners\' guidelines.                  |
|                       |                                              |
|                       | When we are the primary payer, we will pay   |
|                       | the benefits described in this brochure.     |
|                       |                                              |
|                       | When we are the secondary payer, we will pay |
|                       | after the primary plan pays. We will pay     |
|                       | what is left, up to our eligible charge for  |
|                       | covered services.                            |
|                       |                                              |
|                       | The benefits payable under this plan, when   |
|                       | combined with benefits paid under your other |
|                       | coverage, will not exceed the lesser of:     |
|                       |                                              |
|                       | -   100 percent of eligible charge, or       |
|                       |                                              |
|                       | -   the amount payable by your other         |
|                       |     coverage plus any deductible and         |
|                       |     copayment you would owe if the other     |
|                       |     coverage were your only coverage.        |
+-----------------------+----------------------------------------------+
| **What is             | Medicare is a Health Insurance Program for:  |
| Medicare?**[]{#Secti  |                                              |
| on_9_What_Is_Medicare | -   People 65 years of age and older.        |
| .anchor}              |                                              |
|                       | -   Some people with disabilities, under 65  |
|                       |     years of age.                            |
|                       |                                              |
|                       | -   People with End-Stage Renal Disease      |
|                       |     (permanent kidney failure requiring      |
|                       |     dialysis or a transplant).               |
|                       |                                              |
|                       | Medicare has two parts:                      |
|                       |                                              |
|                       | -   Part A (Hospital Insurance). Most people |
|                       |     do not have to pay for Part A. If you or |
|                       |     your spouse worked for at least 10 years |
|                       |     in Medicare-covered employment, you      |
|                       |     should be able to qualify for            |
|                       |     premium-free Part A insurance (Someone   |
|                       |     who was a federal employee on January 1, |
|                       |     1983 or since automatically qualifies.)  |
|                       |     Otherwise, if you are age 65 or older,   |
|                       |     you may be able to buy it. Contact       |
|                       |     800/MEDICARE (800/633-4227) for more     |
|                       |     information.                             |
|                       |                                              |
|                       | -   Part B (Medical Insurance). Most people  |
|                       |     pay monthly for Part B. Generally, Part  |
|                       |     B premiums are withheld from your        |
|                       |     monthly Social Security check or your    |
|                       |     retirement check.                        |
+-----------------------+----------------------------------------------+
| -   **Should I enroll | The decision to enroll in Medicare is yours. |
|     in**              | We encourage you to apply for Medicare       |
|                       | benefits 3 months before you turn age 65.    |
| []{#medicare_should_I | It's easy. Just call the Social Security     |
|                       | Administration toll-free number              |
| .anchor}**Medicare?** | 1-800-772-1213 to set up an appointment to   |
|                       | apply. If you do not apply for one or both   |
|                       | Parts of Medicare, you can still be covered  |
|                       | under the FEHB Program.                      |
+-----------------------+----------------------------------------------+
|                       | If you can get premium-free Part A coverage, |
|                       | we advise you to enroll in it. Most Federal  |
|                       | employees and annuitants are entitled to     |
|                       | Medicare Part A at age 65 **without cost**.  |
|                       | When you don't have to pay premiums for      |
|                       | Medicare Part A, it makes good sense to      |
|                       | obtain the coverage. It can reduce your      |
|                       | out-of-pocket expenses as well as costs to   |
|                       | the FEHB, which can help keep FEHB premiums  |
|                       | down.                                        |
+-----------------------+----------------------------------------------+

####### *Continued on next page*

+-----------------------+----------------------------------------------+
| Section 9.            |                                              |
| Coordinating benefits |                                              |
| with other coverage   |                                              |
| *(continued)*         |                                              |
+-----------------------+----------------------------------------------+
|                       | Everyone is charged a premium for Medicare   |
|                       | Part B coverage. The Social Security         |
|                       | Administration can provide you with premium  |
|                       | and benefit information. Review the          |
|                       | information and decide if it makes sense for |
|                       | you to buy the Medicare Part B coverage.     |
+-----------------------+----------------------------------------------+
|                       | If you are eligible for Medicare, you may    |
|                       | have choices in how you get your health      |
|                       | care. Medicare+Choice is the term used to    |
|                       | describe the various health plan choices     |
|                       | available to Medicare beneficiaries. The     |
|                       | information in the next few pages show how   |
|                       | we coordinate benefits with Medicare,        |
|                       | depending on the type of Medicare managed    |
|                       | care plan you have.                          |
+-----------------------+----------------------------------------------+
| -   **The Original    | The Original Medicare Plan (Original         |
|     Medicare Plan     | Medicare) is available everywhere in the     |
|     (Part A or Part   | United States. It is the way everyone used   |
|     B)**              | to get Medicare benefits and is the way most |
|                       | people get their Medicare Part A and Part B  |
|                       | benefits now. You may go to any doctor,      |
|                       | specialist, or hospital that accepts         |
|                       | Medicare. The Original Medicare Plan pays    |
|                       | its share and you pay your share. Original   |
|                       | Medicare does not cover everything, like     |
|                       | hearing aids.                                |
|                       |                                              |
|                       | When you are enrolled in Original Medicare   |
|                       | along with this Plan, you still need to      |
|                       | follow the rules in this brochure for us to  |
|                       | cover your care. Your care must continue to  |
|                       | be precertified as required.                 |
+-----------------------+----------------------------------------------+
|                       | We will not waive any of our                 |
|                       | copayment/coinsurance for services or        |
|                       | supplies that are not covered by Original    |
|                       | Medicare (for example, hearing aids). Your   |
|                       | regular plan benefits will be applied to     |
|                       | your claim and you are responsible for any   |
|                       | applicable copayments or costs.              |
|                       |                                              |
|                       | **Claims process when you have the Original  |
|                       | Medicare Plan**\-- You probably will never   |
|                       | have to file a claim form when you have both |
|                       | our Plan and the Original Medicare Plan.     |
|                       |                                              |
|                       | -   When we are the primary payer, we        |
|                       |     process the claim first.                 |
|                       |                                              |
|                       | -   When Original Medicare is the primary    |
|                       |     payer, Medicare processes your claim     |
|                       |     first. In most cases, your claims will   |
|                       |     be coordinated automatically and we will |
|                       |     then provide secondary benefits for      |
|                       |     covered charges. You will not need to do |
|                       |     anything. To find out if you need to do  |
|                       |     something to file your claim, call us at |
|                       |     808/948-6499.                            |
|                       |                                              |
|                       | -   If your Plan physician does not          |
|                       |     participate in Medicare, you will have   |
|                       |     to file a claim with Medicare.           |
|                       |                                              |
|                       | **We waive some costs if the Original        |
|                       | Medicare is your primary payer\--** For      |
|                       | services paid by Medicare, we will waive the |
|                       | following out-of-pocket costs:               |
|                       |                                              |
|                       | -   Plan physician visit copayments          |
|                       |                                              |
|                       | -   Plan emergency room copayments           |
|                       |                                              |
|                       | **Facilities or Providers Not Eligible or    |
|                       | Entitled to Medicare Payment**\-- When       |
|                       | services are rendered at a facility or by a  |
|                       | provider that is not eligible or entitled to |
|                       | receive reimbursement from Medicare, and     |
|                       | Medicare is allowed by law to be the primary |
|                       | payer, we will limit payment to an amount    |
|                       | that supplements the benefits that would     |
|                       | have been payable by Medicare had the        |
|                       | facility or provider been eligible or        |
|                       | entitled to receive such payments,           |
|                       | regardless of whether or not Medicare        |
|                       | benefits are paid.                           |
+-----------------------+----------------------------------------------+

####### *Continued on next page*

Medicare always makes the final determination as to whether they are the
primary payer. The following chart illustrates whether Medicare or this
Plan should be the primary payer for you according to your employment
status and other factors determined by Medicare. It is critical that you
tell us if you or a covered family member has Medicare coverage so we
can administer these requirements correctly.

