2023 LGBS Benefit Guide

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LGBS BENEFIT GUIDE EFFECTIVE: 01/01/2023 12/31/2023 WWW.MYBENEFITSHUB.COM/LGBS 2023 PlanYear 1
Table of Contents FLIP TO...How to Enroll 4-5 Annual Benefit Enrollment 6-11 1. Benefit Updates 6 2. Eligibility Requirements 7 3. Helpful Definitions 8 Basic Life and AD&D 9 Hospital Indemnity 10 Disability 11 Accident 12 Critical Illness 13 Voluntary Life and AD&D 14 Individual Life 15 HOW TO ENROLLPG. 4 SUMMARY PAGESPG. 6 YOUR BENEFITSPG. 9 2

Benefit Contact Information

BENEFIT ADMINISTRATORS

Financial Benefit Services Ann Brownlee, Account Executive 210 243 1337 annb@fbsbenefits.com

LGBS BENEFITS COORDINATOR

Leah Lozano (210) 403 8600 leah.p.lozano@lgbs.com

BASIC & VOLUNTARY LIFE AND AD&D HOSPITAL INDEMNITY

AUL a OneAmerica Company Group #614838 (800) 553 5318 www.oneamerica.com

ACCIDENT

VOYA Group #694819 (800) 955 7736 www.voya.com

VOYA Group #694819 (800) 955 7736 www.voya.com

CRITICAL ILLNESS

VOYA Group #694819 (800) 955 7736 www.voya.com

LGBS DEPUTY DIRECTOR

Christine Stromme (512) 634 3745 christine.stromme@lgbs.com

DISABILITY

AUL a OneAmerica Company Group #614838 (800) 553 5318 Claims: (855) 517 6365 www.oneamerica.com

INDIVIDUAL LIFE

5Star Life Insurance Company (800) 776 2322 www.5starlifeinsurance.com

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Employee benefits made easy through the FBS Benefits App! AllYour BenefitsOne App OR SCAN Text “FBS LGBS” to (800) 583-6908 App Group #: FBSLGBS Text “FBS LGBS” to (800) 583-6908 and get access to everything you need to complete your benefits enrollment: • Benefit Resources • Online Enrollment • Interactive Tools • And more! 4
1 www.mybenefitshub.com/lgbs How to Log In 2 CLICK LOGIN 3 ENTER USERNAME & PASSWORD Your Username Is: Your email in THEbenefitsHUB. (Typically your work email) Your Password Is: Last name and last 4 of SS#. All lower case, excluding punctuation. If you have previously logged in, you will use the password that you created, NOT the password format listed above. 5

Annual Benefit Enrollment

Benefit Updates What’s New:

2023 BENEFITS ENROLLMENT

The supplemental benefits you elected last year will "rollover" and remain in effect for next plan year (01/01/2023 12/31/2023). However, we suggest that you log into the benefits HUB and verify your profile information such as name, address, phone numbers, email addresses and dependent information to avoid any unnecessary delays. Should there be any missing or inaccurate information, it is possible that your benefits could be delayed or denied.

IMPORTANT LIFE INSURANCE OPPORTUNITY!

This year only, the voluntary group life insurance offered through OneAmerica is having an open enrollment for all employees that do not have coverage, or, that have coverage below the original guarantee issue of $250,000 for employees and $50,000 for spouse. This year only, these employees have the opportunity to enroll in life insurance coverage with no medical questions or underwriting required! Employees may elect up to $250,000 and may also elect spouse coverage up to $50,000.

ELECTION OF A BENEFICIARY

All eligible employees of LGBS are given a $15,000 Basic Life Policy at no cost to the employee. This employer paid life insurance policy requires you to designate a beneficiary for this plan. If you also select additional life coverage for yourself or eligible family members you will also need to designate a beneficiary for that product also. If you do not designate a beneficiary, your life insurance benefits will be paid to your estate.

Don’t Forget!

