CENTRAL TEXAS REHABILITATON HOSPITAL. FINANCIAL ASSISTANCE POLICY June 30, 2016

Transcription

1 POLICY/PRINCIPLES CENTRAL TEXAS REHABILITATON HOSPITAL FINANCIAL ASSISTANCE POLICY June 30, 2016 The Seton Family of Hospitals (Seton) is a 501(c)(3) nonprofit organization. Its parent corporation, Ascension Health Texas (d/b/a Seton Healthcare Family), is a minority owner of Central Texas Rehabilitation Hospital. It is the policy of Central Texas Rehabilitation Hospital (the Organization ) to ensure a socially just practice for providing emergency or other medically necessary care at the Organization s facilities. This policy is specifically designed to address the financial assistance eligibility for patients who are in need of financial assistance and receive care from the Organization. 1. All financial assistance will reflect our commitment to and reverence for individual human dignity and the common good, our special concern for and solidarity with persons living in poverty and other vulnerable persons, and our commitment to distributive justice and stewardship. 2. This policy applies to all emergency and other medically necessary services provided by the Organization, including employed physician services and behavioral health. This policy does not apply to payment arrangements for elective procedures or other care that is not emergency care or otherwise medically necessary. 3. The List of Providers Covered by the Financial Assistance Policy provides a list of any providers delivering care within the Organization s facilities that specifies which are covered by the financial assistance policy and which are not. DEFINITIONS For the purposes of this Policy, the following definitions apply: 501(r) means Section 501(r) of the Internal Revenue Code and the regulations promulgated thereunder. Amount Generally Billed or AGB means, with respect to emergency or other medically necessary care, the amount generally billed to individuals who have insurance covering such care. Community means geographic areas, grouped by counties, Seton uses for planning in Central Texas: 1.) Central Travis County, 2.) South Hays and Caldwell Counties, 3.) North Williamson County, 4.) West Burnet, Blanco and Llano Counties, and 5.) East Bastrop, Fayette, Gonzales and Lee Counties. Emergency Care means labor or a medical condition of such severity that the absence of immediate medical attention could reasonably be expected to result in seriously jeopardizing the health of the patient (or unborn child), serious impairment to bodily function, or serious dysfunction of any body organ or part. Medically Necessary Care means care that is determined to be medically necessary Page 1 of 4

2 following a determination of clinical merit by a licensed provider. In the event that care requested by a Patient covered by this policy is determined not to be medically necessary by a reviewing physician, that determination also must be confirmed by the admitting or referring physician. Organization means Central Texas Rehabilitation Hospital. Patient means those persons who receive emergency or medically necessary care at the Organization and the person who is financially responsible for the care of the patient. Financial Assistance Provided Financial assistance described in this section is limited to Patients that live in the Community Seton defined for planning in Central Texas which is grouped by counties: 1.) Central Travis County, 2.) South Hays and Caldwell Counties, 3.) North Williamson County, 4.) West Burnet, Blanco and Llano Counties, and 5.) East Bastrop, Fayette, Gonzales and Lee Counties. 