+-----------------------------------------------------+-------+---+--------+
| > **Primary Payer Chart**[]{#medicare_primary_chart |       |   |        |
| > .anchor}                                          |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| **A. When you - or your covered spouse - are age 65 | **The |   |        |
| or over and have Medicare and you...**              | pr    |   |        |
|                                                     | imary |   |        |
|                                                     | payer |   |        |
|                                                     | for   |   |        |
|                                                     | the   |   |        |
|                                                     | indiv |   |        |
|                                                     | idual |   |        |
|                                                     | with  |   |        |
|                                                     | Med   |   |        |
|                                                     | icare |   |        |
|                                                     | is    |   |        |
|                                                     | ...** |   |        |
+-----------------------------------------------------+-------+---+--------+
|                                                     | **    |   | **This |
|                                                     | Medic |   | Plan** |
|                                                     | are** |   |        |
+-----------------------------------------------------+-------+---+--------+
| 1)  Are an active employee with the Federal         |       |   |       |
|     government and**...**                           |       |   |        |
|                                                     |       |   |        |
|     -   You have FEHB coverage on your own or       |       |   |        |
|         through your spouse who is also an active   |       |   |        |
|         employee                                    |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| -   You have FEHB coverage through your spouse who  |      |   |        |
|     is an annuitant                                 |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| 2)  Are an annuitant and**...**                     |      |   |        |
|                                                     |       |   |        |
|     -   You have FEHB coverage on your own or       |       |   |        |
|         through your spouse who is also an          |       |   |        |
|         annuitant                                   |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| -   You have FEHB coverage through your spouse who  |       |   | >     |
|     is an active employee                           |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| 3)  Are a reemployed annuitant with the Federal     | \*   |   |        |
|     government and your position is excluded from   |       |   |        |
|     the FEHB (your employing office will know if    |       |   |        |
|     this is the case)                               |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| 4)  Are a reemployed annuitant with the Federal     |       |   | >     |
|     government and your position is not excluded    |       |   |        |
|     from the FEHB (your employing office will know  |       |   |        |
|     if this is the case) and**...**                 |       |   |        |
|                                                     |       |   |        |
|     -   You have FEHB coverage on your own or       |       |   |        |
|         through your spouse who is also an active   |       |   |        |
|         employee                                    |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| -   You have FEHB coverage through your spouse who  |      |   |        |
|     is an annuitant                                 |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| 5)  Are a Federal judge who retired under title 28, | ##### |   |        |
|     U.S.C., or a Tax Court judge who retired under  | # \* |   |        |
|     Section 7447 of title 26, U.S.C. (or if your    |       |   |        |
|     covered spouse is this type of judge)           |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| 6)  Are enrolled in Part B only, regardless of your |  for |   |  for  |
|     employment status                               | Part  |   | other  |
|                                                     | B     |   | se     |
|                                                     | ser   |   | rvices |
|                                                     | vices |   |        |
+-----------------------------------------------------+-------+---+--------+
| 7)  Are a former Federal employee receiving         | \*\* |   |        |
|     Workers' Compensation and the Office of         |       |   |        |
|     Workers' Compensation Programs has determined   |       |   |        |
|     that you are unable to return to duty           |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| **B. When you or a covered family member...**       |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| ###### Have Medicare solely                         |       |  |        |
|  based on end stage renal disease (ESRD) and**...** |       |   |        |
|                                                     |       |   |        |
| ###### It is within the fir                         |       |   |        |
| st 30 months of eligibility for or entitlement to M |       |   |        |
| edicare due to ESRD (30- month coordination period) |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| -   It is beyond the 30-month coordination period   |      |   |        |
|     and you or a family member are still entitled   |       |   |        |
|     to Medicare due to ESRD                         |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| 1)  Become eligible for Medicare due to ESRD while  |       |  |        |
|     already a Medicare beneficiary and**...**       |       | f |        |
|                                                     |       | o |        |
| -   This Plan was the primary payer before          |       | r |        |
|     eligibility due to ESRD                         |       | 3 |        |
|                                                     |       | 0 |        |
|                                                     |       | - |        |
|                                                     |       | m |        |
|                                                     |       | o |        |
|                                                     |       | n |        |
|                                                     |       | t |        |
|                                                     |       | h |        |
|                                                     |       | c |        |
|                                                     |       | o |        |
|                                                     |       | o |        |
|                                                     |       | r |        |
|                                                     |       | d |        |
|                                                     |       | i |        |
|                                                     |       | n |        |
|                                                     |       | a |        |
|                                                     |       | t |        |
|                                                     |       | i |        |
|                                                     |       | o |        |
|                                                     |       | n |        |
|                                                     |       | p |        |
|                                                     |       | e |        |
|                                                     |       | r |        |
|                                                     |       | i |        |
|                                                     |       | o |        |
|                                                     |       | d |        |
+-----------------------------------------------------+-------+---+--------+
| -   Medicare was the primary payer before           |      |   |        |
|     eligibility due to ESRD                         |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| **C. When either you or your spouse are eligible    |       |   |        |
| for Medicare solely due to disability and you**     |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| 1)  Are an active employee with the Federal         |       |  |        |
|     government and**...**                           |       |   |        |
|                                                     |       |   |        |
|     -   You have FEHB coverage on your own or       |       |   |        |
|         through your spouse who is also an active   |       |   |        |
|         employee                                    |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| -   You have FEHB coverage through your spouse who  |      |   |        |
|     is an annuitant                                 |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| 2)  Are an annuitant and**...**                     |      | [ |        |
|                                                     |       | ] |        |
|     -   You have FEHB coverage on your own or       |       | { |        |
|         through your spouse who is also an          |       | . |        |
|         annuitant                                   |       | m |        |
|                                                     |       | a |        |
|                                                     |       | r |        |
|                                                     |       | k |        |
|                                                     |       | } |        |
+-----------------------------------------------------+-------+---+--------+
| -   You have FEHB coverage through your spouse who  |       |  |        |
|     is an active employee                           |       |   |        |
+-----------------------------------------------------+-------+---+--------+
| **D. Are covered under the FEHB Spouse Equity       |      |   |        |
| provision as a former spouse**                      |       |   |        |
+-----------------------------------------------------+-------+---+--------+

\* Unless you have FEHB coverage through your spouse who is an active
employee

\*\* Workers' Compensation is primary for claims related to your
condition under Workers' Compensation

+------------------------+---------------------------------------------+
| Section 9.             |                                             |
| Coordinating benefits  |                                             |
| with other coverage    |                                             |
| *(continued)*          |                                             |
+------------------------+---------------------------------------------+
| -   []{#Section_9_Medi | > If you are eligible for Medicare, you may |
| care_Managed_Care_Plan | > choose to enroll in and get your Medicare |
|                        | > benefits from a Medicare + Choice plan.   |
|   .anchor}**Medicare + | > These are health care choices (like HMOs) |
|     Choice**           | > in some areas of the country. In most     |
|                        | > Medicare + Choice plans, you can only go  |
|                        | > to doctors, specialists, or hospitals     |
|                        | > that are part of the plan. Medicare +     |
|                        | > Choice plans provide all the benefits     |
|                        | > that Original Medicare covers. Some cover |
|                        | > extras, like prescription drugs. To learn |
|                        | > more about enrolling in a Medicare +      |
|                        | > Choice plan, contact Medicare at          |
|                        | > 800/MEDICARE (800/633-4227) or at         |
|                        | > [w                                        |
|                        | ww.medicare.gov](http://www.medicare.gov/). |
|                        | >                                           |
|                        | > If you enroll in a Medicare + Choice      |
|                        | > plan, the following options are available |
|                        | > to you:                                   |
|                        | >                                           |
|                        | > **This Plan and another plan's Medicare + |
|                        | > Choice plan:** You may enroll in another  |
|                        | > plan's Medicare + Choice plan and also    |
|                        | > remain enrolled in our FEHB Plan. We will |
|                        | > still provide benefits when your          |
|                        | > Medicare + Choice plan is primary, even   |
|                        | > out of the Medicare + Choice plan's       |
|                        | > network and/or service area, and for      |
|                        | > services paid by a Medicare + Choice plan |
|                        | > we will waive our Plan physician visit    |
|                        | > and emergency room copayments. If you     |
|                        | > enroll in a Medicare + Choice plan, tell  |
|                        | > us. We will need to know whether you are  |
|                        | > in the Original Medicare Plan or in a     |
|                        | > Medicare + Choice plan so we can          |
|                        | > correctly coordinate benefits with        |
|                        | > Medicare.                                 |
|                        | >                                           |
|                        | > **Suspended FEHB coverage to enroll in a  |
|                        | > Medicare + Choice plan:** If you are an   |
|                        | > annuitant or former spouse, you can       |
|                        | > suspend your FEHB coverage to enroll in a |
|                        | > Medicare + Choice plan, eliminating your  |
|                        | > FEHB premium. (OPM does not contribute to |
|                        | > your Medicare + Choice plan premium). For |
|                        | > information on suspending your FEHB       |
|                        | > enrollment, contact your retirement       |
|                        | > office. If you later want to re-enroll in |
|                        | > the FEHB Program, generally you may do so |
|                        | > only at the next open season unless you   |
|                        | > involuntarily lose coverage or move out   |
|                        | > of the Medicare + Choice plan's service   |
|                        | > area.                                     |
+------------------------+---------------------------------------------+
| > **TRICARE and        | > TRICARE is the health care program for    |
| > CHAMPVA**[]{#Sec     | > eligible dependents of military persons,  |
| tion_9_Tricare_ChampVA | > and retirees of the military. TRICARE     |
| > .anchor}             | > includes the CHAMPUS program. CHAMPVA     |
|                        | > provides health coverage to disabled      |
|                        | > Veterans and their eligible dependents.   |
|                        | > If TRICARE or CHAMPVA and this Plan cover |
|                        | > you, we pay first. See your TRICARE or    |
|                        | > CHAMPVA Health Benefits Advisor if you    |
|                        | > have questions about these programs.      |
|                        | >                                           |
|                        | > **Suspended FEHB coverage to enroll in    |
|                        | > TRICARE or CHAMPVA:** If you are an       |
|                        | > annuitant or former spouse, you can       |
|                        | > suspend your FEHB coverage to enroll in a |
|                        | > one of these programs, eliminating your   |
|                        | > FEHB premium. (OPM does not contribute to |
|                        | > any applicable plan premiums.) For        |
|                        | > information on suspending your FEHB       |
|                        | > enrollment, contact your retirement       |
|                        | > office. If you later want to re-enroll in |
|                        | > the FEHB Program, generally you may do so |
|                        | > only at the next Open Season unless you   |
|                        | > involuntarily lose coverage under the     |
|                        | > program.                                  |
+------------------------+---------------------------------------------+