SUPPLEMENTAL PLANS FROM VOYA have decreased in premium amounts! In addition, the following benefits have been enhanced:

• Critical Illness Plan additional illnesses have been added covering major organ and cancer, and infectious diseases. There are no waiting periods or reduction in coverage at a certain age.

• Accident increased amounts across most treatments included in the schedule, with major increases on some illnesses such as paralysis, burns, and comas.

• Hospital Indemnity increased to up to eight eligible hospital admissions per calendar year and added an amount for observation unit care. Also added alcohol and mental health facilities. This benefit is issued on a guaranteed basis, with no medical underwriting or questions required.

• Login and complete your benefit enrollment from 10/18/2022 10/31/2022

• Enrollment assistance is available by calling Financial Benefit Services at (866) 914 5202.

• Update your information: home address, phone numbers, email, and beneficiaries.

• REQUIRED!! Due to the Affordable Care Act (ACA) reporting requirements, you must add your dependent’s CORRECT social security numbers in the online enrollment system. If you have questions, please contact your Benefits Administrator.

SUMMARY PAGES
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Annual Benefit Enrollment

Employee Eligibility Requirements

Supplemental Benefits: Eligible employees must work 20 or more regularly scheduled hours each work week.

Eligible employees must be actively at work on the plan effective date for new benefits to be effective, meaning you are physically capable of performing the functions of your job on the first day of work concurrent with the plan effective date. For example, if your 2023 benefits become effective on January 1, 2023, you must be actively at work on January 1, 2023 to be eligible for your new benefits.

Dependent Eligibility Requirements

Dependent Eligibility: You can cover eligible dependent children under a benefit that offers dependent coverage, provided you participate in the same benefit, through the maximum age listed below. Dependents cannot be double covered by married spouses within the company as both employees and dependents.

If your dependent is disabled, coverage may be able to continue past the maximum age under certain plans. If you have a disabled dependent who is reaching an ineligible age, you must provide a physician’s statement confirming your dependent’s disability. Contact your HR/Benefit Administrator to request a continuation of coverage.

Please note, limits and exclusions may apply when obtaining coverage as a married couple or when obtaining coverage for dependents.

Potential Spouse Coverage Limitations: When enrolling in coverage, please keep in mind that some benefits may not allow you to cover your spouse as a dependent if your spouse is enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on spouse eligibility.

FSA/HSA Limitations: Please note, in general, per IRS regulations, married couples may not enroll in both a Flexible Spending Account (FSA) and a Health Savings Account (HSA). If your spouse is covered under an FSA that reimburses for medical expenses then you and your spouse are not HSA eligible, even if you would not use your spouse's FSA to reimburse your expenses. However, there are some exceptions to the general limitation regarding specific types of FSAs. To obtain more information on whether you can enroll in a specific type of FSA or HSA as a married couple, please reach out to the FSA and/or HSA provider prior to enrolling or reach out to your tax advisor for further guidance.

Potential Dependent Coverage Limitations: When enrolling for dependent coverage, please keep in mind that some benefits may not allow you to cover your eligible dependents if they are enrolled for coverage as an employee under the same employer. Review the applicable plan documents, contact Financial Benefit Services, or contact the insurance carrier for additional information on dependent eligibility.

Disclaimer: You acknowledge that you have read the limitations and exclusions that may apply to obtaining spouse and dependent coverage, including limitations and exclusions that may apply to enrollment in Flexible Spending Accounts and Health Savings Accounts as a married couple. You, the enrollee, shall hold harmless, defend, and indemnify Financial Benefit Services, LLC from any and all claims, actions, suits, charges, and judgments whatsoever that arise out of the enrollee's enrollment in spouse and/or dependent coverage, including enrollment in Flexible Spending Accounts and Health Savings Accounts.

