Great Plains Health at a glance
Emergency department renovation is complete
Preventative care is a priority
COMMUNITY IMPACT 2020
Message from the CEO As a nonprofit organization, Great Plains Health has a responsibility to our region that goes beyond providing medical care for the residents of the communities we serve. We have a long tradition of improving the health and well-being of the communities. Whether it’s through health education, partnerships with local organizations, financial contributions or the many hours that our employees and physicians give annually through volunteering, we are committed to our corporate responsibility of helping ensure the continued success of the North Platte region.
I am proud to be a part of the dedicated team at Great Plains Health. Our providers, clinical care staff and support staff are committed to excellence and improving the health and well-being of our community.
Mel McNea, MHA Great Plains Health CEO
Addressing our community’s most pressing needs
At Great Plains Health, we believe we can rise to challenges that lie before us. We are committed to inspiring a healthier community and in putting patients first in everything we do. The COVID-19 pandemic is no exception, and we have remained steadfast in our commitment to keeping our patients, staff and community safe while continuing to work on our community’s biggest health challenges identified in the 2020-2022 Community Health Needs Assessment. Following extensive data collection and review, community input, leadership prioritization and final approval by the Great Plains Health Board of Directors, the following have been identified as the five most significant community health needs in Lincoln County.
• Increase access to mental and behavioral health care. • Increase prevention and education to reduce the prevalence of chronic diseases, preventable conditions, readmissions and high mortality rates. • Increase access to safe and affordable housing. • Improve access to medical and dental care. • Recruit and retain quality healthcare professionals. To review the data collected and the Community Health Needs Assessment implementation plan created to address these six key areas over the next two years, go to gphealth.org/CommunityBenefit.
For questions or to provide feedback, please contact: Fiona Libsack, MPA, FACHE Chief development officer email@example.com
Great Plains Health serves: 38 counties in three states 67,882 square miles
A glance at Great Plains Health
116 Physicians 1
30 Medical and surgical specialties available Over
$ 108.3M Annual economic impact of Great Plains Health to the region 2
25,000 Hours given back by Great Plains Health employees
30 Great Plains Physician Network clinics and outreach clinics in North Platte and throughout the region
volunteering to serve the community: approximately 25,000 hours per year over the last five years
$ 1,385,195 Patient medication (Rx) assistance program
$ 150,105 Given in donations to local nonprofit groups that align with our goal to improve the health and wellness of the communities we serve.
179,604 Provider encounters
Average monthly utility bills
$ 71,200 Electricity
$ 19,000 Gas
$ 2,700 Water
$ 3,500 Fuel
$ 27,100 Phone/Internet
$ 23,900 Refuse/Sewer
1 Includes active medical staff and courtesy medical staff. 2 Estimate computed by Kenneth Lemke, PhD, Nebraska Public Power District, economic development division.
Great Plains Health utilizes infection control team to help community
In January 2020, the infection control professionals at Great Plains Health formed a plan of action for the possibility of a pandemic with the COVID-19 virus. Jenny Lantis, RN, Great Plains Health infection prevention coordinator explained, “Preparing for an outbreak wasn’t something that surprised us. My job is to keep people safe from infectious disease at any time.” Under the supervision of Eduardo Freitas, MD, Lantis took her skill and expertise to help the community. Along with Jasmine Hahn, RN, they visited various schools and businesses to help implement safe practices. James McGown, Superintendent, Brady Public School, said: “We are a small rural school district. We do not have a school nurse and our Pandemic Procedure Committee was primarily made up of educators, not health experts. Jenny and Jasmine walked around our building and helped us develop plans based on scientific knowledge. They took the
time to process what a ‘new normal’ day could look like while being sensitive to the needs of our students and staff.” “We needed the guidelines on COVID-19 from various governmental agencies paraphrased,” explained McGown. “Jenny and Jasmine did that, and explained what that meant in a school setting. GPHealth filled in the gaps in a time of need and provided assistance so we could safely start the school year. I am proud to report that we have had minimal disruptions. This is largely due to the procedures that were implemented with the assistance of GPHealth.”
Lantis and Hahn also collaborated with North Platte Public Schools, Hershey Public School, the Walmart Distribution Center and Gary’s Superfoods. In partnership with North Platte Chamber and Development and West Central District Health Department, they hosted a virtual Q&A session for area businesses, which over 150 businesses took part in. “All the community sites we visited were very knowledgeable and prepared.” said Lantis, “They had done their homework. We basically helped reassure them that they were doing what was best and tweaked a few things here and there.”