1. Patients with income less than or equal to 250% of the Federal Poverty Level ( FPL ), will be eligible for 100% charity care write off on that portion of the charges for services for which the Patient is responsible following payment by an insurer, if any. 2. At a minimum, Patients with incomes above 250% of the FPL but not exceeding 375% of the FPL, will receive a sliding scale discount on that portion of the charges for services provided for which the Patient is responsible following payment by an insurer, if any. A Patient eligible for the sliding scale discount will not be charged more than the calculated AGB charges. As such, the Patient portion will be the lessor of the AGB amount or the sliding scale amount. The Sliding Scale Amounts document provides a detailed list of the sliding scale amounts. 3. Patients with demonstrated financial needs with income greater than 375% of the FPL may be eligible for consideration under a Means Test for some discount of their charges for services from the Organization based on a substantive assessment of their ability to pay. A Patient eligible for the Means Test discount will not be charged more than the calculated AGB charges. a. The amount owed by the Patient, after payment by any/all third party payers, must exceed fifty percent (50%) of the Patient s annual income. b. To ensure that financial assistance does not subsidize lifestyle choices, standard allowances consistent with federal and state financial means testing guidelines for clothing, food, housing, utilities and transportation will be utilized to calculate disposable income. 4. For a Patient that participates in certain insurance plans that deem the Organization to be out-of-network, the Organization may reduce or deny the financial assistance that would otherwise be available to Patient based upon a review of Patient s insurance information and other pertinent facts and circumstances. 5. Patients that are eligible for 100% charity care may be charged a nominal flat fee of up to $15 for services. The Patient portion will be the lessor of the AGB amount or the nominal fee amount. 6. Eligibility for financial assistance may be determined at any point in the revenue cycle and may include the use of presumptive scoring to determine eligibility notwithstanding an applicant s failure to complete a financial assistance application ( FAP Page 2 of 4

3 Application ). 7. Eligibility for financial assistance must be determined for any balance for which the Patient with financial need is responsible. 