PLAN MAXIMUM AGE Accident Up to 26 Hospital Indemnity Up to 26 Critical Illness Up to 26 Voluntary Life Up to 26 Individual Life Up to 23
SUMMARY PAGES
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Helpful Definitions

Actively at Work

You are performing your regular occupation for the employer on a full time basis, either at one of the employer’s usual places of business or at some location to which the employer’s business requires you to travel If you will not be actively at work beginning 1/1/2023 please notify your benefits administrator.

Annual Enrollment

The period during which existing employees are given the opportunity to enroll in or change their current elections.

Annual Deductible

The amount you pay each plan year before the plan begins to pay covered expenses.

Calendar Year

January 1st through December 31st Co insurance

After any applicable deductible, your share of the cost of a covered health care service, calculated as a percentage (for example, 20%) of the allowed amount for the service.

Guaranteed Coverage

The amount of coverage you can elect without answering any medical questions or taking a health exam. Guaranteed coverage is only available during initial eligibility period. Actively at work and/or pre existing condition exclusion provisions do apply, as applicable by carrier.

In Network

SUMMARY PAGES

Doctors, hospitals, optometrists, dentists and other providers who have contracted with the plan as a network provider.

Out of Pocket Maximum

The most an eligible or insured person can pay in co insurance for covered expenses.

Plan Year

January 1st through December 31st

Pre Existing Conditions

Applies to any illness, injury or condition for which the participant has been under the care of a health care provider, taken prescription drugs or is under a health care provider’s orders to take drugs, or received medical care or services (including diagnostic and/or consultation services).

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Life and AD&D Carrier Name

ABOUT LIFE AND AD&D

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

For full plan details, please visit your benefit website: www.mybenefitshub.com/lgbs

What you need to know about your Basic Life and AD&D Benefits

Guaranteed Issue: Employee: $15,000

EMPLOYEE BENEFITS

Accidental Death and Dismemberment (AD&D): Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, child care, paralysis/loss of use, severe burns, disappearance, and exposure.

Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.

Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule.

Age: 65 70 75 80 Reduces To: 65% 40% 25% 15%

Basic Employee Life and AD&D Coverage

Your Life and AD&D insurance coverage amount is $15,000. Coverage is provided at no cost to you.

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Hospital Indemnity Carrier Name

ABOUT HOSPITAL INDEMNITY

This is an affordable supplemental plan that pays you should you be in patient hospital confined. This plan complements your health insurance by helping you pay for costs left unpaid by your health insurance.

For full plan details, please visit your benefit website: www.mybenefitshub.com/lgbs

BENEFITS

What is Hospital Confinement Indemnity Insurance?

Hospital Confinement Indemnity Insurance pays a daily benefit if you have a covered stay in a hospital*, critical care unit and rehabilitation facility. The benefit amount is determined based on the type of facility and the number of days you stay. Hospital Confinement Indemnity Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

Features of Hospital Confinement Indemnity Insurance include:

• Guaranteed Issue: No medical questions or tests required for coverage.

• Flexible: You can use the benefit money for any purpose you like.

• Payroll deductions: Premiums paid through convenient payroll deductions.

• Affordable coverage: Rates are typically lower when you purchase coverage through your employer.

• Portable: Should you leave your current employer or retire, you can take the policy with you and select from a variety of payment plans.

* A hospital does not include an institution or part of an institution used as: a hospice care unit; a convalescent home; a rest or nursing facility; a free standing surgical center; a rehabilitative center; an extended care facility; a skilled nursing facility; or a facility primarily affording custodial, educational care, or care or treatment for persons suffering from mental diseases or disorders, or care for the aged, or drug or alcohol addiction. “Critical care unit” and “rehabilitative facility” are specifically defined in this policy. See the certificate for details.

EMPLOYEE
Hospital Indemnity Low High Employee $11.16 $31.60 Employee + Spouse $21.85 $61.79 Employee + Child(ren) $17.12 $47.61 Family $27.81 $77.80 10

Disability Insurance Carrier Name

ABOUT DISABILITY

Disability insurance protects one of your most valuable assets, your paycheck. This insurance will replace a portion of your income in the event that you become physically unable to work due to sickness or injury for an extended period of time.