####### *Continued on next page*

+------------------------+---------------------------------------------+
| Section 9.             |                                             |
| Coordinating benefits  |                                             |
| with other coverage    |                                             |
| *(continued)*          |                                             |
+------------------------+---------------------------------------------+
| > **Workers'           | > We do not cover services that:            |
| > Comp                 |                                             |
| ensation**[]{#Section_ | -   You need because of a workplace-related |
| 9_Workers_Compensation |     illness or injury that the Office of    |
| > .anchor}             |     Workers' Compensation Programs (OWCP)   |
|                        |     or a similar Federal or State agency    |
|                        |     determines they must provide; or        |
|                        |                                             |
|                        | -   OWCP or a similar agency pays for       |
|                        |     through a third party injury settlement |
|                        |     or other similar proceeding that is     |
|                        |     based on a claim you filed under OWCP   |
|                        |     or similar laws.                        |
|                        |                                             |
|                        | > Once OWCP or similar agency pays its      |
|                        | > maximum benefits for your treatment, we   |
|                        | > will cover your care.                     |
+------------------------+---------------------------------------------+
| > **Medicaid**         | > When you have this Plan and Medicaid, we  |
| []{#Section_9_Medicaid | > pay first.                                |
| > .anchor}             | >                                           |
|                        | > **Suspended FEHB coverage to enroll in    |
|                        | > Medicaid or a similar State-sponsored     |
|                        | > program of medical assistance:** If you   |
|                        | > are an annuitant or former spouse, you    |
|                        | > can suspend your FEHB coverage to enroll  |
|                        | > in one of these State programs,           |
|                        | > eliminating your FEHB premium. For        |
|                        | > information on suspending your FEHB       |
|                        | > enrollment, contact your retirement       |
|                        | > office. If you later want to re-enroll in |
|                        | > the FEHB Program, generally you may do so |
|                        | > only at the next Open Season unless you   |
|                        | > involuntarily lose coverage under the     |
|                        | > State program.                            |
+------------------------+---------------------------------------------+
| > **When other         | > We do not cover services and supplies     |
| > Government agencies  | > when a local, State, or Federal           |
| > are responsible for  | > Government agency directly or indirectly  |
| > your                 | > pays for them.                            |
| > c                    |                                             |
| are**[]{#Section_9_Oth |                                             |
| er_Government_Agencies |                                             |
| > .anchor}             |                                             |
+------------------------+---------------------------------------------+
| > **When others are    | > If your medical expenses are or may be    |
| > responsible for      | > covered under workers' compensation       |
| > injurie              | > insurance or automobile insurance,        |
| s**[]{#Section_9_When_ | > benefits under this plan may not be       |
| Others_Are_Responsible | > available to you. When others may be      |
| > .anchor}             | > responsible for payment of your medical   |
|                        | > expenses (due to tort liability,          |
|                        | > insurance or otherwise), our Third Party  |
|                        | > Liability Rules apply, and you should     |
|                        | > request a copy of these Rules from HMSA.  |
|                        | > You must give us prompt written notice of |
|                        | > your injuries, claims and demands for     |
|                        | > recovery, and recoveries received, and    |
|                        | > must promptly fill out and return to us   |
|                        | > all papers we require to determine        |
|                        | > coverage and to secure our reimbursement  |
|                        | > rights for any amounts we pay. We have a  |
|                        | > lien and right of reimbursement to the    |
|                        | > full extent of any expenses paid.         |
+------------------------+---------------------------------------------+

+-----------------------+----------------------------------------------+
| Section 10.           |                                              |
| Definitions of terms  |                                              |
| we use in this        |                                              |
| brochure[]{#S         |                                              |
| ection_10_Definitions |                                              |
| .anchor}              |                                              |
+-----------------------+----------------------------------------------+
| **Calendar year**     | January 1 through December 31 of the same    |
|                       | year. For new enrollees, the calendar year   |
|                       | begins on the effective date of their        |
|                       | enrollment and ends on December 31 of the    |
|                       | same year.                                   |
+-----------------------+----------------------------------------------+
| **Coinsur             | Coinsurance is the percentage of our         |
| ance**[]{#coinsurance | allowance that you must pay for your care.   |
| .anchor}              | See page [15](#Section_4_Coinsurance).       |
+-----------------------+----------------------------------------------+
| **Copayment**         | A copayment is a fixed amount of money you   |
|                       | pay when you receive covered services. See   |
|                       | page [15](#Section_4_Copayments).            |
+-----------------------+----------------------------------------------+
| **Covered**           | Care we provide benefits for, as described   |
| []{#definitio         | in this brochure.                            |
| n_of_covered_services |                                              |
| .anchor}**services**  |                                              |
+-----------------------+----------------------------------------------+
| **Custodial care**    | Helps you meet your daily living activities. |
|                       | This type of care does not require the       |
|                       | continuing attention and assistance of       |
|                       | licensed medical or trained paramedical      |
|                       | personnel. Custodial care lasting 90 days or |
|                       | more is sometimes known as long term care.   |
+-----------------------+----------------------------------------------+
| **Deductible**[]{#def | A deductible is a fixed amount of covered    |
| inition_of_deductible | expenses you must incur for certain covered  |
| .anchor}              | services and supplies before we start paying |
|                       | benefits for those services. We do not have  |
|                       | a deductible.                                |
+-----------------------+----------------------------------------------+
| **Eligible Charge**   | Eligible charge is the amount we use to      |
|                       | determine our payment and your coinsurance   |
|                       | for covered services. We determine our       |
|                       | eligible charge as the lower of either the   |
|                       | provider's actual charge or the amount we    |
|                       | establish as the maximum allowable fee.      |
|                       |                                              |
|                       | The maximum allowable fee is the maximum     |
|                       | dollar amount paid for a covered service,    |
|                       | supply, or treatment. We use the following   |
|                       | method to determine the maximum allowable    |
|                       | fee:                                         |
|                       |                                              |
|                       | -   For most services, supplies, or          |
|                       |     procedures, we consider:                 |
|                       |                                              |
|                       | ```{=html}                                   |
|                       | <!-- -->                                     |
|                       | ```                                          |
|                       | -   increases in the cost of medical and     |
|                       |     non-medical services in Hawaii over the  |
|                       |     previous year;                           |
|                       |                                              |
|                       | -   the relative difficulty of the services  |
|                       |     compared to other services;              |
|                       |                                              |
|                       | -   changes in technology; and               |
|                       |                                              |
|                       | -   payment for the service under federal,   |
|                       |     state, and other private insurance       |
|                       |     programs.                                |
|                       |                                              |
|                       | ```{=html}                                   |
|                       | <!-- -->                                     |
|                       | ```                                          |
|                       | -   For some facility-billed services (not   |
|                       |     to include practitioner-billed facility  |
|                       |     services), we use a per case, per        |
|                       |     treatment, or per day fee (per diem)     |
|                       |     rather than an itemized amount (fee for  |
|                       |     service). For Non-Plan hospitals, our    |
|                       |     maximum allowable fee for all-inclusive  |
|                       |     daily rates established by the hospital  |
|                       |     will never exceed more than if the       |
|                       |     hospital had charged separately for      |
|                       |     services.                                |
|                       |                                              |
|                       | Plan providers agree to accept the eligible  |
|                       | charge for covered services. Non-Plan        |
|                       | providers generally do not. Therefore, if    |
|                       | you received services from a non-Plan        |
|                       | provider you are responsible for any         |
|                       | difference between the actual charge and the |
|                       | eligible charge.                             |
+-----------------------+----------------------------------------------+

####### *Continued on next page*

+-----------------------+----------------------------------------------+
| Section 10.           |                                              |
| Definitions of terms  |                                              |
| we use in this        |                                              |
| brochure              |                                              |
| *(continued)*         |                                              |
+-----------------------+----------------------------------------------+
| **Experimental or     | A medical treatment, procedure, drug,        |
| investigational       | device, or care is experimental or           |
| s                     | investigative if:                            |
| ervices**[]{#experime |                                              |
| ntal_or_investigative | -   The drug or device cannot be lawfully    |
| .anchor}              |     marketed without approval of the U.S.    |
|                       |     Food and Drug Administration and         |
|                       |     approval for marketing has not been      |
|                       |     given at the time the drug or device is  |
|                       |     furnished; or                            |
|                       |                                              |
|                       | -   The drug, device, medical treatment, or  |
|                       |     procedure, or the patient informed       |
|                       |     consent document utilized with the drug, |
|                       |     device, treatment, or procedure, was     |
|                       |     reviewed and approved by the treating    |
|                       |     facility's Institutional Review Board or |
|                       |     other body serving a similar function,   |
|                       |     or if federal law requires such review   |
|                       |     and approval; or                         |
|                       |                                              |
|                       | -   Reliable evidence shows that the drug,   |
|                       |     device, medical treatment or procedure   |
|                       |     is the subject of ongoing phase I or     |
|                       |     phase II clinical trials, is for the     |
|                       |     research, experimental, study or         |
|                       |     investigational arm or ongoing phase III |
|                       |     clinical trials, or is otherwise under   |
|                       |     study to determine its maximum tolerated |
|                       |     dose, its toxicity, its safety, its      |
|                       |     efficacy or its efficacy as compared     |
|                       |     with a standard means of treatment or    |
|                       |     diagnosis; or                            |
|                       |                                              |
|                       | -   Reliable evidence shows that the         |
|                       |     prevailing opinion among experts         |
|                       |     regarding the drug, device, medical      |
|                       |     treatment or procedure is that further   |
|                       |     studies or clinical trials are necessary |
|                       |     to determine its maximum tolerated dose, |
|                       |     toxicity, safety, efficacy, or its       |
|                       |     efficacy compared with a standard means  |
|                       |     of treatment or diagnosis.               |
|                       |                                              |
|                       | -   Reliable evidence shall mean only:       |
|                       |                                              |
|                       | ```{=html}                                   |
|                       | <!-- -->                                     |
|                       | ```                                          |
|                       | -   Published reports and articles in        |
|                       |     authoritative medical and scientific     |
|                       |     literature;                              |
|                       |                                              |
|                       | -   The written protocol or protocols used   |
|                       |     by the treating facility or the          |
|                       |     protocols(s) of another facility         |
|                       |     studying substantially the same drug,    |
|                       |     device, medical treatment or procedure;  |
|                       |     or                                       |
|                       |                                              |
|                       | -   The written informed consent used by the |
|                       |     treating facility or by another facility |
|                       |     studying substantially the same drug,    |
|                       |     device, medical treatment or procedure.  |
+-----------------------+----------------------------------------------+