8. The process for Patients and families to appeal an Organization s decisions regarding eligibility for financial assistance is as follows: a. Patients and families may submit a written appeal letter by mail to the Controller at Central Texas Rehabilitation Hospital. The appeal letter should include financial information, not considered in the Patient s original Financial Assistance Application, important to reconsidering the Patient s eligibility for charity care. In addition to the written appeal letter, Patients and families must include documentation of reconsideration information included in the appeal letter. Without appropriate documentation, the consideration of the appeal may be delayed until appropriate documentation is received. The appeal letter and supporting documentation must be mailed to Controller, Central Texas Rehabilitation Hospital, 700 West 45 th Street, Austin, Texas b. All appeals will be considered by Central Texas Rehabilitation Hospital s 100% charity care and financial assistance appeals committee, and decisions of the committee will be sent in writing to the Patient or family that filed the appeal. Other Assistance for Patients Not Eligible for Financial Assistance Patients who are not eligible for financial assistance, as described above, still may qualify for other types of assistance offered by the Organization. In the interest of completeness, these other types of assistance are listed here, although they are not need-based and are not intended to be subject to 501(r) but are included here for the convenience of the community served by Central Texas Rehabilitation Hospital. 1. Uninsured Patients who are not eligible for financial assistance will be provided a discount based on the discount provided to the highest-paying payor for that Organization. The highest paying payor must account for at least 3% of the Organization s population as measured by volume or gross patient revenues. If a single payor does not account for this minimum level of volume, more than one payor contract should be averaged such that the payment terms that are used for averaging account for at least 3% of the volume of the Organization s business for that given year. 2. Uninsured and insured Patients who are not eligible for financial assistance may receive a prompt pay discount. The prompt pay discount may be offered in addition to the uninsured discount described in the immediately preceding paragraph. Limitations on Charges for Patients Eligible for Financial Assistance Patients eligible for Financial Assistance will not be charged individually more than AGB for emergency and other medically necessary care and not more than gross charges for all other medical care. The Organization calculates one or more AGB percentages using the look-back method and including Medicare fee-for-service and all private health insurers that pay claims to the Organization, all in accordance with 501(r). A free copy of the AGB calculation description Page 3 of 4

4 and percentage(s) may be obtained by request in any admissions area. Patients may also request a free copy of the AGB calculation and percentage by mail by calling the Controller for Central Texas Rehabilitation Hospital at to request a copy be sent to the Patient s mailing address. Applying for Financial Assistance and Other Assistance A Patient may qualify for financial assistance through presumptive scoring eligibility or by applying for financial assistance by submitting a completed FAP Application. A Patient may be denied financial assistance if the Patient provides false information on a FAP Application or in connection with the presumptive scoring eligibility process. The FAP Application and FAP Application instructions will