For full plan details, please visit your benefit website: www.mybenefitshub.com/lgbs

Why should you consider purchasing disability insurance protection at your workplace?

Many of us lead busy lives and seldom take time to think about life’s risks.

Consider the following reasons many people purchase disability insurance:

• Lost wages

• Daily living expenses, such as Mortgage / rent, Utilities, Car, Food, Childcare, Eldercare, Hobbies, Pet Care, etc.

Worksite Disability Short Term Insurance Coverage for Eligible Employees

About your benefit options:

• Short Term Disability (STD) benefits are illustrated weekly and are paid on a weekly basis.

• Amounts not requested timely will require Evidence of Insurability.

• Benefit amounts are based upon a percentage of covered earnings. Potential benefits are reduced by other income offsets including but not limited to Social Security benefits.

need to know

is a

Maximum Benefit Duration: This is the length of time that you may be paid benefits if continuously disabled as outlined in the contract.

Pre Existing Condition Period: Certain disabilities are not covered if the cause of the disability is traceable to a condition existing prior to your effective date of coverage.

Worksite Long Term Disability Coverage Option 1

benefit is 60% of your monthly pre disability earnings, up to a maximum monthly benefit of $10,000.

BENEFITS

EMPLOYEE
What you
about your Worksite Long Term Disability Benefits Elimination Period: This
period of consecutive days of disability before benefits may become payable under the contract.
Your
Benefit Percentage Maximum Weekly Benefit Elimination Period Maximum Benefit Duration Pre Existing Condition Period Option 1 WDS 60% $1,500 14/14 11 weeks 3/12 Maximum Benefit Duration Pre Existing Condition Period Elimination Period Age When Total Disability Begins Maximum Duration 90 days injury / 90 days sickness Less than age 60 60 61 62 63 64 65 66 67 68 69 and over Greater of Social Security Full Retirement Age or: To age 65 5 years 4 years 3.5 years 3 years 2.5 years 2 years 21 months 18 months 15 months 12 months 3 months / 12 month Disability Age Brackets SHORT TERM per $10 of covered weekly earnings LONG TERM per $100 of covered monthly earnings 0 19 $0.770 $0.135 20 24 $0.770 $0.135 25 29 $0.770 $0.135 30 34 $0.770 $0.194 35 39 $0.590 $0.303 40 44 $0.500 $0.438 45 49 $0.540 $0.565 50 54 $0.650 $0.793 55 59 $0.800 $1.088 60 64 $0.930 $1.400 65 69 $1.000 $1.484 70 74 $1.000 $1.855 75+ $1.000 $1.855 11

Accident Insurance Carrier Name EMPLOYEE BENEFITS

ABOUT ACCIDENT

Do you have kids playing sports, are you a weekend warrior, or maybe accident prone? Accident plans are designed to help pay for medical costs associated with accidents and benefits are paid directly to you.

For full plan details, please visit your benefit website: www.mybenefitshub.com/lgbs

What is Accident Insurance?

Accident Insurance pays you benefits for specific injuries and events resulting from a covered accident while on/off job. The amount paid depends on the type of injury and care received. Accident Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

You may qualify to receive benefits for items listed below, as long as they are the result of a covered accident. See the certificate of insurance and any riders for specific details.

• Accident hospital care

• Follow up care

• Common Injuries

• Emergency care benefits

Other features of Accident Insurance include:

• Guaranteed Issue: No medical questions or tests required for coverage.

• Flexible: You can use the benefit money for any purpose you like.

• Payroll deductions: Premiums are paid through convenient payroll deductions.

• Portable: Should you leave your current employer or retire, you can take your coverage with you.

How can Accident Insurance help?