My mask protects you . Your mask protects me.
“Wear a mask for me so I can stay in school and participate in sports during my senior year.” -Rachel, North Platte Catholic Schools
“Wear a mask for me so we are able to participate in extracurricular activities!” -Ty, Sutherland High School
“Wear a mask for me. My dad is a firefighter and I want him to be safe.” -Violet, Brady Schools
“I wear a mask to help others stay safe and not get sick.” -Isaiah, North Platte Public Schools
“My job is to keep people safe from infectious disease at any time.” -Jenny Lantis, RN Infection Prevention Coordinator
“I want to enjoy my senior year at school and play football this fall.” -Michael, Maxwell Schools
“Wear a mask for me because I’m excited to finally be in kindergarten!” -Karson, North Platte Public Schools
“Wear a mask for me because I want to have an uninterrupted volleyball season.” -Tahlia, Hershey Schools
“It’s my first year at school and I want to see my teacher
and friends in person.” - Knox, Wallace Schools
Wear a mask for me.
Great Plains Health adds neurosurgery program
In the United States, there are approximately 3,500 neurosurgeons to serve a population of more than 311 million people. To say that neurosurgeons in rural America are hard to find is an understatement. In March, Great Plains Health began recruiting Dr. W. Lee Warren to become North Platte’s first neurosurgeon, and by June Great Plains Health Brain & Spine opened with two providers, Dr. Warren and Starr Bartlett-Rone, PA. “When we brought Dr. Warren on board, we knew it would be incredibly beneficial to our community and the surrounding areas,” said Ivan Mitchell, Great Plains Health chief operations officer. Bringing neurosurgery to the region was a game-changer. “Previously, residents would have to travel long distances to see a neurosurgeon,” explained Mitchell. “Already, we’ve been able to treat many patients here with the quality of neurosurgery and expertise one would only expect to find in a larger city.”
Dr. Warren grew up in Broken Bow, Okla., with a population around 4,000. “I am a small town guy at heart,” said Dr. Warren. “I feel a real connection to the land and to those who work the land. They are my people, and that’s who I want to serve.” “What has been built here has no compromise. Great Plains Health has added another line of world-class level service.” -DrW. LeeWarren Although Great Plains Health is not located in a big city, Dr. Warren said, “It has been clear to me since I arrived that the entire team at GPHealth truly wants what is best for the patient and they are willing to do what it takes to ensure that care is the highest quality. This includes state-of-the-art equipment investments, such as the Aesculap 3D robotic surgical microscope, for which North Platte became the first delivery site in the world. He continued, “Great Plains Health has added another line of world-class level service.”
Saving lives in the Middle East In 2004, Dr. Warren, a member of the United States Air Force, was deployed to Iraq. He described performing brain surgery in a tent in the middle of the desert. “It reframed the way I thought about surgery,” Dr. Warren said, “You learn quickly to differentiate between what you want and what you need.” During his time overseas Dr. Warren performed lifesaving surgery for many. “We operated on whoever needed it,” said Dr. Warren. “Sometimes it was soldiers, sometimes it was residents and other times it was the terrorist who had just planted a bomb. We worked to save every life.”
COMMUNITY IMPACT 2020
COVID-19 screening lab makes testing safe and convenient “Initially, there was very little known about COVID-19, and it scared a lot of people. Those who stepped up were willing to stay out in the elements, risk contracting the virus, and also self-quarantine away from their own family.”
-WendyWard, BSN, RN, Great Plains Health director of patient safety and risk management
On March 17, shortly after the first case of COVID-19 was confirmed in Lincoln County, the Great Plains Health drive- through screening lab opened its doors. “At first, there were a lot of questions, a lot of unknowns,” said Barb Petersen, Great Plains Health chief quality officer. “We determined right away that bringing patients with COVID-19 symptoms into the emergency room would create a lot of problems—to avoid contamination, it would take three hours to clear a room and have it safely ready for the next patient. We would have become bogged down very quickly, and not been able to serve our community in a timely and safe manner,” explained Petersen. Dr. Eduardo Freitas, Great Plains Health infectious disease specialist, and Jenny Lantis, RN, Great Plains Health infectious disease coordinator, quickly determined the testing needed to be done outdoors. Initially, the screening lab was stationed at the North Platte Health Pavilion, with Dr. Jeff Brittan, Midlands Family Medicine family practice physician, helping to establish the location. The North Platte Fire Department volunteered a hazmat truck.
