4A (Expenses $ 6605557 including grants of $ 0) (Revenue $ 8524151)
TO PROVIDE HIGH QUALITY AND COST-EFFECTIVE HEALTH CARE SERVICES, CLOSE TO HOME, IN A PATIENT-CENTERED ENVIRONMENT AND PROVIDE SYSTEMS OF CARE THAT ASSIST PATIENTS AS THEY TRANSITION THROUGH VARIOUS CARE CONTINUUMS. ALSO TO WORK CLOSELY WITH THE LOCAL COMMUNITY TO SUPPORT THE HEALTH AND WELLNESS OF THE COMMUNITY AS A WHOLE.DECKERVILLE OFFERS, AS PART OF ITS MISSION, NECESSARY MEDICAL CARE TO THOSE INDIVIDUALS NOT COVERED UNDER A THIRD PARTY INSURER OR GOVERNMENT PROGRAM OR WHO DO NOT HAVE RESOURCES TO PAY ALL OR A PORTION OF THEIR BILLS.DURING THE FISCAL YEAR ENDED JUNE 30, 2022, THE HOSPITAL SERVICED 51 INPATIENTS, 1,987 EMERGENCY ROOM PATIENTS, AND 16,233 OUTPATIENTS THROUGH ITS CLINICS, OFFICE PRACTICES, AND ANCILLARY DEPARTMENTS.

DECKERVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 5: STAKEHOLDER MEETINGS AND SURVEYS INTENTIONALLY SOUGHT TO INCLUDE VULNERABLE POPULATIONS. THIS WAS ACHIEVED BY DISTRIBUTING SURVEYS TO INDIVIDUALS PARTICIPATING IN SERVICES FOR LOW INCOME POPULATION AND SENIOR CITIZENS. ADDITIONALLY, SOCIAL SERVICE ORGANIZATIONS THAT SERVE VULNERABLE POPULATIONS WERE PROVIDED SURVEYS. AGENCIES INCLUDED HUMAN DEVELOPMENT COMMISSION, MENTAL HEALTH AGENCIES, THE PUBLIC HEALTH AND SOCIAL SERVICES DIVISION OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, SOCIAL WORKERS, INTERMEDIATE SCHOOL DISTRICTS, STAFF FROM HEALTHCARE SECTOR WITH FREE OR LOW-COST HEALTH CLINICS, EARLY CHILDHOOD SERVICE PROVIDERS, AND LAW ENFORCEMENT. A COMMUNITY SURVEY TARGETING SERVICE AREA BY ZIP CODES 286 PARTICIPANTS.

DECKERVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 6A: THERE WERE MULTIPLE HOSPITAL FACILITIES IN THE FOUR COUNTIES OF HURON, LAPEER, SANILAC, AND TUSCOLA THAT RECEIVED SUPPORT FROM THE MICHIGAN CENTER FOR RURAL HEALTH AND MICHIGAN THUMB PUBLIC HEALTH ALLIANCE (HURON, LAPEER, SANILAC, AND TUSCOLA).

DECKERVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 6B: THERE WERE MULTIPLE HOSPITAL FACILITIES THAT RECEIVED SUPPORT FROM THE MICHIGAN CENTER FOR RURAL HEALTH AND MICHIGAN THUMB PUBLIC HEALTH ALLIANCE (HURON, LAPEER, SANILAC, AND TUSCOLA).

DECKERVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 7D: HTTPS://DECKERVILLEHOSP.ORG/DOCUMENTS/CHNA-2022.PDF

DECKERVILLE COMMUNITY HOSPITAL, INC.
"PART V, SECTION B, LINE 11: DECKERVILLE IDENTIFIED THE FOLLOWING FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT COMPLETED IN TAX YEAR 2021 AS TOP CONCERNS AND AREAS. THE BOARD HAS APPROVED THE ORGANIZATION FOCUS ITS EFFORTS ON THE FOLLOWING:DECKERVILLE COMMUNITY HOSPITAL UTILIZED THE REGIONAL WORK COMPLETED BY THE THUMB COMMUNITY HEALTHPARTNERSHIP TO IDENTIFY LOCAL PRIORITIES. AS INDICATED IN STEP 4 OF THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS, PRIORITIES MUST BE SELECTED TO ENSURE THAT LIMITED RESOURCES HAVE THE GREATEST IMPACT. SELECTION OF PRIORITIES WILL OFTEN RESULT IN MORE COMPLEX AND EFFECTIVE IMPLEMENTATION STRATEGIES. IDENTIFYING A LIMITED NUMBER OF PRIORITIES ON WHICH TO FOCUS ALSO ALLOWS COMMUNITY INITIATIVES TO BE DEVELOPED WITH COLLABORATING ORGANIZATIONS. EVALUATION AND PROGRESS CAN BE MORE EFFECTIVELY MANAGED WHEN THE PRIORITIES ARE FEWER IN NUMBER.IN REVIEW OF EXISTING EFFORTS, THE TEAM DETERMINED THAT DECKERVILLE COMMUNITY HOSPITAL WOULD HAVE THE GREATEST IMPACT ON COMMUNITY HEALTH BY TARGETING SEVEN FOCUS AREAS. DATA THAT LED TO THESE PRIORITIES IS INCLUDED IN THE FOLLOWING SECTION.1. CANCER- DCH PARTNERS WITH P.C.U.P.S FOUNDATION TO RAISE FUNDS AND CREATE A HIGHER AWARENESS IN THE FIGHT AGAINST PROSTATE CANCER. P.C.U.P.S. STANDS FOR PROSTATE CANCER UNDERSTANDING, PREVENTION AND SCREENINGS.- DCH PARTICIPATES IN THE ACS ""GO RED"" CAMPAIGN.- PARTNERED WITH THE HEALTH DEPARTMENT FOR UNDER INSURED PATIENTS FOR SCREENING EXAMS.2. CHRONIC DISEASE- SPECIALIST OPTIONS EITHER ON-SITE OR THROUGH TELE-HEALTH, UTILIZING CRTN NETWORK.- INCREASE TELEHEALTH UTILIZATION- AWARENESS OF SERVICES-UTILIZE SOCIAL MEDIA TO INCREASE AWARENESS OF SERVICE LINES- UTILIZING THE ACO POPULATION MANAGEMENT DASHBOARD, PREVENTION AND SCREENING MEASUREMENTS, AND MONTHLY HEALTH MONTH AWARENESS CAMPAIGNS TO IDENTIFY THOSE INDIVIDUALS WHO NEED THOSE SCREENINGS AND NOTIFY THEM, ""IT'S TIME FOR YOUR YEARLY SCREENING.""3. SUBSTANCE USE/MENTAL HEALTH- PHYSICIAN OFFICES AND EMERGENCY DEPARTMENT CONTINUE TO ABIDE BY STRICT GUIDELINES IN THE PRESCRIBING AND ADMINISTRATION OF OPIOIDS AND NARCOTICS.- MEMBER OF THUMB OPIOID RESPONSE CONSORTIUM (TORC) TO REDUCE THE HARM OF SUBSTANCE USE DISORDERS BY WORKING TOGETHER AS A REGION (HURON, SANILAC, TUSCOLA, AND THE RURAL TRACKS OF LAPEER COUNTY) TO ENSURE THAT PREVENTION, TREATMENT, AND RECOVERY SERVICES ARE ALIGNED WITH THE NEEDS OF THE COMMUNITY.- PREVIOUSLY COMPLETED SBIRT TRAINING THROUGH THE TORC.- MEMBER OF THUMB COMMUNITY HEALTH PARTNERSHIP TO PROVIDE MAN THERAPY.4. TOBACCO USE & VAPING- DCH PARTICIPATES IN ""IDENTIFYING EVERY DAY DANGERS IN THE LIVES OF YOUTH"" EVENT TARGETING TOBACCO USE AND VAPING- MEMBER OF THE THUMB OPIOID RESPONSE CONSORTIUM (TORC) TO REDUCE THE HARM OF SUBSTANCE USE DISORDERS BY WORKING TOGETHER AS A REGION (HURON, SANILAC, TUSCOLA, AND THE RURAL TRACKS OF LAPEER COUNTY) TO ENSURE THAT PREVENTION, TREATMENT, AND RECOVERY SERVICES ARE ALIGNED WITH THE NEEDS OF THE COMMUNITY.5. PRENATAL AND INFANT HEALTH- OFFER COMMUNITY EDUCATION ON PRENATAL AND INFANT HEALTH ISSUES- REFER PATIENTS TO THE SCHD FOR THESE SERVICES.6. VETERAN'S SERVICES- IDENTIFYING WHAT SERVICES CAN BE PERFORMED AND PARTNERS7. ACCESS TO THE INTERNET- LOCATING A POTENTIAL LOCATION FOR OUR REFERRED PATIENTS TO UTILIZE TELEHEALTH SERVICES IF THEY DO NOT HAVE ADEQUATE INTERNET AT HOME"