+-----------------------+----------------------------------------------+
| **Medical             | Care, treatment, service, or supply, which   |
| necessity**[]         | is all of the following:                     |
| {#medically_necessity |                                              |
| .anchor}              | -   Appropriate and necessary for the        |
|                       |     symptoms, diagnosis, and direct care or  |
|                       |     treatment of your illness or injury;     |
|                       |                                              |
|                       | -   Consistent with professionally           |
|                       |     recognized standards of health care in   |
|                       |     the United States, and given at the      |
|                       |     right time and in the right setting;     |
|                       |                                              |
|                       | -   Not primarily for your convenience or    |
|                       |     the convenience of your provider;        |
|                       |                                              |
|                       | -   The most appropriate supply or level of  |
|                       |     service that can safely be provided; and |
|                       |                                              |
|                       | -   Consistent with our medical guidelines   |
|                       |     and policies.                            |
+-----------------------+----------------------------------------------+
| **Us/We**             | Us and we refer to HMSA.                     |
+-----------------------+----------------------------------------------+
| **You**               | You refers to the enrollee and each covered  |
|                       | family member.                               |
+-----------------------+----------------------------------------------+

+----------------------+-----------------------------------------------+
| Section 11. FEHB     |                                               |
| facts[]{#S           |                                               |
| ection_10_FEHB_Facts |                                               |
| .anchor}             |                                               |
+----------------------+-----------------------------------------------+
| **Coverage           |                                               |
| Information**        |                                               |
+----------------------+-----------------------------------------------+
| **No pre-existing    | We will not refuse to cover the treatment of  |
| condition            | a condition that you had before you enrolled  |
| limitation*          | in this Plan solely because you had the       |
| *[]{#Section_11_No_P | condition before you enrolled.                |
| reexisting_Condition |                                               |
| .anchor}             |                                               |
+----------------------+-----------------------------------------------+
| **Where you can get  | See [www.opm.gov/insure]{.underline}. Also,   |
| information about    | your employing or retirement office can       |
| enrolling in the     | answer your questions, and give you *a Guide  |
| FEHB                 | to Federal Employees Health Benefits Plans,*  |
| Program**[]{#        | brochures for other plans, and other          |
| Section_11_Where_You | materials you need to make an informed        |
| _Get_Info_About_FEHB | decision about your FEHB coverage. These      |
| .anchor}             | materials tell you:                           |
|                      |                                               |
|                      | -   When you may change your enrollment       |
|                      |                                               |
|                      | -   How you can cover your family members     |
|                      |                                               |
|                      | -   What happens when you transfer to another |
|                      |     Federal agency, go on leave without pay,  |
|                      |     enter military service, or retire         |
|                      |                                               |
|                      | -   When your enrollment ends                 |
|                      |                                               |
|                      | -   When the next open season for enrollment  |
|                      |     begins                                    |
|                      |                                               |
|                      | We don't determine who is eligible for        |
|                      | coverage and, in most cases, cannot change    |
|                      | your enrollment status without information    |
|                      | from your employing or retirement office.     |
+----------------------+-----------------------------------------------+
| **Types of coverage  | Self Only coverage is for you alone. Self and |
| available for you    | Family coverage is for you, your spouse, and  |
| and your             | your unmarried dependent children under age   |
| family**[]{#Section_ | 22, including any foster children or          |
| 11_Types_Of_Coverage | stepchildren your employing or retirement     |
| .anchor}             | office authorizes coverage for. Under certain |
|                      | circumstances, you may also continue coverage |
|                      | for a disabled child 22 years of age or older |
|                      | who is incapable of self-support.             |
|                      |                                               |
|                      | If you have a Self Only enrollment, you may   |
|                      | change to a Self and Family enrollment if you |
|                      | marry, give birth, or add a child to your     |
|                      | family. You may change your enrollment 31     |
|                      | days before to 60 days after that event. The  |
|                      | Self and Family enrollment begins on the      |
|                      | first day of the pay period in which the      |
|                      | child is born or becomes an eligible family   |
|                      | member. When you change to Self and Family    |
|                      | because you marry, the change is effective on |
|                      | the first day of the pay period that begins   |
|                      | after your employing office receives your     |
|                      | enrollment form; benefits will not be         |
|                      | available to your spouse until you marry.     |
|                      |                                               |
|                      | Your employing or retirement office will      |
|                      | **not** notify you when a family member is no |
|                      | longer eligible to receive health benefits,   |
|                      | nor will we. Please tell us immediately when  |
|                      | you add or remove family members from your    |
|                      | coverage for any reason, including divorce,   |
|                      | or when your child under age 22 marries or    |
|                      | turns 22.                                     |
|                      |                                               |
|                      | If you or one of your family members is       |
|                      | enrolled in one FEHB Plan, that person may    |
|                      | not be enrolled in or covered as a family     |
|                      | member by another FEHB Plan.                  |
+----------------------+-----------------------------------------------+

####### *Continued on next page* 

+----------------------+-----------------------------------------------+
| Section 11. FEHB     |                                               |
| facts *(continued)*  |                                               |
+----------------------+-----------------------------------------------+
| **Children's Equity  | OPM has implemented the Federal Employees     |
| Act*                 | Health Benefits Children\'s Equity Act of     |
| *[]{#children_equity | 2000. This law mandates that you be enrolled  |
| .anchor}             | for Self and Family coverage in the Federal   |
|                      | Employees Health Benefits (FEHB) Program, if  |
|                      | you are an employee subject to a court or     |
|                      | administrative order requiring you to provide |
|                      | health benefits for your child(ren).          |
|                      |                                               |
|                      | If this law applies to you, you must enroll   |
|                      | for Self and Family coverage in a health plan |
|                      | that provides full benefits in the area where |
|                      | your children live or provide documentation   |
|                      | to your employing office that you have        |
|                      | obtained other health benefits coverage for   |
|                      | your children. If you do not do so, your      |
|                      | employing office will enroll you              |
|                      | involuntarily as follows:                     |
|                      |                                               |
|                      | -   If you have no FEHB coverage, your        |
|                      |     employing office will enroll you for Self |
|                      |     and Family coverage in the Blue Cross and |
|                      |     Blue Shield Service Benefit Plan's Basic  |
|                      |     Option;                                   |
|                      |                                               |
|                      | -   if you have a Self Only enrollment in a   |
|                      |     fee-for-service plan or in an HMO that    |
|                      |     serves the area where your children live, |
|                      |     your employing office will change your    |
|                      |     enrollment to Self and Family in the same |
|                      |     option of the same plan; or               |
|                      |                                               |
|                      | -   if you are enrolled in an HMO that does   |
|                      |     not serve the area where the children     |
|                      |     live, your employing office will change   |
|                      |     your enrollment to Self and Family in the |
|                      |     Blue Cross and Blue Shield Service        |
|                      |     Benefit Plan's Basic Option.              |
|                      |                                               |
|                      | As long as the court/administrative order is  |
|                      | in effect, and you have at least one child    |
|                      | identified in the order who is still eligible |
|                      | under the FEHB Program, you cannot cancel     |
|                      | your enrollment, change to Self Only, or      |
|                      | change to a plan that doesn\'t serve the area |
|                      | in which your children live, unless you       |
|                      | provide documentation that you have other     |
|                      | coverage for the children. If the             |
|                      | court/administrative order is still in effect |
|                      | when you retire, and you have at least one    |
|                      | child still eligible for FEHB coverage, you   |
|                      | must continue your FEHB coverage into         |
|                      | retirement (if eligible) and cannot cancel    |
|                      | your coverage, change to Self Only, or change |
|                      | to a plan that doesn't serve the area in      |
|                      | which your children live as long as the       |
|                      | court/administrative order is in effect.      |
|                      | Contact your employing office for further     |
|                      | information.                                  |
+----------------------+-----------------------------------------------+
| **When benefits and  | The benefits in this brochure are effective   |
| premiums             | on January 1. If you joined this Plan during  |
| s                    | Open Season, your coverage begins on the      |
| tart**[]{#Section_11 | first day of your first pay period that       |
| _When_Benefits_Start | starts on or after January 1. If you changed  |
| .anchor}             | plans or plan options during Open Season and  |
|                      | you receive care between January 1 and the    |
|                      | effective date of coverage under your new     |
|                      | plan or option, your claims will be paid      |
|                      | according to the 2004 benefits of your old    |
|                      | plan or option. However, if your old plan     |
|                      | left the FEHB Program at the end of the year, |
|                      | you are covered under that plan's 2003        |
|                      | benefits until the effective date of your     |
|                      | coverage with your new plan. Annuitants'      |
|                      | coverage and premiums begin on January 1. If  |
|                      | you joined at any other time during the year, |
|                      | your employing office will tell you the       |
|                      | effective date of coverage.                   |
+----------------------+-----------------------------------------------+
| **When you           | When you retire, you can usually stay in the  |
| retire**[]{#Sectio   | FEHB Program. Generally, you must have been   |
| n_11_When_You_Retire | enrolled in the FEHB Program for the last     |
| .anchor}             | five years of your Federal service. If you do |
|                      | not meet this requirement, you may be         |
|                      | eligible for other forms of coverage, such as |
|                      | Temporary Continuation of Coverage (TCC).     |
+----------------------+-----------------------------------------------+