This station worked well for several months, until the summer weather brought high temperatures and new challenges. The location then changed to the Great Plains Health parking lot, and instead of a hazmat truck, the hospital rented a camping trailer. The trailer provided air conditioning for those working at the site, and a larger area for parking. Recently, the screening lab has found a new location just off I-80 at the former Whiskey Creek location. “As we move into the winter months, the new location will better serve both the patients and staff,” said Petersen. The mobile lab averages 80 to 100 tests daily. On their busiest day, they ran over 200 tests. In an effort to better serve the elderly, the screening lab would visit nursing homes. “While elective surgeries were suspended, we were able to take the testing mobile and swab patients in their nursing homes,” said Petersen, “making it more comfortable for the residents and alleviating the burden of the nursing home staff to get the patient to the screening lab.”
“One of the biggest challenges facing the screening lab has been staffing it,” said Wendy Ward, Great Plains Health director of patient safety and risk management. “Initially, there was very little known about COVID-19, and it scared a lot of people. Those who stepped up were willing to stay
Although the screening unit came together quickly, one can expect the same quality, safety and level of care as provided inside the Great Plains Health facility. “We follow the same protocols at the screening lab as we do inside the hospital,” explained Ward. “We use two patient
out in the elements, risk contracting the virus, and also self-quarantine away from their own family.” Ward continued, “For example, Stephanie Jacobsen, RN, couldn’t see her grandkids for months. She was willing to give up her time with her loved ones to help serve
identifiers, and Dr. Freitas has personally monitored the process of collection to make sure everything is done in a safe and professional manner.” Those working at the screening lab have also had the opportunity to help alleviate fears and spend time talking with patients. “There is so much conflicting information
“We follow the same protocols at the screening lab as we do inside the hospital.” -WendyWard Great Plains Health director of patient safety and risk management
our community.” Ward also named several others: “Ginger Irdman, Tina Heinzen, Candi Myers, Carrie Obrien, Beth Obrien, Shelby Malsbury, Veronica Sederlin, Heather Jensen and Erin Arensdorf—they all went above and beyond the call of duty to staff our front lines. This wasn’t something they were forced to do—they put themselves out there to help others.” Ward also noted the hard work and long hours of the quality department staff, along with the lab technicians and staff.
out there, a lot of people are afraid.” said Ward. “We are able to talk with them, share our experiences and let them know we care.” Although the working conditions can be challenging, there are many community members who show appreciation. “There isn’t a week that goes by without some sort of thanks from a community member. Sometimes they deliver food, drinks or even treats. We really appreciate that.”
COMMUNITY IMPACT 2020
On track and under budget, the $15 million ED renovation project is now complete Newly renovated emergency department provides world-class service
In the spring of 2018, construction on the Great Plains Health emergency department began. Two years later, the project is complete. With $5 million raised by community members, $5 million from the hospital foundation, and $5 million from Bill Scott, a philanthropist and former patient at Great Plains Health, the newly renovated emergency department is truly state of the art.
James Smith, MD, Great Plains Health director of emergency services, said, “I have worked in Omaha and Lincoln, and I can say this is the most state-of- the-art emergency department (ED) in the state of Nebraska.” “We doubled our rooms, going from 13 to 26,” said Dr. Smith. “The data showed volume increasing over the years—we were quickly outgrowing our facility.” Misti Hutchison, Great Plains Health emergency department director, explained the different patient rooms in the ED. “We previously had two trauma rooms; now we have three, one of which is set up as a preferred area for pediatrics. Advanced equipment in all three rooms allows for ease of access and immediate lifesaving interventions. The preferred pediatric trauma room now contains a neonatal unit; this unit allows resuscitative efforts, warming and continuous monitoring to all happen simultaneously. The same equipment can be observed in our NICU upstairs,” she continued. “We also have two bariatric rooms designed for the safety of our patients and staff on the forefront; equipment allows for safe lifting and transport,
whether within the patient room or transporting to other units.”