be made available upon Patient request at the time of service. If a Patient wishes to apply for financial assistance after the day(s) of service, a Patient may access the FAP Application and FAP Application instructions and print directly from Seton s website. Patients may also request a copy of the FAP Application and FAP Application Instructions by mail. To request a copy of the documents by mail, Patients should call the Controller at In each of the aforementioned accessible locations, the FAP Application and FAP Application instructions are available in English, Spanish, Chinese, Vietnamese, Korean, and Arabic. Billing and Collections The actions that the Organization may take in the event of nonpayment are described in a separate billing and collections policy. A free copy of the billing and collections policy may be obtained upon Patient request at the time of service. Patients may also request a free copy of the Billing and Collections policy by mail. To request a copy of the document by mail, Patients should call the Controller at Interpretation This policy is intended to comply with 501(r), except where specifically indicated. This policy, together with all applicable procedures, shall be interpreted and applied in accordance with 501(r) except where specifically indicated. Page 4 of 4

5 CENTRAL TEXAS REHABILITATION HOSPITAL SLIDING SCALE AMOUNTS Updated 3/1/16 FAMILY SIZE Pt FPIL ,206 1,518 1,830 2,142 2,453 2,765 3,078 3,392 3,705 4,018 4,331 4,645 4,958 5, ,269 1,597 1,925 2,253 2,581 2,909 3,239 3,568 3,898 4,228 4,557 4,887 5,216 5, ,332 1,676 2,021 2,365 2,709 3,054 3,400 3,745 4,091 4,437 4,783 5,129 5,475 5, ,035 1,395 1,756 2,116 2,477 2,837 3,198 3,560 3,922 4,285 4,647 5,009 5,372 5,734 6, ,081 1,458 1,835 2,212 2,588 2,965 3,342 3,721 4,099 4,478 4,857 5,235 5,614 5,993 6, ,128 1,521 1,914 2,307 2,700 3,093 3,486 3,881 4,276 4,671 5,066 5,461 5,856 6,251 6, ,175 1,584 1,993 2,403 2,812 3,221 3,631 4,042 4,453 4,865 5,276 5,687 6,099 6,510 6, ,221 1,647 2,073 2,498 2,924 3,349 3,775 4,203 4,630 5,058 5,486 5,913 6,341 6,769 7, ,268 1,710 2,152 2,594 3,035 3,477 3,919 4,363 4,807 5,251 5,695 6,139 6,583 7,027 7, ,315 1,773 2,231 2,689 3,147 3,605 4,063 4,524 4,984 5,445 5,905 6,365 6,826 7,286 7, ,361 1,836 2,310 2,785 3,259 3,733 4,208 4,684 5,161 5,638 6,115 6,591 7,068 7,545 8, ,408 1,899 2,389 2,880 3,371 3,861 4,352 4,845 5,338 5,831 6,324 6,817 7,310 7,803 8, ,455 1,962 2,469 2,975 3,482 3,989 4,496 5,006 5,515 6,024 6,534 7,043 7,553 8,062 8, ,501 2,025 2,548 3,071 3,594 4,117 4,641 5,166 5,692 6,218 6,743 7,269 7,795 8,321 8, ,548 2,088 2,627 3,166 3,706 4,245 4,785 5,327 5,869 6,411 6,953 7,495 8,037 8,579 9, ,595 2,150 2,706 3,262 3,818 4,373 4,929 5,488 6,046 6,604 7,163 7,721 8,280 8,838 9, ,641 2,213 2,785 3,357 3,929 4,501 5,073 5,648 6,223 6,798 7,372 7,947 8,522 9,097 9, ,688 2,276 2,865 3,453 4,041 4,629 5,218 5,809 6,400 6,991 7,582 8,173 8,764 9,355 9, ,735 2,339 2,944 3,548 4,153 4,757 5,362 5,969 6,577 7,184 7,792 8,399 9,007 9,614 10, ,781 2,402 3,023 3,644 4,265 4,885 5,506 6,130 6,754 7,378 8,001 8,625 9,249 9,873 10, ,828 2,465 3,102 3,739 4,376 5,013 5,650 6,291 6,931 7,571 8,211 8,851 9,491 10,132 10, ,875 2,528 3,181 3,835 4,488 5,141 5,795 6,451 7,108 7,764 8,421 9,077 9,734 10,390 11, ,921 2,591 