*Continued on next page*

+----------------------+-----------------------------------------------+
| Section 11. FEHB     |                                               |
| facts *(continued)*  |                                               |
+----------------------+-----------------------------------------------+
| **When you lose      |                                               |
| benefit              |                                               |
| s**[]{#Section_11_Wh |                                               |
| en_You_Lose_Benefits |                                               |
| .anchor}             |                                               |
+----------------------+-----------------------------------------------+
| -   **When FEHB      | You will receive an additional 31 days of     |
|     coverage         | coverage, for no additional premium, when:    |
|     ends             |                                               |
| **[]{#Section_11_Whe | -   Your enrollment ends, unless you cancel   |
| n_FEHB_Coverage_Ends |     your enrollment, or                       |
|     .anchor}         |                                               |
|                      | -   You are a family member no longer         |
|                      |     eligible for coverage.                    |
|                      |                                               |
|                      | You may be eligible for spouse equity         |
|                      | coverage or Temporary Continuation of         |
|                      | Coverage (TCC), or a conversion policy (a     |
|                      | non-FEHB individual policy).                  |
+----------------------+-----------------------------------------------+
| -   **Spouse equity  | If you are divorced from a Federal employee   |
|     coverag          | or annuitant, you may not continue to get     |
| e**[]{#Section_11_Sp | benefits under your former spouse's           |
| ouse_Equity_Coverage | enrollment. This is the case even when the    |
|     .anchor}         | court has ordered your former spouse to       |
|                      | supply health coverage to you. But, you may   |
|                      | be eligible for your own FEHB coverage under  |
|                      | the spouse equity law or Temporary            |
|                      | Continuation of Coverage (TCC). If you are    |
|                      | recently divorced or are anticipating a       |
|                      | divorce, contact your ex-spouse's employing   |
|                      | or retirement office to get RI 70-5, the      |
|                      | *Guide to Federal Employees Health Benefits   |
|                      | Plans for Temporary Continuation of Coverage  |
|                      | and Former Spouse Enrollees*, or other        |
|                      | information about your coverage choices. You  |
|                      | can also download the guide from OPM's Web    |
|                      | site, [www.opm.gov/insure]{.underline}.       |
+----------------------+-----------------------------------------------+
| -   **Temporary      | If you leave Federal service, or if you lose  |
|     continuation of  | coverage because you no longer qualify as a   |
|     coverage         | family member, you may be eligible for        |
|     (TCC             | Temporary Continuation of Coverage (TCC). For |
| **[]{#Section_11_TCC | example, you can receive TCC if you are not   |
|     .anchor}**)**    | able to continue your FEHB enrollment after   |
|                      | you retire, if you lose your job, if you are  |
|                      | a covered dependent child and you turn 22 or  |
|                      | marry, etc.                                   |
|                      |                                               |
|                      | You may not elect TCC if you are fired from   |
|                      | your Federal job due to gross misconduct.     |
|                      |                                               |
|                      | **Enrolling in TCC.** Get the RI 79-27, which |
|                      | describes TCC, and the RI 70-5, the *Guide to |
|                      | Federal Employees Health Benefits Plans for   |
|                      | Temporary Continuation of Coverage and Former |
|                      | Spouse Enrollees*, from your employing or     |
|                      | retirement office or from                     |
|                      | [www.opm.gov/insure]{.underline}. It explains |
|                      | what you have to do to enroll.                |
+----------------------+-----------------------------------------------+
| -   **Converting to  | You may convert to a non-FEHB individual      |
|     individual       | policy if:                                    |
|     coverage*        |                                               |
| *[]{#Section_11_Conv | -   Your coverage under TCC or the spouse     |
| erting_To_Individual |     equity law ends (If you canceled your     |
|     .anchor}         |     coverage or did not pay your premium, you |
|                      |     cannot convert);                          |
|                      |                                               |
|                      | -   You decided not to receive coverage under |
|                      |     TCC or the spouse equity law; or          |
|                      |                                               |
|                      | -   You are not eligible for coverage under   |
|                      |     TCC or the spouse equity law.             |
|                      |                                               |
|                      | If you leave Federal service, your employing  |
|                      | office will notify you of your right to       |
|                      | convert. You must apply in writing to us      |
|                      | within 31 days after you receive this notice. |
|                      | However, if you are a family member who is    |
|                      | losing coverage, the employing or retirement  |
|                      | office will **not** notify you. You must      |
|                      | apply in writing to us within 31 days after   |
|                      | you are no longer eligible for coverage.      |
|                      |                                               |
|                      | Your benefits and rates will differ from      |
|                      | those under the FEHB Program; however, you    |
|                      | will not have to answer questions about your  |
|                      | health, and we will not impose a waiting      |
|                      | period or limit your coverage due to          |
|                      | pre-existing conditions.                      |
+----------------------+-----------------------------------------------+

####### *Continued on next page*

+----------------------+-----------------------------------------------+
| Section 11. FEHB     |                                               |
| facts *(continued)*  |                                               |
+----------------------+-----------------------------------------------+
| -   []{#Section_11_G | The Health Insurance Portability and          |
| etting_A_Certificate | Accountability Act of 1996 (HIPAA) is a       |
|                      | Federal law that offers limited Federal       |
|    .anchor}**Getting | protections for health coverage availability  |
|     a Certificate of | and continuity to people who lose employer    |
|     Group Health     | group coverage. If you leave the FEHB         |
|     Plan Coverage**  | Program, we will give you a Certificate of    |
|                      | Group Health Plan Coverage that indicates how |
|                      | long you have been enrolled with us. You can  |
|                      | use this certificate when getting health      |
|                      | insurance or other health care coverage. Your |
|                      | new plan must reduce or eliminate waiting     |
|                      | periods, limitations, or exclusions for       |
|                      | health related conditions based on the        |
|                      | information in the certificate, as long as    |
|                      | you enroll within 63 days of losing coverage  |
|                      | under this Plan. If you have been enrolled    |
|                      | with us for less than 12 months, but were     |
|                      | previously enrolled in other FEHB plans, you  |
|                      | may also request a certificate from those     |
|                      | plans. For more information, get OPM pamphlet |
|                      | RI 79-27, Temporary Continuation of Coverage  |
|                      | (TCC) under the FEHB Program. See also the    |
|                      | FEHB Web site                                 |
|                      | ([www.opm.gov/insure/                         |
|                      | health](http://www.opm.gov/insure/health);)); |
|                      | refer to the "TCC and HIPAA" frequently asked |
|                      | questions. These highlight HIPAA rules, such  |
|                      | as the requirement that Federal employees     |
|                      | must exhaust any TCC eligibility as one       |
|                      | condition for guaranteed access to individual |
|                      | health coverage under HIPAA, and have         |
|                      | information about Federal and State agencies  |
|                      | you can contact for more information.         |
+----------------------+-----------------------------------------------+

  -----------------------------------------------------------------------
  Two new Federal Programs complement FEHB benefits[]{#Two_new_programs
  .anchor}

  -----------------------------------------------------------------------

**Important information** OPM wants to be sure you know about two new
Federal programs that complement the FEHB Program. First, the **Flexible
Spending Account (FSA) Program**, also known as **FSAFEDS,** lets you
set aside tax-free money to pay for health and dependent care expenses.
The result can be a discount of 20 to more than 40 percent on services
you routinely pay for out-of-pocket. Second, the **Federal Long Term
Care Insurance Program** (FLTCIP) covers long term care costs not
covered under the FEHB.