Below are a few examples of how your Accident Insurance benefits could be used:

• Medical expenses, such as deductibles and copays

• Home healthcare costs

• Lost income due to lost time at work

• Everyday expenses like utilities and groceries

Accident Employee $15.56 Employee + Spouse $22.23 Employee + Child(ren) $29.64 Family $36.31 12

Critical Illness Insurance Carrier Name EMPLOYEE BENEFITS

ABOUT CRITICAL ILLNESS

Critical illness insurance can be used towards medical or other expenses. It provides a lump sum benefit payable directly to the insured upon diagnosis of a covered condition or event, like a heart attack or stroke. The money can also be used for non medical costs related to the illness, including transportation, child care, etc.

For full plan details, please visit your benefit website: www.mybenefitshub.com/lgbs

What is Critical Illness Insurance?

Critical Illness Insurance pays a lump sum benefit if you are diagnosed with a covered illness or condition. Critical Illness Insurance is a limited benefit policy. It is not health insurance and does not satisfy the requirement of minimum essential coverage under the Affordable Care Act.

Features of Critical Illness Insurance include:

• Guaranteed Issue: No medical questions or tests required for coverage.

• Flexible: You can use the benefit money for any purpose you like.

• Payroll deductions: Premiums are paid through convenient payroll deductions.

• Portable: Should you leave your current employer or retire, you can take your coverage with you.

For what critical illnesses and conditions are benefits available? Critical Illness Insurance provides a benefit for the following illnesses and conditions. Covered illnesses/conditions are broken out into groups called “modules”. Benefits are paid at 100% of the Maximum Critical Illness Benefit amount unless otherwise stated. For a complete description of your benefits, along with applicable provisions, conditions on benefit determination, exclusions and limitations, see

your certificate of insurance and any riders. Critical Illness rates per $1,000 Age Employee Spouse Non Tobacco Tobacco Non Tobacco Tobacco Under 25 $0.36 $0.48 $0.43 $0.58 25 29 $0.36 $0.48 $0.43 $0.58 30 34 $0.53 $0.80 $0.61 $0.90 35 39 $0.53 $0.80 $0.61 $0.90 40 44 $1.02 $1.59 $1.20 $1.87 45 49 $1.02 $1.59 $1.20 $1.87 50 54 $1.77 $2.86 $2.15 $3.49 55 59 $1.77 $2.86 $2.15 $3.49 60 64 $2.47 $4.14 $2.98 $5.02 65 69 $3.21 $4.90 $4.06 $6.27 70+ $4.68 $7.12 $5.48 $8.79 Critical Illness Child(ren) $1,000 $2,500 $5,000 $10,000 $15,000 $0.20 $0.50 $1.00 $2.00 $3.00 13

Life and AD&D

Carrier Name

ABOUT LIFE AND AD&D

Group term life is the most inexpensive way to purchase life insurance. You have the freedom to select an amount of life insurance coverage you need to help protect the well being of your family.

Accidental Death & Dismemberment is life insurance coverage that pays a death benefit to the beneficiary, should death occur due to a covered accident. Dismemberment benefits are paid to you, according to the benefit level you select, if accidentally dismembered.

For full plan details, please visit your benefit website: www.mybenefitshub.com/lgbs

What you need to know about your Voluntary Term Life and AD&D Benefits

Flexible Options:

• Employee: $10,000 to $1,000,000, in $10,000 increments, not to exceed 5 times your annual salary

EMPLOYEE BENEFITS

• Spouse under age 99: $10,000 to $250,000, in $10,000 increments, not to exceed 100% of the employee’s amount

Guaranteed Issue:

• Employee: $250,000

• Spouse: $50,000

• Child: $10,000

Dependent Life Coverage: Optional dependent life coverage is available to eligible employees. You must select employee coverage in order to cover your spouse and/or child(ren).

Accidental Death and Dismemberment (AD&D): Additional life insurance benefits may be payable in the event of an accident which results in death or dismemberment as defined in the contract. Additional AD&D benefits include seat belt, air bag, repatriation, child higher education, child care, paralysis/loss of use, severe burns, disappearance, and exposure.