There is a room designated for sexual assault victims. The treatment space has a private restroom, high-tech cameras and lighting specific to evidence collection. “These victims experience severe trauma,” said Hutchison. “We want to make their experience here is as comfortable as possible while offering a sense of security.” “There are two behavioral health emergency rooms secured from the rest of the department, right next to security,” said Dr. Smith. “They are completely ligature-free and ensure safety as the highest priority for our patients.” “All the glass out front is made of level seven ballistic material,” continued Dr. Smith. “We can have the entire ED secured within seconds at any time.” There is also 24- hour security and updated security monitors placed throughout. The ED also gained five fast track rooms with the expansion. “The fast track rooms were designed and intended for those patient populations who need to be seen, but generally present
“I have worked in both Omaha and Lincoln, and I can say this is the nicest emergency
department in the state of Nebraska.”
-Dr. James Smith
with lower acuities,” explained Hutchison. “With a quick assessment and interventions, we can get patients treated and on their way.” “We have eight negative- pressure rooms,” said Dr. Smith. “There is also a decontamination room right off the ambulance bay.” The ED also has a telehealth robot, a GlideScope for guided intubation, and Phillips Intelli-Vue ICU level portable monitoring. The Cath Lab is conveniently located just down the hall if immediate services are needed.
department that the Great Plains Health team and its donors have built but adds he is equally proud of his clinical team. “We are the first hospital in the state of Nebraska with all our ED physicians being board- certified and residency-trained
• Leaving the emergency department without being seen rate at GPHealth: less than 1 percent. National average: 1.7 percent • Average wait time at GPHealth (arrival to provider): 12 minutes. National average: 40 minutes • American Hospital Association’s highest award for stroke care four years in a row (2016-2020), the only hospital in Nebraska to receive the award in 2020 • Gold award from the American Heart Association for STEMI Care (heart attacks) for the past two years
in emergency medicine.” They are supported by a
dedicated team of emergency department nurses and clinical staff, many of whom hold advanced certifications in emergency care. Dr. Smith reflected, “With talented physi- cians and a state-of-the-art facility, our community can count on getting the best possible care.”
Dr. Smith notes his level of pride in the emergency
COMMUNITY IMPACT 2020
Telehealth robot utilized in COVID-19 pandemic
Telehealth robot helps to save lives by limiting exposure to COVID-19 It’s really amazing what the Intouch Telehealth Robot can do,” said Chastity Orr, Great Plains Health telemedicine clinical manager. “It is capable of providing physicians the ability to not only monitor the patient, but to give consultation and take vital signs.” Prior to the COVID-19 pandemic, Great Plains Health had three robots––one in the emergency department, one in themedical-surgical floor and a third
in the intensive care unit (ICU). “The robot in the emergency department was mainly utilized to monitor stroke code victims and the inpatient robots were used for specialty coverage assistance” said Orr. In March 2020, with the first confirmed case of COVID-19 in Lincoln County, “Everything changed,” said Orr. “We started using the robots with COVID-19 patients, reducing the exposure to our healthcare providers and staff.” “In the early days of the COVID-19 surge within our community, it quickly became apparent that we would need to rely on a different way to deliver patient care,” said Fiona Libsack, Great Plains Health chief development officer. “Keeping our patients, physicians and nursing staff safe while still ensuring that patients got the care they needed was our chief objective,” she added. In April 2020, Great Plains Health purchased a fourth robot for the third floor, primarily for COVID-19 patients in the ICU. “When it comes to providing the best possible care for patients, leadership doesn’t hesitate to invest in what is needed,” remarked Orr.
Utilizing the robot provides the ability for multiple specialists to see a patient. “We have staff assisting with robot rounding with providers seeing
patients back to back, without having to bring each provider
into the patient’s room. This really benefits the patient as well as our providers,” said Orr. “We are also able to utilize physicians from other parts of the country. For example, we have infectious disease doctors from Atlanta, neurology/stroke specialists from Denver and other specialists from Bryan Health in Lincoln.” Since March 2020, GPHealth tele- visits have increased 357 percent, a number that falls right in line with what many leading health systems across the country are experiencing. “Our organization looks at telehealth as a tool in the provider’s toolbox,” said Libsack. “When clinically appropriate, it creates the technology possible to offer vastly easier access for patients, decreases outreach travel time for providers, and reduces no-show appointments and cancellations; telehealth has a place in medicine and in improving access.”