**The Federal Flexible Spending Account Program --
*FSAFEDS***[]{#FSAFEDS .anchor}

+-----------------------+---+-------------------------+--------+--------+---+
| -   **What is an      | I |                         |        |        |   |
|     FSA?**            | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | % |                         |        |        |   |
|                       | ! |                         |        |        |   |
|                       | ! |                         |        |        |   |
|                       | * |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| **Health Care         | - |                         |        |        |   |
| Flexible**            |   |                         |        |        |   |
|                       |   |                         |        |        |   |
| **Spending Account**  |   |                         |        |        |   |
|                       | C |                         |        |        |   |
| **(HCFSA)**           | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | q |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | U |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | j |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | ' |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | " |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | " |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| **Dependent Care      | - |                         |        |        |   |
| Flexible Spending     |   |                         |        |        |   |
| Account**             |   |                         |        |        |   |
|                       |   |                         |        |        |   |
| **(DCFSA)**           | C |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | q |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | j |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | j |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| -   **Enroll during   | Y |                         |        |        |   |
|     Open Season**     | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | 8 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | [ |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | ] |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 8 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | M |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | 9 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | 9 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| > **What is SHPS?**   | S |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | M |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| > **Who is eligible   | I |                         |        |        |   |
| > to enroll?**        | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | ' |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | [ |                         |        |        |   |
|                       | W |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | ] |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | 8 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | L |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | U |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | U |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | J |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| -   **How much should | P |                         |        |        |   |
|     I contribute to   | l |                         |        |        |   |
|     my FSA?**         | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | Y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | q |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | " |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | " |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | Y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 9 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | Y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | J |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | [ |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | ] |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| -   **What can my     | E |                         |        |        |   |
|     HCFSA**           | v |                         |        |        |   |
|                       | e |                         |        |        |   |
| > **pay for?**        | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | z |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | [ |                         |        |        |   |
|                       | 8 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | ] |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | # |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | _ |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | Y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | U |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | V |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | W |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | W |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | < |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | > |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 8 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | q |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| -   **Tax savings     | A |                         |        |        |   |
|     with an FSA**     | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | W |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | : |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       |   | **Annual Tax Savings    | **With | **W    |   |
|                       |   | Example**               | FSA**  | ithout |   |
|                       |   |                         |        | FSA**  |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       |   | If your taxable income  | \$     | \$     |   |
|                       |   | is:                     | 50,000 | 50,000 |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       |   | And you deposit this    | \$     | -\$0-  |   |
|                       |   | amount into a FSA:      | 2,000  |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       |   | Your taxable income is  | \$     | \$     |   |
|                       |   | now:                    | 48,000 | 50,000 |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       |   | Subtract Federal &      | \$     | \$     |   |
|                       |   | Social Security taxes:  | 13,807 | 14,383 |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       |   | If you spend after-tax  | -\$0-  | \$     |   |
|                       |   | dollars for expenses:   |        | 2,000  |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       |   | Your real spendable     | \$     | \$     |   |
|                       |   | income is:              | 34,193 | 33,617 |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       |   | **Your tax savings:**   | **\    | **-    |   |
|                       |   |                         | $576** | \$0-** |   |
+-----------------------+---+-------------------------+--------+--------+---+
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | % |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | 6 |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | % |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 6 |                         |        |        |   |
|                       | % |                         |        |        |   |
|                       | ! |                         |        |        |   |
|                       | Y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| -   **Tax credits     | Y |                         |        |        |   |
|     and**             | o |                         |        |        |   |
|                       | u |                         |        |        |   |
| > **deductions**      | * |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| > **Health care       | T |                         |        |        |   |
| > expenses**          | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | ' |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | O |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | % |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | j |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | U |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | % |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| > **Dependent care    | T |                         |        |        |   |
| > expenses**          | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | N |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | V |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | [ |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | ] |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | W |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | Q |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | L |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | Y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| -   **Does it cost me | P |                         |        |        |   |
|     anything**        | r |                         |        |        |   |
|                       | o |                         |        |        |   |
| > **to participate in | b |                         |        |        |   |
| > FSAFEDS?**          | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | W |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | \ |                         |        |        |   |
|                       | $ |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | % |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | W |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 8 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | ' |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | I |                         |        |        |   |
|                       | R |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | " |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | " |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | . |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+
| -   **Contact us**    | T |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | W |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | [ |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | ] |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | / |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | * |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | H |                         |        |        |   |
|                       | P |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | B |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | C |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | b |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | 9 |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | 9 |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | , |                         |        |        |   |
|                       | M |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | y |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | < |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | @ |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | . |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | > |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 8 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       | A |                         |        |        |   |
|                       | F |                         |        |        |   |
|                       | E |                         |        |        |   |
|                       | D |                         |        |        |   |
|                       | S |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 3 |                         |        |        |   |
|                       | 7 |                         |        |        |   |
|                       | ) |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | T |                         |        |        |   |
|                       | Y |                         |        |        |   |
|                       | : |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | 1 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 8 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 9 |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 2 |                         |        |        |   |
|                       | - |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       | 4 |                         |        |        |   |
|                       | 5 |                         |        |        |   |
|                       | 0 |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | ( |                         |        |        |   |
|                       | f |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | p |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | h |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | w |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | d |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | k |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | o |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | u |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | l |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | z |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | x |                         |        |        |   |
|                       | t |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | m |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | a |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | n |                         |        |        |   |
|                       | g |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       |   |                         |        |        |   |
|                       | s |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | r |                         |        |        |   |
|                       | v |                         |        |        |   |
|                       | i |                         |        |        |   |
|                       | c |                         |        |        |   |
|                       | e |                         |        |        |   |
|                       | ) |                         |        |        |   |
+-----------------------+---+-------------------------+--------+--------+---+

**The Federal Long Term Care Insurance Program**[]{#Long_term_care
.anchor}

+-----------------------+----------------------------------------------+
| **It's important      | Here's why you should consider enrolling in  |
| protection**          | the Federal Long Term Care Insurance         |
|                       |                                              |
|                       | Program:                                     |
|                       |                                              |
|                       | -   **FEHB plans do not cover the cost of    |
|                       |     long term care.** Also called "custodial |
|                       |     care," long term care is help you        |
|                       |     receive when you need assistance         |
|                       |     performing activities of daily living -- |
|                       |     such as bathing or dressing yourself.    |
|                       |     This need can strike anyone at any age   |
|                       |     and the cost of care can be substantial. |
|                       |                                              |
|                       | -   **The Federal Long Term Care Insurance   |
|                       |     Program can help protect you from the    |
|                       |     potentially high cost of long term       |
|                       |     care**. This coverage gives you control  |
|                       |     over the type of care you receive and    |
|                       |     where you receive it. It can also help   |
|                       |     you remain independent, so you won't     |
|                       |     have to worry about being a burden to    |
|                       |     your loved ones.                         |
|                       |                                              |
|                       | -   **It's to your advantage to apply sooner |
|                       |     rather than later**. Long term care      |
|                       |     insurance is something you must apply    |
|                       |     for, and pass a medical screening        |
|                       |     (called underwriting) in order to be     |
|                       |     enrolled. Certain medical conditions     |
|                       |     will prevent some people from being      |
|                       |     approved for coverage. By applying while |
|                       |     you're in good health, you could avoid   |
|                       |     the risk of having a change in health    |
|                       |     disqualify you from obtaining coverage.  |
|                       |     Also, the younger you are when you       |
|                       |     apply, the lower your premiums.          |
|                       |                                              |
|                       | -   **You don't have to wait for an open     |
|                       |     season to apply**. The Federal Long Term |
|                       |     Care Insurance Program accepts           |
|                       |     applications from eligible persons at    |
|                       |     any time. You will have to complete a    |
|                       |     full underwriting application, which     |
|                       |     asks a number of questions about your    |
|                       |     health. However, if you are a new or     |
|                       |     newly eligible employee, you (and your   |
|                       |     spouse, if applicable) have a limited    |
|                       |     opportunity to apply using the           |
|                       |     abbreviated underwriting application,    |
|                       |     which asks fewer questions. If you       |
|                       |     marry, your new spouse will also have a  |
|                       |     limited opportunity to apply using       |
|                       |     abbreviated underwriting. Qualified      |
|                       |     relatives are also eligible to apply     |
|                       |     with full underwriting                   |
+-----------------------+----------------------------------------------+
| **To find out more    | Call 1-800-LTC-FEDS (1-800-582-3337) (TTY    |
| and**                 | 1-800-843-3557) or visit                     |
|                       | [www.ltcfeds.com](http://www.ltcfeds.com/).  |
| **to request an       |                                              |
| application**         |                                              |
+-----------------------+----------------------------------------------+

  -----------------------------------------------------------------------
  **Index**[]{#Index .anchor}

  -----------------------------------------------------------------------

> Do not rely on this page; it is for your convenience and may not show
> all pages where the terms appear.

**A**ccidental injury [47](#accidental-injury-benefit)

Allergy tests [23](#Allergy_tests)

> Alternative treatment [27](#alternative-treatments)
>
> Allogeneic (donor) bone marrow transplant
> [31](#Allogenetic_donor_bone_marrow)

Ambulance [35](#ambulance), [38](#Ambulance_1)

Anesthesia [32](#Anesthesia)

Autologous bone marrow\
transplant [31](#Allogenetic_donor_bone_marrow)

**B**iopsy [29](#Biopsy)

Blood and blood plasma [33](#blood_plasma_costs), [34](#blood_plasma)

Breast cancer screening [18](#routine_pap)

**C**asts [33](#casts), [34](#dressings_casts)

> Catastrophic protection [15](#catastrophic),
> [80](#Catastrophic_protection)

Changes for 2004 [10](#Section_2_Changes_to_this_Plan)

Chemotherapy [23](#chemotherapy)

Childbirth [21](#delivery)

> Chiropractic [27](#chiropractic)

Cholesterol tests [18](#cholesterol_tests), [19](#Blood_Cholesterol)

Claims [55](#Section_7_Filing_A_Claim)

Coinsurance [15](#Section_4_Coinsurance), [64](#coinsurance)

Colonoscopy [18](#Colonoscopy)

Colorectal cancer screening [18](#cholorectal_screening)

Congenital anomalies [29](#congenital_anomalies),
[30](#correction_of_congenital_anomalies)

Contraceptive devices and drugs [22](#contraceptive_devices_and_drugs),
[43](#oral_contraceptives)

Coordination of benefits [59](#Section_9_Coordinating_Benefits)

Covered services [15](#Section_4_Your_Costs_For_Covered_Service),
[64](#definition_of_covered_services)

Covered providers [12](#Section_3_Plan_Providers)

> Crutches [26](#crutches)

**D**eductible [15](#Section_4_Deductible),
[64](#definition_of_deductible)

Definitions [64](#Section_10_Definitions)

Dental care [47](#Section_5_Dental)

Diagnostic services [17](#diagnostic-and-treatment-services)

Disputed claims review [57](#Section_8_Disputed_Claims)

Donor expenses (transplants) [31](#Section_5_Organ_Transplants)

Dressings [33](#casts), [34](#dressings)

Durable medical equipment (DME) [26](#durable-medical-equipment-dme)

**E**ducational classes and programs
[27](#educational-classes-and-programs)

Effective date of enrollment [67](#Section_11_When_Benefits_Start)

Emergency [36](#section-5-d.-emergency-servicesaccidents)

Experimental or investigational [65](#experimental_or_investigative)