DECKERVILLE COMMUNITY HOSPITAL, INC.
PART V, SECTION B, LINE 20E: WHEN A PATIENT IS ADMITTED TO THE HOSPITAL WITHOUT INSURANCE AND THE PATIENT FINANCIAL LIAISON IS AVAILABLE, SHE WILL PHYSICALLY MEET WITH THE PATIENT TO DISCUSS PAYMENT OPTIONS INCLUDING FAP. THIS WOULD BE PRIOR TO DISCHARGE. HER SCHEDULED HOURS ARE MONDAY - FRIDAY 7:00 AM - 3:30 PM. FOR PATIENTS THAT ARE ADMITTED OUTSIDE OF HER SCHEDULED HOURS FAP INFORMATION IS POSTED IN ALL ER ROOMS AND PATIENT ROOMS FOR DISPLAY. FINANCIAL ASSISTANCE AVAILABILITY IS NOTATED ON ALL PATIENT STATEMENTS AND A LETTER DETAILING THE FAP IS SENT TO A PATIENT PRIOR TO ECA. THE PATIENT IS CALLED SEVERAL TIMES TO IDENTIFY THEIR ELIGIBILITY FOR FAP PRIOR TO INITIATING ECA.

PART I, LINE 7G:
THE ORGANIZATION IS REPORTING THE FOLLOWING SERVICE LINES AS SUBSIDIZED ON SCHEDULE H, PART I, LINE 7G: EMERGENCY ROOM, HOSPITAL CLINIC, RURAL HEALTH CLINIC.

PART I, LINE 7, COLUMN (F):
THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 193,602.

PART III, LINE 2:
THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.

PART III, LINE 4:
THE ORGANIZATION DOES NOT HAVE A SPECIFIC BAD DEBT FOOTNOTE IN THEIR FINANCIAL STATEMENTS. ACCOUNTS RECEIVABLE AND CREDIT POLICY:ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE HOSPITAL EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND IMPLICIT PRICE CONCESSIONS, WHICH REFLECT MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE. THE HOSPITAL DOES NOT HAVE A POLICY TO CHARGE INTEREST ON PAST DUE ACCOUNTS.THE AUDITED FINANCIAL STATEMENTS DO NOT CONTAIN A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.