3,261 3,930 4,600 5,269 5,939 6,612 7,285 7,958 8,630 9,303 9,976 10,649 11, ,968 2,654 3,340 4,026 4,712 5,397 6,083 6,772 7,462 8,151 8,840 9,529 10,218 10,908 11, ,015 2,717 3,419 4,121 4,823 5,525 6,228 6,933 7,639 8,344 9,050 9,755 10,461 11,166 11, ,061 2,780 3,498 4,217 4,935 5,653 6,372 7,094 7,816 8,537 9,259 9,981 10,703 11,425 12, ,108 2,843 3,577 4,312 5,047 5,781 6,516 7,254 7,993 8,731 9,469 10,207 10,945 11,684 12, ,155 2,906 3,657 4,408 5,159 5,909 6,660 7,415 8,170 8,924 9,679 10,433 11,188 11,942 12, ,202 2,969 3,736 4,503 5,270 6,037 6,805 7,576 8,346 9,117 9,888 10,659 11,430 12,201 12, ,248 3,032 3,815 4,599 5,382 6,166 6,949 7,736 8,523 9,311 10,098 10,885 11,672 12,460 13, ,295 3,095 3,894 4,694 5,494 6,294 7,093 7,897 8,700 9,504 10,308 11,111 11,915 12,718 13, ,342 3,158 3,974 4,790 5,606 6,422 7,238 8,057 8,877 9,697 10,517 11,337 12,157 12,977 13, ,388 3,220 4,053 4,885 5,717 6,550 7,382 8,218 9,054 9,891 10,727 11,563 12,399 13,236 14, ,435 3,283 4,132 4,980 5,829 6,678 7,526 8,379 9,231 10,084 10,937 11,789 12,642 13,494 14, ,482 3,346 4,211 5,076 5,941 6,806 7,670 8,539 9,408 10,277 11,146 12,015 12,884 13,753 14, ,528 3,409 4,290 5,171 6,052 6,934 7,815 8,700 9,585 10,471 11,356 12,241 13,126 14,012 14, ,575 3,472 4,370 5,267 6,164 7,062 7,959 8,861 9,762 10,664 11,566 12,467 13,369 14,271 15, ,622 3,535 4,449 5,362 6,276 7,190 8,103 9,021 9,939 10,857 11,775 12,693 13,611 14,529 15, ,668 3,598 4,528 5,458 6,388 7,318 8,247 9,182 10,116 11,050 11,985 12,919 13,854 14,788 15, ,715 3,661 4,607 5,553 6,499 7,446 8,392 9,342 10,293 11,244 12,194 13,145 14,096 15,047 15, ,762 3,724 4,686 5,649 6,611 7,574 8,536 9,503 10,470 11,437 12,404 13,371 14,338 15,305 16, ,808 3,787 4,766 5,744 6,723 7,702 8,680 9,664 10,647 11,630 12,614 13,597 14,581 15,564 16, ,855 3,850 4,845 5,840 6,835 7,830 8,825 9,824 10,824 11,824 12,823 13,823 14,823 15,823 16, ,902 3,913 4,924 5,935 6,946 7,958 8,969 9,985 11,001 12,017 13,033 14,049 15,065 16,081 17, ,948 3,976 5,003 6,031 7,058 8,086 9,113 10,145 11,178 12,210 13,243 14,275 15,308 16,340 17, ,995 4,039 5,082 6,126 7,170 8,214 9,257 10,306 11,355 12,404 13,452 14,501 15,550 16,599 17, ,042 4,102 5,162 6,222 7,282 8,342 9,402 10,467 11,532 12,597 13,662 14,727 15,792 16,857 17, ,088 4,165 5,241 6,317 7,393 8,470 9,546 10,627 11,709 12,790 13,872 14,953 16,035 17,116 18, ,135 4,228 5,320 6,413 7,505 8,598 9,690 10,788 11,886 12,984 14,081 15,179 16,277 17,375 18, ,182 4,291 5,399 6,508 7,617 8,726 9,834 10,949 12,063 13,177 14,291 15,405 16,519 17,633 18,748 Page 1 of 3

6 301 3,228 4,353 5,479 6,604 7,729 8,854 9,979 11,109 12,240 13,370 14,501 15,631 16,762 17,892 19, ,275 4,416 5,558 6,699 7,840 8,982 10,123 11,270 12,417 13,563 14,710 15,857 17,004 18,151 19, ,322 4,479 5,637 6,795 7,952 9,110 10,267 11,430 12,594 13,757 14,920 16,083 17,246 18,410 19, ,368 4,542 5,716 6,890 8,064 9,238 10,412 11,591 12,771 13,950 15,130 16,309 17,489 18,668 19, ,415 4,605 5,795 6,985 8,176 9,366 10,556 11,752 12,948 14,143 15,339 16,535 17,731 18,927 20, ,462 4,668 5,875 7,081 8,287 9,494 10,700 11,912 13,125 14,337 15,549 16,761 17,973 19,186 20, ,508 4,731 5,954 7,176 8,399 9,622 10,844 12,073 13,301 14,530 15,759 16,987 18,216 19,444 20, ,555 4,794 6,033 7,272 8,511 9,750 10,989 12,234 13,478 