Eyeglasses [25](#Eyeglasses_Covered)

**F**amily planning [22](#family-planning)

Fecal occult blood test [18](#fecal_occult_blood_test),
[20](#fecal_occult_blood_test_Prev)

**G**eneral Exclusions [54](#Section_6_General_Exclusions)

**H**earing services [24](#Section_5_Hearing_Services)

Home health services [26](#home-health-services)

Hospice care [35](#hospice-care)

Home nursing care [26](#home-health-services)

Hospital [33](#Section_5_Hospital)

**I**mmunizations [19](#immunizations), [20](#childhood_immunizations)

Infertility [22](#infertility-services)

Inhospital physician care [17](#diagnostic-and-treatment-services)

Inpatient Hospital Benefits [33](#inpatient-hospital)

Insulin [44](#insulin)

**L**aboratory and pathological services
[17](#lab-x-ray-and-other-diagnostic-tests)

**M**achine diagnostic tests [17](#diagnostic-and-treatment-services)

Magnetic Resonance Imagings (MRIs) [17](#MRI)

Mail Order Prescription Drugs [45](#mail_order_prescription_drugs)

Mammograms [17](#Non_Routine_Mammograms), [18](#mammograms)

Maternity Benefits [21](#maternity-care)

Medicaid [63](#Section_9_Medicaid)

Medically necessary [65](#medically_necessity)

Medicare [59](#Section_9_What_Is_Medicare)

Mental Conditions/Substance Abuse Benefits
[39](#Section_5_Mental_Health)

> **N**ewborn care [21](#newborn_care)

Non-FEHB Benefits [52](#Section_5_Non_FEHB)

Nurse

> Advanced Practice Registered Nurse
> [39](#professional-services-including-individual-or-group-therapy-by-providers-such-as-psychiatrists-psychologists-clinical-social-workers-or-advanced-practice-registered-nurses-aprn)

Nurse Anesthetist [33](#nurse_anesthetist)

> Nursery charges [21](#Nursery_care)

**O**bstetrical care [21](#maternity-care)

Occupational therapy [24](#Section_5_PT_and_OT)

> Office visits [17](#diagnostic-and-treatment-services)

Oral and maxillofacial surgery [31](#Section_5_Oral_And_Maxillofacial)

Orthopedic devices [25](#Section_5_Orthopedic_and_Prosthetic)

Out-of-pocket expenses [15](#Section_4_Your_Out_Of_Pocket_Maximum)

Outpatient facility care
[34](#outpatient-hospital-or-ambulatory-surgical-center)

Oxygen [26](#durable-medical-equipment-dme), [33](#oxygen)

**P**ap test [17](#Nonroutine_pap), [18](#routine_pap)

Physical examination [18](#physical_exam)

Physical therapy [24](#Section_5_PT_and_OT)

Physician [17](#diagnostic-and-treatment-services)

Point-of-service (POS) [49](#Section_5_Point_Of_Service)

> Precertification [14](#Precertification)

Preventive care, adult [18](#preventive-care-adult)

Preventive care, children [20](#preventive-care-children)

Prescription drugs [41](#Section_5_Prescription_Drug)

Preventive services [18](#preventive-care-adult)

Prior approval [14](#Section_3_Services_Requiring_Approval)

Prostate cancer screening [18](#prostate_screening)

Prosthetic devices [25](#Section_5_Orthopedic_and_Prosthetic)

Psychologist
[39](#professional-services-including-individual-or-group-therapy-by-providers-such-as-psychiatrists-psychologists-clinical-social-workers-or-advanced-practice-registered-nurses-aprn)

**R**adiation therapy [23](#treatment-therapies)

Renal dialysis [23](#treatment-therapies)

Room and board [33](#inpatient-hospital)

> **S**killed nursing facility care
> [34](#extended-care-benefitsskilled-nursing-care-facility-benefits)

Smoking cessation [27](#smoking_cessation_QUIT_NOW),
[43](#smoking_cessation), [45](#smoking_cessation_not_covered)

Speech therapy [24](#Section_5_Speech_Therapyl)

Splints [33](#Splints), [48](#Dental_Splints)

Sterilization procedures [22](#sterilization_procedures)

Substance abuse [39](#Section_5_Mental_Health)

Surgery [29](#Section_5_Surgical_And_Anesthesia)

-   Anesthesia [32](#Anesthesia)

-   Oral [31](#Section_5_Oral_And_Maxillofacial)

-   Outpatient [29](#Section_5_Surgical_And_Anesthesia)

-   Reconstructive [30](#Section_5_Reconstructive_Surgery)

    Syringes [44](#syringes)

    **T**emporary continuation of coverage [68](#Section_11_TCC)

    Transplants [31](#Section_5_Organ_Transplants)

> Treatment therapies [23](#treatment-therapies)

**V**ision services [25](#Section_5_Vision_Services)

**W**ell child care [20](#well_child)

Wheelchairs [26](#wheelchair)

Workers' compensation [63](#Section_9_Workers_Compensation)

> **X**-rays [17](#lab-x-ray-and-other-diagnostic-tests)

**NOTES:**

**NOTES:**

**NOTES:**

  -----------------------------------------------------------------------
  **Summary of benefits for the HMSA Plan -- 2004**[]{#summary_2004
  .anchor}

  -----------------------------------------------------------------------

-   **Do not rely on this chart alone.** All benefits are provided in
    full unless indicated and are subject to the definitions,
    limitations, and exclusions in this brochure. On this page we
    summarize specific expenses we cover; for more detail, look inside.

-   If you want to enroll or change your enrollment in this Plan, be
    sure to put the correct enrollment code from the cover on your
    enrollment form.

-   When you receive services from a non-Plan provider you have a higher
    out-of-pocket cost. You generally must pay any difference between
    our eligible charge and the billed amount.