PART III, LINE 8:
THE AMOUNT OF MEDICARE ALLOWABLE COST WAS TAKEN DIRECTLY FROM THE MEDICARE COST REPORT. WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES TO MEDICARE BENEFICIARIES, THESE PATIENTS, WHO ARE TYPICALLY ELDERLY MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.THE TOTAL MEDICARE REVENUE SHOWN ON SCHEDULE H IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY THE CHARGES FROM MEDICARE PROGRAM BENEFICIARIES THAT ARE REPORTED ON THE HOSPITAL'S MEDICARE COST REPORT. THE AMOUNT LISTED FOR MEDICARE REVENUE DOES NOT INCLUDE PHYSICIAN SERVICES PROVIDED AT THE HOSPITAL, OUTLYING CLINIC LOCATIONS. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARE FOR PATIENTS. PHYSICIAN SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AN ADDITIONAL COMMUNITY BENEFIT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COST METHOD USED ABOVE FOR IRS 990 COMPLIANCES REPORTING IS BASED ON THE OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE DIVIDED BY THE HOSPITAL PATIENT SERVICE REVENUE (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE). THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES, WHICH ARE REIMBURSED BASED ON MEDICARE REGULATIONS. INCLUDING THE FEE SCHEDULE ITEMS, SUCH AS PHYSICIAN SERVICES, WOULD PRODUCE A LOSS OR SHORTFALL ON THESE SERVICES TO BE REPORTED ON THE FORM 990 IN ANY GIVEN YEAR.

PART III, LINE 9B:
IF A PATIENT PRESENTS WITHOUT INSURANCE FOR OUTPATIENT SERVICES, THE FRONT DESK INFORMS THE PATIENT OF THE AVAILABILITY OF FINANCIAL ASSISTANCE VIA A FORM THAT THE PATIENT RECEIVES PRIOR TO SERVICES. THE PATIENTS SEEN IN THE EMERGENCY ROOM DEPARTMENT IF STILL IN THE HOSPITAL DURING FINANCIAL SERVICES REGULAR BUSINESS HOURS, THE PATIENT IS APPROACHED TO OFFER THE OPPORTUNITY FOR FINANCIAL ASSISTANCE. THERE IS SIGNAGE IN THE EMERGENCY ROOMS AND WAITING ROOM AREAS INFORMING PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. THERE IS VERBIAGE ON THE PATIENT STATEMENTS INDICATING AVAILABILITY OF THE PROGRAM AS WELL. EACH PATIENT PRIOR TO BAD DEBT COLLECTIONS RECEIVES A LETTER FROM THE FINANCIAL LIAISON AND A PHONE CALL FOR OUTREACH AS WELL.

PART VI, LINE 2:
THE ORGANIZATION USES STATISTICS FROM THE MICHIGAN THUMB PUBLIC HEALTH ALLIANCE, ONGOING PATIENT SATISFACTION SURVEYS, PATIENT QUESTIONNAIRES AT THE HEALTHCARE CLINIC RELATED TO SOCIOECONOMIC SITUATIONS OF THE PATIENT, AND AN ANNUAL PROGRAM EVALUATION COMPLETED BY THE CEO/CFO FOR THE HOSPITAL AND RHC AND REPORTED AT THE ANNUAL MEETINGS. ALSO, THE RELATIONSHIP BUILT UNDER UNITED HEALTHCARE PARTNERS WITH MARLETTE REGIONAL HOSPITAL HAS ALSO BEEN A GOOD RESOURCE OF INFORMATION ON WHAT PATIENTS IN THE COUNTY ARE LOOKING FOR AS WELL.

PART VI, LINE 3:
WHEN A PATIENT IS ADMITTED TO THE HOSPITAL WITHOUT INSURANCE AND THE PATIENT FINANCIAL LIAISON IS AVAILABLE, SHE WILL PHYSICALLY MEET WITH THE PATIENT TO DISCUSS PAYMENT OPTIONS INCLUDING THE FAP PRIOR TO DISCHARGE. THE FINANCIAL LIAISON RUNS/REVIEWS DAILY REPORTS TO IDENTIFY UN-INSURED PATIENTS THAT WERE SEEN AND CONTACTS THEM TO ASSIST. ADDITIONALLY, FOR PATIENTS THAT ARE ADMITTED OUTSIDE OF HER OFFICE HOURS, THE FAP INFORMATION IS POSTED IN ALL OF THE EMERGENCY ROOMS/PATIENT ROOMS AND DISPLAYED IN PATIENT WAITING AREAS THROUGHOUT THE HOSPITAL. THE PATIENT STATEMENTS INDICATE THE AVAILABILITY OF THE FAP AND PATIENTS RECEIVE A LETTER NOTICE WITH A PLAIN LANGUAGE SUMMARY PRIOR TO INITIATING EXTRAORDINARY COLLECTION EFFORTS.