“When it comes to providing the best possible care for patients, leadership doesn’t hesitate to invest inwhat is needed.” -ChastityOrr Great PlainsHealth telemedicine clinicalmanager
Donor Milk Program launches at Great Plains Health
In August 2020, the Donor Human Milk Program launched at Great Plains Health. “You won’t find another program like this within a 100-mile radius,” said Serena Findley, Great Plains registered nurse and lactation consultant. “There is a great need in the area for this service.” Breastmilk donation comes from Mother’s Milk Bank in Denver. Milk is donated from women in good health who pass through a medical screening. The Milk Bank works under regulations from the FDA, CDC and American Pediatric Association. Once the milk has been pasteurized, it is sent to Great Plains Health. The milk is then used to feed babies in the NICU or newborns whose mothers are struggling with milk production. “Our goal is to make sure mothers don’t feel as if they have failed at breastfeeding” said Findley. “In one situation, we had a mother who initially used donor milk to supplement, but by the time she was released from the hospital, her milk had come in and she was able to feed her baby without any supplementation.”
“If a mother chooses to breastfeed, we want to give her the tools to accomplish that,” said Findley. “It doesn’t always come easily, and can take time. By adding the breast milk donation program, we are offering more options. Our main goal is to have both mother and baby healthy and happy.” Benefits of breastfeeding for infants: Protects infants against respiratory tract infections, otitis media, urinary tract infections, diarrhea, necrotizing enterocolitis, diabetes, lymphoma, leukemia, Hodgkin’s disease, allergies, sudden infant death syndrome (SIDS), obesity and celiac disease (AAP, 2014). Benefits of breastfeeding for mothers: • Decreased risk of ovarian and breast cancers, lower risk of postpartum hemorrhage and quicker return of pre-pregnancy weight (AAP, 2014). • Reduction in maternal high blood pressure and Type 2 Diabetes (CDC, 2019). • Reduction of heart disease and obesity (Medela, 2019).
“If amother chooses to breastfeed, we want to give her the tools to accomplish that.”
The program is free to all patients, thanks to grants provided by the Great Plains Health Care Foundation and HERO club.
“Since its launch, we have seen exciting progress,” said Findley. “Prior to the introduction of the program, our exclusive breastfeeding/breast milk rate was 40-50 percent. Currently our rates are 70-80 percent.”
- SerenaFindley RegisteredNurse and Lactation Consultant at Great PlainsHealth
COMMUNITY IMPACT 2020
Lending a helping hand: uncompensated care
Total free care
2019 local spending
Physician related: $218,786
Property & vehicle taxes
Construction & capital: $2,980,505
Supplies & equipment: $985,393
Salaries & benefits
North Platte spending:
Rent & food: $1,954,185
Other Nebraska spending: Total Nebraska spending:
Making a difference: patient medication assistance program
Great Plains Health formally started the patient medication assistance program in 2006. The program aids individuals who cannot afford their long-term medications by helping them take advantage of low-cost and no-cost prescription programs.
Great Plains Health has a long tradition of improving the health and well-being of the communities we serve. Whether it is through partnerships with local organizations, charitable contribution, or the many hours each year that our employees and physicians give through volunteering, we strongly believe that we have a corporate responsibility to help ensure the continued success of the North Platte region. Each year, we dedicate thousands of dollars to assist nonprofit organizations working on projects designed to improve the health and well-being of the communities we serve.
Great Plains Health provided many significant donations to community organizations in the past year, including:
+ Bridge of Hope Child Advocacy Center + Community Connections + Curtis Community + Golden Games + Hershey Lions Club + Lincoln County CASA + Mid-Nebraska Community Foundation + Mid-Plains Community College + Mid-Plains United Way + NEBRASKAland DAYS + North Platte Area Chamber & Development + North Platte Area Children’s Museum + North Platte Buffalo Bill Kiwanis Club + North Platte Catholic Schools
+ North Platte Community Playhouse + North Platte Fire Department + North Platte Kids Academy + North Platte Noon Rotary Club
+ North Platte Public Schools + North Platte Trails Network + Other local schools + Platte River Fitness Series + Prairie Arts Center + Rape/Domestic Abuse Program of North Platte + Teammates Mentoring Program + Town Hall Lecture Series + West Central District Health Department
COMMUNITY IMPACT 2020
2021 Wellness Calendar
MELANOMA MONDAY Location to be determined May 3 10 a.m. to 2 p.m.