+---------------------------------------+-------------------------+---+
| **Benefits**                          | **You Pay Plan          | * |
|                                       | Providers**             | * |
|                                       |                         | P |
|                                       |                         | a |
|                                       |                         | g |
|                                       |                         | e |
|                                       |                         | * |
|                                       |                         | * |
+---------------------------------------+-------------------------+---+
| Medical services provided by          | \$15 copayment          | > |
| physicians:                           |                         |   |
|                                       | 20% of eligible charges | [ |
| -   Physician visits                  |                         | 1 |
|                                       |                         | 7 |
| -   Other diagnostic and treatment    |                         | ] |
|     services provided in the office   |                         | ( |
|                                       |                         | # |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | c |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | 5 |
|                                       |                         | _ |
|                                       |                         | M |
|                                       |                         | e |
|                                       |                         | d |
|                                       |                         | i |
|                                       |                         | c |
|                                       |                         | a |
|                                       |                         | l |
|                                       |                         | _ |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | r |
|                                       |                         | v |
|                                       |                         | i |
|                                       |                         | c |
|                                       |                         | e |
|                                       |                         | s |
|                                       |                         | _ |
|                                       |                         | A |
|                                       |                         | n |
|                                       |                         | d |
|                                       |                         | _ |
|                                       |                         | S |
|                                       |                         | u |
|                                       |                         | p |
|                                       |                         | p |
|                                       |                         | l |
|                                       |                         | i |
|                                       |                         | e |
|                                       |                         | s |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+
| Services provided by a hospital:      | Nothing                 | > |
|                                       |                         |   |
| -   Inpatient                         | > 20% of eligible       | [ |
|                                       | > charges               | 3 |
| -   Outpatient                        |                         | 3 |
|                                       |                         | ] |
|                                       |                         | ( |
|                                       |                         | # |
|                                       |                         | i |
|                                       |                         | n |
|                                       |                         | p |
|                                       |                         | a |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | e |
|                                       |                         | n |
|                                       |                         | t |
|                                       |                         | - |
|                                       |                         | h |
|                                       |                         | o |
|                                       |                         | s |
|                                       |                         | p |
|                                       |                         | i |
|                                       |                         | t |
|                                       |                         | a |
|                                       |                         | l |
|                                       |                         | ) |
|                                       |                         | > |
|                                       |                         | > |
|                                       |                         |   |
|                                       |                         | [ |
|                                       |                         | 3 |
|                                       |                         | 4 |
|                                       |                         | ] |
|                                       |                         | ( |
|                                       |                         | # |
|                                       |                         | o |
|                                       |                         | u |
|                                       |                         | t |
|                                       |                         | p |
|                                       |                         | a |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | e |
|                                       |                         | n |
|                                       |                         | t |
|                                       |                         | - |
|                                       |                         | h |
|                                       |                         | o |
|                                       |                         | s |
|                                       |                         | p |
|                                       |                         | i |
|                                       |                         | t |
|                                       |                         | a |
|                                       |                         | l |
|                                       |                         | - |
|                                       |                         | o |
|                                       |                         | r |
|                                       |                         | - |
|                                       |                         | a |
|                                       |                         | m |
|                                       |                         | b |
|                                       |                         | u |
|                                       |                         | l |
|                                       |                         | a |
|                                       |                         | t |
|                                       |                         | o |
|                                       |                         | r |
|                                       |                         | y |
|                                       |                         | - |
|                                       |                         | s |
|                                       |                         | u |
|                                       |                         | r |
|                                       |                         | g |
|                                       |                         | i |
|                                       |                         | c |
|                                       |                         | a |
|                                       |                         | l |
|                                       |                         | - |
|                                       |                         | c |
|                                       |                         | e |
|                                       |                         | n |
|                                       |                         | t |
|                                       |                         | e |
|                                       |                         | r |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+
| Emergency benefits:                   | > \$15 physician visit  | > |
|                                       | > copay; \$50 emergency |   |
| -   In-area                           | > room facility copay;  | [ |
|                                       | > Nothing for           | 3 |
| -   Out-of-area                       | > laboratory tests; and | 6 |
|                                       | > 20% of eligible       | ] |
|                                       | > charges for other     | ( |
|                                       | > emergency services    | # |
|                                       | >                       | S |
|                                       | > \$15 physician visit  | e |
|                                       | > copay; \$50 emergency | c |
|                                       | > room facility copay;  | t |
|                                       | > Nothing for           | i |
|                                       | > laboratory tests; and | o |
|                                       | > 20% of eligible       | n |
|                                       | > charges for other     | _ |
|                                       | > emergency services    | 5 |
|                                       |                         | _ |
|                                       |                         | E |
|                                       |                         | m |
|                                       |                         | e |
|                                       |                         | r |
|                                       |                         | g |
|                                       |                         | e |
|                                       |                         | n |
|                                       |                         | c |
|                                       |                         | y |
|                                       |                         | _ |
|                                       |                         | W |
|                                       |                         | i |
|                                       |                         | t |
|                                       |                         | h |
|                                       |                         | i |
|                                       |                         | n |
|                                       |                         | ) |
|                                       |                         | > |
|                                       |                         | > |
|                                       |                         |   |
|                                       |                         | [ |
|                                       |                         | 3 |
|                                       |                         | 7 |
|                                       |                         | ] |
|                                       |                         | ( |
|                                       |                         | # |
|                                       |                         | e |
|                                       |                         | m |
|                                       |                         | e |
|                                       |                         | r |
|                                       |                         | g |
|                                       |                         | e |
|                                       |                         | n |
|                                       |                         | c |
|                                       |                         | y |
|                                       |                         | - |
|                                       |                         | o |
|                                       |                         | u |
|                                       |                         | t |
|                                       |                         | s |
|                                       |                         | i |
|                                       |                         | d |
|                                       |                         | e |
|                                       |                         | - |
|                                       |                         | o |
|                                       |                         | u |
|                                       |                         | r |
|                                       |                         | - |
|                                       |                         | s |
|                                       |                         | e |
|                                       |                         | r |
|                                       |                         | v |
|                                       |                         | i |
|                                       |                         | c |
|                                       |                         | e |
|                                       |                         | - |
|                                       |                         | a |
|                                       |                         | r |
|                                       |                         | e |
|                                       |                         | a |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+
| Mental health and substance abuse     | > Regular benefits      | > |
| treatment                             |                         |   |
|                                       |                         | [ |
|                                       |                         | 3 |
|                                       |                         | 9 |
|                                       |                         | ] |
|                                       |                         | ( |
|                                       |                         | # |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | c |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | 5 |
|                                       |                         | _ |
|                                       |                         | M |
|                                       |                         | e |
|                                       |                         | n |
|                                       |                         | t |
|                                       |                         | a |
|                                       |                         | l |
|                                       |                         | _ |
|                                       |                         | H |
|                                       |                         | e |
|                                       |                         | a |
|                                       |                         | l |
|                                       |                         | t |
|                                       |                         | h |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+
| Prescription drugs                    | > \$5 copayment for     | > |
|                                       | > generic drugs         |   |
|                                       | >                       | [ |
|                                       | > \$20 copayment for    | 4 |
|                                       | > preferred name brand  | 1 |
|                                       | > drugs                 | ] |
|                                       | >                       | ( |
|                                       | > 50% copayment of      | # |
|                                       | > eligible charges not  | S |
|                                       | > less than \$20        | e |
|                                       | > copayment for other   | c |
|                                       | > brand name drugs      | t |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | 5 |
|                                       |                         | _ |
|                                       |                         | P |
|                                       |                         | r |
|                                       |                         | e |
|                                       |                         | s |
|                                       |                         | c |
|                                       |                         | r |
|                                       |                         | i |
|                                       |                         | p |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | D |
|                                       |                         | r |
|                                       |                         | u |
|                                       |                         | g |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+
| Dental Care                           | > Nothing for           | > |
|                                       | > preventive dental     |   |
|                                       | > care                  | [ |
|                                       |                         | 4 |
|                                       |                         | 7 |
|                                       |                         | ] |
|                                       |                         | ( |
|                                       |                         | # |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | c |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | 5 |
|                                       |                         | _ |
|                                       |                         | D |
|                                       |                         | e |
|                                       |                         | n |
|                                       |                         | t |
|                                       |                         | a |
|                                       |                         | l |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+
| Vision Care                           | > \$7 copayment for     | > |
|                                       | > optometrist           |   |
|                                       | >                       | [ |
|                                       | > 20% of eligible       | 2 |
|                                       | > charges for other     | 5 |
|                                       | > Plan providers        | ] |
|                                       |                         | ( |
|                                       |                         | # |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | c |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | 5 |
|                                       |                         | _ |
|                                       |                         | V |
|                                       |                         | i |
|                                       |                         | s |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | r |
|                                       |                         | v |
|                                       |                         | i |
|                                       |                         | c |
|                                       |                         | e |
|                                       |                         | s |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+
| > Point of Service benefits -- Yes    |                         | > |
|                                       |                         |   |
|                                       |                         | [ |
|                                       |                         | 4 |
|                                       |                         | 9 |
|                                       |                         | ] |
|                                       |                         | ( |
|                                       |                         | # |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | c |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | 5 |
|                                       |                         | _ |
|                                       |                         | P |
|                                       |                         | o |
|                                       |                         | i |
|                                       |                         | n |
|                                       |                         | t |
|                                       |                         | _ |
|                                       |                         | O |
|                                       |                         | f |
|                                       |                         | _ |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | r |
|                                       |                         | v |
|                                       |                         | i |
|                                       |                         | c |
|                                       |                         | e |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+
| Protection against catastrophic costs | Nothing after           | > |
|                                       | \$2,500/Self-Only or    |   |
| (your catastrophic                    | \$7,500/Family          | [ |
| []{#Catastrophic_protection           | enrollment per year     | 1 |
| .anchor}protection out-of-pocket      |                         | 5 |
| maximum)                              | Some costs do not count | ] |
|                                       | toward this protection  | ( |
|                                       |                         | # |
|                                       |                         | S |
|                                       |                         | e |
|                                       |                         | c |
|                                       |                         | t |
|                                       |                         | i |
|                                       |                         | o |
|                                       |                         | n |
|                                       |                         | _ |
|                                       |                         | 4 |
|                                       |                         | _ |
|                                       |                         | Y |
|                                       |                         | o |
|                                       |                         | u |
|                                       |                         | r |
|                                       |                         | _ |
|                                       |                         | O |
|                                       |                         | u |
|                                       |                         | t |
|                                       |                         | _ |
|                                       |                         | O |
|                                       |                         | f |
|                                       |                         | _ |
|                                       |                         | P |
|                                       |                         | o |
|                                       |                         | c |
|                                       |                         | k |
|                                       |                         | e |
|                                       |                         | t |
|                                       |                         | _ |
|                                       |                         | M |
|                                       |                         | a |
|                                       |                         | x |
|                                       |                         | i |
|                                       |                         | m |
|                                       |                         | u |
|                                       |                         | m |
|                                       |                         | ) |
+---------------------------------------+-------------------------+---+

####### 2004 Rate Information for

**Hawaii Medical Service Association Plan**

**Non-Postal rates** apply to most non-Postal enrollees. If you are in a
special enrollment category, refer to the FEHB Guide for that category
or contact the agency that maintains your health benefits enrollment.

**Postal rates** apply to career Postal Service employees. Most
employees should refer to the FEHB Guide for United States Postal
Service Employees, RI 70-2. Different postal rates apply and a special
FEHB guide is published for Postal Service Inspectors and Office of
Inspector General (OIG) employees (see RI 70-2IN).

Postal rates do not apply to non-career postal employees, postal
retirees, or associate members of any postal employee organization who
are not career postal employees. Refer to the applicable FEHB Guide.

+--------------+-----+-------+-------+-------+-------+-------+-------+
|              |     | **    |       |       |       | **P   |       |
|              |     | Non-P |       |       |       | ostal |       |
|              |     | ostal |       |       |       | Prem  |       |
|              |     | Prem  |       |       |       | ium** |       |
|              |     | ium** |       |       |       |       |       |
+--------------+-----+-------+-------+-------+-------+-------+-------+
|              |     | **    |       | *     |       | **    |       |
|              |     | Biwee |       | *Mont |       | Biwee |       |
|              |     | kly** |       | hly** |       | kly** |       |
+--------------+-----+-------+-------+-------+-------+-------+-------+
| **Type of**  | **  | **Go  | **Y   | **Go  | **Y   | **U   | **Y   |
|              | Cod | v't** | our** | v't** | our** | SPS** | our** |
| **           | e** |       |       |       |       |       |       |
| Enrollment** |     | **Sh  | **Sh  | **Sh  | **Sh  | **Sh  | **Sh  |
|              |     | are** | are** | are** | are** | are** | are** |
+--------------+-----+-------+-------+-------+-------+-------+-------+

All of Hawaii

  ---------------- --------- -------------- ------------- -------------- -------------- -------------- -------------
  **Self Only**    **871**   **\$101.20**   **\$33.73**   **\$219.26**   **\$73.09**    **\$119.75**   **\$15.18**

  **Self and       **872**   **\$225.26**   **\$75.09**   **\$488.07**   **\$162.69**   **\$266.56**   **\$33.79**
  Family**                                                                                             
  ---------------- --------- -------------- ------------- -------------- -------------- -------------- -------------