14,723 15,968 17,213 18,458 19,703 20, ,602 4,857 6,112 7,367 8,623 9,878 11,133 12,394 13,655 14,917 16,178 17,439 18,700 19,962 21, ,649 4,920 6,191 7,463 8,734 10,006 11,277 12,555 13,832 15,110 16,388 17,665 18,943 20,220 21, ,695 4,983 6,271 7,558 8,846 10,134 11,421 12,715 14,009 15,303 16,597 17,891 19,185 20,479 21, ,742 5,046 6,350 7,654 8,958 10,262 11,566 12,876 14,186 15,497 16,807 18,117 19,427 20,738 22, ,789 5,109 6,429 7,749 9,070 10,390 11,710 13,037 14,363 15,690 17,017 18,343 19,670 20,996 22, ,835 5,172 6,508 7,845 9,181 10,518 11,854 13,197 14,540 15,883 17,226 18,569 19,912 21,255 22, ,882 5,235 6,587 7,940 9,293 10,646 11,999 13,358 14,717 16,076 17,436 18,795 20,154 21,514 22, ,929 5,298 6,667 8,036 9,405 10,774 12,143 13,518 14,894 16,270 17,645 19,021 20,397 21,772 23, ,975 5,361 6,746 8,131 9,516 10,902 12,287 13,679 15,071 16,463 17,855 19,247 20,639 22,031 23, ,022 5,423 6,825 8,227 9,628 11,030 12,431 13,840 15,248 16,656 18,065 19,473 20,881 22,290 23, ,069 5,486 6,904 8,322 9,740 11,158 12,576 14,000 15,425 16,850 18,274 19,699 21,124 22,549 23, ,115 5,549 6,983 8,418 9,852 11,286 12,720 14,161 15,602 17,043 18,484 19,925 21,366 22,807 24, ,162 5,612 7,063 8,513 9,963 11,414 12,864 14,322 15,779 17,236 18,694 20,151 21,608 23,066 24, ,209 5,675 7,142 8,609 10,075 11,542 13,008 14,482 15,956 17,430 18,903 20,377 21,851 23,325 24, ,255 5,738 7,221 8,704 10,187 11,670 13,153 14,643 16,133 17,623 19,113 20,603 22,093 23,583 25, ,302 5,801 7,300 8,800 10,299 11,798 13,297 14,803 16,310 17,816 19,323 20,829 22,336 23,842 25, ,349 5,864 7,380 8,895 10,410 11,926 13,441 14,964 16,487 18,010 19,532 21,055 22,578 24,101 25, ,395 5,927 7,459 8,990 10,522 12,054 13,586 15,125 16,664 18,203 19,742 21,281 22,820 24,359 25, ,442 5,990 7,538 9,086 10,634 12,182 13,730 15,285 16,841 18,396 19,952 21,507 23,063 24,618 26, ,489 6,053 7,617 9,181 10,746 12,310 13,874 15,446 17,018 18,590 20,161 21,733 23,305 24,877 26, ,535 6,116 7,696 9,277 10,857 12,438 14,018 15,607 17,195 18,783 20,371 21,959 23,547 25,135 26, ,582 6,179 7,776 9,372 10,969 12,566 14,163 15,767 17,372 18,976 20,581 22,185 23,790 25,394 26, ,629 6,242 7,855 9,468 11,081 12,694 14,307 15,928 17,549 19,169 20,790 22,411 24,032 25,653 27, ,675 6,305 7,934 9,563 11,193 12,822 14,451 16,088 17,726 19,363 21,000 22,637 24,274 25,911 27, ,722 6,368 8,013 9,659 11,304 12,950 14,595 16,249 17,903 19,556 21,210 22,863 24,517 26,170 27, ,769 6,431 8,092 9,754 11,416 13,078 14,740 16,410 18,079 19,749 21,419 23,089 24,759 26,429 28, ,815 6,494 8,172 9,850 11,528 13,206 14,884 16,570 18,256 19,943 21,629 23,315 25,001 26,688 28, ,862 6,556 8,251 9,945 11,640 13,334 15,028 16,731 18,433 20,136 21,839 23,541 25,244 26,946 28, ,909 6,619 8,330 10,041 11,751 13,462 15,173 16,891 18,610 20,329 22,048 23,767 25,486 27,205 28, ,955 6,682 8,409 10,136 11,863 13,590 15,317 17,052 18,787 20,523 22,258 23,993 25,728 27,464 29, ,002 6,745 8,488 10,232 11,975 13,718 15,461 17,213 18,964 20,716 22,467 24,219 25,971 27,722 29, ,049 6,808 8,568 10,327 12,087 13,846 15,605 17,373 19,141 20,909 22,677 24,445 26,213 27,981 29, ,095 6,871 8,647 10,423 12,198 13,974 15,750 17,534 19,318 21,103 22,887 24,671 26,455 28,240 30, ,142 6,934 8,726 10,518 12,310 14,102 15,894 17,695 19,495 21,296 23,096 