PART VI, LINE 5:
IN FY22 THERE WERE NO NEW SERVICES LINES ADDED TO THE HOSPITAL. HOWEVER, THE HOSPITAL HAS UPGRADED A SIGNIFICANT AMOUNT OF OUR PATIENT CARE EQUIPMENT AS WELL AS FURNITURE IN PATIENT CARE AREAS. THIS AROSE FROM THE NEEDS ADDRESSED DURING THE COVID-19 PANDEMIC.

PART VI, LINE 6:
DECKERVILLE COMMUNITY HOSPITAL IS WORKING TOGETHER WITH MARLETTE REGIONAL HOSPITAL AND UNITED HEALTHCARE PARTNERS TO BETTER SERVE THE COMMUNITY AND CREATE MORE EFFICIENT PATIENT CARE PROGRAMS THROUGHOUT THE TWO ORGANIZATIONS. DURING THE END OF FY'20 BOTH ORGANIZATIONS COMBINED THEIR ADMINISTRATIVE TEAMS TO HAVE ONE CEO, COO, AND CFO OVER BOTH FACILITIES TO CREATE AN EVEN BETTER FLOW OF EFFICIENCIES BETWEEN THE TWO HOSPITALS. THE HOSPITAL IS ABLE TO UTILIZE RESOURCES FROM EACH FACILITY TO ENHANCE THE PATIENT EXPERIENCE. DURING THIS PAST YEAR UHP HAS BEEN WORKING ON BUILING AN ASSISTED LIVING/MEMORY CARE/INDEPENDENT LIVING FACILITY IN THE COUNTY TO ALSO BETTER TAKE CARE OF OUR ELDERLY POPULATION.

PART VI, LINE 4:
DECKERVILLE COMMUNITY HOSPITAL SERVES RURAL COMMUNITIES IN SANILAC COUNTY AND PORTIONS OF HURON COUNTY. THE HOSPITAL'S SERVICE AREA INCLUDES NUMEROUS MUNICIPALITIES: APPLEGATE, CARSONVILLE, CROSWELL, DECKERVILLE, HARBOR BEACH, MINDEN CITY, PORT SANILAC, RUTH, SANDUSKY, SNOVER, AND PALMS. BASED ON CENSUS DATA FOR THESE MUNICIPALITIES, APPROXIMATELY 27,077 PEOPLE LIVE IN THE SERVICE AREA. (CENSUS-AMERICAN COMMUNITY SURVEY 5-YEAR AVERAGE-2020). TWENTY-TWO PERCENT OF THE POPULATION IS OVER THE AGE OF 65 AND ONLY 20.6% ARE UNDER THE AGE OF 18. THE POPULATION HAS LIMITED RACIAL DIVERSITY WITH 97.7% OF THE POPULATION WHITE. THE SERVICE AREA HAS A COLLEGE DEGREE RATE OF 14.45% COMPARED TO MICHIGAN'S 30.5% AND THE UNITED STATES' 32.9%. AVERAGE HOUSEHOLD INCOME IN THE SERVICE AREA IS $65,155 AS COMPARED TO MICHIGAN'S AVERAGE INCOME OF $80,803 AND THE UNITED STATES AVERAGE INCOME OF $91,547. UNEMPLOYMENT IN THE SERVICE AREA RANGED FROM 1 TO 3.7% COMPARED TO MICHIGAN AT 6% AND THE U.S. AT 5.4%. OF THE CIVILIAN NONINSTITUTIONALIZED POPULATION 6.3% HAVE NO HEALTH INSURANCE COVERAGE COMPARED TO MICHIGAN AT 5.4% AND THE U.S. AT 8.7%. THE PERCENTAGE OF PEOPLE WHO HAD INCOMES BELOW POVERTY IN THE PAST 12 MONTHS WAS 12.3% BUT RANGED BY THE MUNICIPALITY FROM 7.1% TO 19.3%.