PREPARED CHILD BIRTH CLASSES Conference rooms A & B 8 a.m. to 1 p.m.
• January 9 • February 6
STROKE SCREENING Conference rooms A, B & C May 8 8 a.m. to noon Open to the public, walk-ins welcome
• March 6 • April 10
• May 1 • June 5 • July 10 • August 7 • September 11 • October 2 • November 6 • December 4
COUCH TO 5K, VIRTUAL WALK, RUN Training to start July 13 to September 28 Virtual race with a possibility of a live race October 10 Registration on the web at gphealth.org
BREASTFEEDING 101 Conference room B 6 to 8 p.m.
FACEBOOK LIVE SESSIONS Parkinson’s disease Anil Kumar, MD, neurologist March 24, noon A colonoscopy can save your life Jacob Wiesen, MD, general surgeon May 19, noon Understanding heart disease Great Plains Health cardiologists September 15, noon Tips for better sleep Jefrey Start, DO, sleep medicine specialist November 10, noon
• January 6 • February 3
• March 3 • April 14
• May 5 • June 2 • July 7 • August 4 • September 1 • October 6
• November 3 • December 1 *If in-person classes are not in session due to COVID-19, these classes will be available online at gphealth.org
All events are subject to change. Please check our website at gphealth.org for the most up-to-date information.
COMMUNITY IMPACT 2020 Preventative care and management of chronic conditions is key
Three years ago, Great Plains Health Innovation Network (GPHIN) was established in North Platte. This Clinically Integrated Network (CIN) is a physician-led organization that focuses on preventative care and management of chronic conditions for patients. “The main goal is to help patients manage their care, identify chronic conditions early and prevent chronic conditions from worsening,” said Andrea Eaton, GPHIN executive director. “Rather than patients being seen only when they are having problems with their health, we are transforming primary care practices into patient-centered-medical-homes that focus on whole-patient care. This involves regular visits and preventative screenings to identify any health issues or changes in chronic conditions early.” GPHIN care coordinators can help patients coordinate visits between different doctors, review and reconcile prescribed medications, and connect them with services offered in the community at little or no cost. “We want to help patients get the right services, from the right provider, at the right time,” stated
Eaton. “It’s basically like having a friend or family member who is a nurse––someone who knows the system, that can help patients navigate and receive the best possible care.” Eaton explained, “Care coordinators also provide education on chronic conditions, healthy choices, diet, exercise and much more. They help the patient set achievable goals and help keep the patient on track through regular phone calls. The frequency of calls is dependent on the patient’s needs and preferences.”
“Themain goal is to help patients manage their care, identify chronic conditions early and prevent chronic conditions fromworsening.”
AndreaEaton Great PlainsHealth InnovationNetwork executive director
Local resident recommends care coordination services fromGreat Plains Health
Harold Poff, of North Platte, Neb. is no stranger to health problems. “I have type two diabetes, heart issues and kidney issues, just to name a few,” explained Poff. He was referred to the Great Plains Health Innovation Network (GPHIN) care coordination program by his primary physician, Dr. Carlson, “I started out talking to GPHIN care coordinator Tammy, RN, every week. We discussed my health concerns, appointments and current medication. “There was some accountability there,” he continued. “I knew someone would call me to check in. But it didn’t feel like pressure, it felt like someone really cared.” Poff said the program has helped him establish a healthy diet, taking all his health risks into consideration. “Julie, GPHIN Health Coach, ARPN-NP, helped to create a plan that would work for me and my specific needs,” Poff explained. Now that he has been in the care coordination program for a while and is doing well managing his conditions, the phone calls happen on a monthly basis. “They work with your needs and your schedule.” Poff said he would recommend the program to others––especially those who may not be well-connected in the community. “Great Plains Health Innovation Network will help you find the best possible care, and you will always have someone looking out for you.”
“I knew someone would call me to check in. But it didn’t feel like pressure, it felt like someone really cared.”
- HaroldPoff NorthPlatte residentPage 1 Page 2 Page 3 Page 4 Page 5 Page 6 Page 7 Page 8 Page 9 Page 10 Page 11 Page 12 Page 13 Page 14 Page 15 Page 16
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