24,897 26,698 28,498 30, ,189 6,997 8,805 10,614 12,422 14,230 16,038 17,855 19,672 21,489 23,306 25,123 26,940 28,757 30, ,236 7,060 8,885 10,709 12,534 14,358 16,183 18,016 19,849 21,682 23,516 25,349 27,182 29,016 30, ,282 7,123 8,964 10,804 12,645 14,486 16,327 18,176 20,026 21,876 23,725 25,575 27,425 29,274 31, ,329 7,186 9,043 10,900 12,757 14,614 16,471 18,337 20,203 22,069 23,935 25,801 27,667 29,533 31, ,376 7,249 9,122 10,995 12,869 14,742 16,615 18,498 20,380 22,262 24,145 26,027 27,909 29,792 31, ,422 7,312 9,201 11,091 12,980 14,870 16,760 18,658 20,557 22,456 24,354 26,253 28,152 30,050 31, ,469 7,375 9,281 11,186 13,092 14,998 16, ,819 20,734 22,649 24,564 26,479 28,394 30,309 32, ,516 7,438 9,360 11,282 13,204 15,126 17,048 18,980 20,911 22,842 24,774 26,705 28,636 30,568 32, ,562 7,501 9,439 11,377 13,316 15,254 17,192 19,140 21,088 23,036 24,983 26,931 28,879 30,827 32, ,609 7,564 9,518 11,473 13,427 15,382 17,337 19,301 21,265 23,229 25,193 27,157 29,121 31,085 33, ,656 7,627 9,597 11,568 13,539 15,510 17,481 19,461 21,442 23,422 25,403 27,383 29,363 31,344 33, ,702 7,689 9,677 11,664 13,651 15,638 17,625 19,622 21,619 23,616 25,612 27,609 29,606 31,603 33, ,749 7,752 9,756 11,759 13,763 15,766 17,770 19,783 21,796 23,809 25,822 27,835 29,848 31,861 33, ,796 7,815 9,835 11,855 13,874 15,894 17,914 19,943 21,973 24,002 26,032 28,061 30,090 32,120 34, ,842 7,878 9,914 11,950 13,986 16,022 18,058 20,104 22,150 24,195 26,241 28,287 30,333 32,379 34, ,889 7,941 9,993 12,046 14,098 16,150 18,202 20,264 22,327 24,389 26,451 28,513 30,575 32,637 34,699 Page 2 of 3

7 359 5,936 8,004 10,073 12,141 14,210 16,278 18,347 20,425 22,504 24,582 26,661 28,739 30,818 32,896 34, ,982 8,067 10,152 12,237 14,321 16,406 18,491 20,586 22,681 24,775 26,870 28,965 31,060 33,155 35, ,029 8,130 10,231 12,332 14,433 16,534 18,635 20,746 22,858 24,969 27,080 29,191 31,302 33,413 35, ,076 8,193 10,310 12,428 14,545 16,662 18,779 20,907 23,034 25,162 27,290 29,417 31,545 33,672 35, ,122 8,256 10,389 12,523 14,657 16,790 18,924 21,068 23,211 25,355 27,499 29,643 31,787 33,931 36, ,169 8,319 10,469 12,619 14,768 16,918 19,068 21,228 23,388 25,549 27,709 29,869 32,029 34,189 36, ,216 8,382 10,548 12,714 14,880 17,046 19,212 21,389 23,565 25,742 27,918 30,095 32,272 34,448 36, ,262 8,445 10,627 12,809 14,992 17,174 19,357 21,549 23,742 25,935 28,128 30,321 32,514 34,707 36, ,309 8,508 10,706 12,905 15,104 17,302 19,501 21,710 23,919 26,129 28,338 30,547 32,756 34,966 37, ,356 8,571 10,786 13,000 15,215 17,430 19,645 21,871 24,096 26,322 28,547 30,773 32,999 35,224 37, ,402 8,634 10,865 13,096 15,327 17,558 19,789 22,031 24,273 26,515 28,757 30,999 33,241 35,483 37, ,449 8,697 10,944 13,191 15,439 17,686 19,934 22,192 24,450 26,708 28,967 31,225 33,483 35,742 38, ,496 8,759 11,023 13,287 15,551 17,814 20,078 22,353 24,627 26,902 29,176 31,451 33,726 36,000 38, ,542 8,822 11,102 13,382 15,662 17,942 20,222 22,513 24,804 27,095 29,386 31,677 33,968 36,259 38, ,589 8,885 11,182 13,478 15,774 18,070 20,366 22,674 24,981 27,288 29,596 31,903 34,210 36,518 38, ,636 8,948 11,261 13,573 15,886 18,198 20,511 22,834 25,158 27,482 29,805 32,129 34,453 36,776 39, ,683 9,011 11,340 13,669 15,998 18,326 20,655 22,995 25,335 27,675 30,015 32,355 34,695 37,035 39,375 Page 3 of 3