Accelerated Life Benefit: If diagnosed with a terminal illness and have less than 12 months to live, you may apply to receive 25%, 50% or 75% of your life insurance benefit to use for whatever you choose.

Guaranteed Increase In Benefit: You may be eligible to increase your coverage annually until you reach your maximum amount without providing evidence of insurability.

Reductions: Upon reaching certain ages, your original benefit amount will reduce to the percentage shown in the following schedule. The amounts of dependent life insurance and dependent AD&D principal sum will reduce according to the employee's reduction schedule.

Age: 65 70 75 80 Reduces To: 65% 40% 25% 15% Voluntary Group Life and AD&D per $10,000 in coverage Age Employee Spouse 18 24 $0.50 $0.50 25 29 $0.50 $0.50 30 34 $0.70 $0.70 35 39 $0.90 $0.90 40 44 $1.50 $1.50 45 49 $2.60 $2.60 50 54 $4.10 $4.10 55 59 $7.30 $7.30 60 64 $12.90 $12.90 65 69 $20.40 $20.40 70 74 $29.90 $29.90 75+ $29.90 $29.90 Spouse rates based on Employee's age. Voluntary Group Life and AD&D: Child(ren) $10,000 in coverage 0 26 $1.90 14

Individual Life Insurance Carrier Name EMPLOYEE BENEFITS

ABOUT INDIVIDUAL LIFE

Individual insurance is a policy that covers a single person and is intended to meet the financial needs of the beneficiary, in the event of the insured’s death. This coverage is portable and can continue after you leave employment or retire.

For full plan details, please visit your benefit website: www.mybenefitshub.com/lgbs

Enhanced coverage options for employees. The 5Star Life Insurance Company’s Family Protection Plan offers both Individual products with Terminal Illness coverage to age 121, making it easy to provide the right benefit for you and your employees.

CUSTOMIZABLE

With several options to choose from, employees select the coverage that best meets the needs of their families.

TERMINAL ILLNESS ACCELERATION OF BENEFITS

Coverage that pays 30% (25% in CT and MI) of the coverage amount in a lump sum upon the occurrence of a terminal condition that will result in a limited life span of less than 12 months (24 months in IL).

PORTABLE

Coverage continues with no loss of benefits or increase in cost if employment terminates after the first premium is paid. We simply bill the employee directly.

CONVENIENCE

Easy payments through payroll deduction.

FAMILY PROTECTION

Coverage is available for spouses and financially dependent children, even if the employee doesn’t elect coverage on themselves.

* Financially dependent children 14 days to 23 years old.

PROTECTION TO COUNT ON

Within one business day of notification, payment of 50% of coverage or $10,000 whichever is less is mailed to the beneficiary, unless the death is within the two year contestability period and/or under investigation. This coverage has no war or terrorism exclusions.

QUALITY OF LIFE

Optional benefit that accelerates a portion of the death benefit on a monthly basis, up to 75% of your benefit, and is payable directly to you on a tax favored basis for the following:

• Permanent inability to perform at least two of the six Activities of Daily Living (ADLs) without substantial assistance; or

• Permanent severe cognitive impairment, such as dementia, Alzheimer’s disease and other forms of senility, requiring substantial supervision

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Enrollment Guide General Disclaimer: This summary of benefits for employees is meant only as a brief description of some of the programs for which employees may be eligible. This summary does not include specific plan details. You must refer to the specific plan documentation for specific plan details such as coverage expenses, limitations, exclusions, and other plan terms, which can be found at the LGBS Benefits Website. This summary does not replace or amend the underlying plan documentation. In the event of a discrepancy between this summary and the plan documentation the plan documentation governs. All plans and benefits described in this summary may be discontinued, increased, decreased, or altered at any time with or without notice.

Rate Sheet General Disclaimer: The rate information provided in this guide is subject to change at any time by your employer and/or the plan provider. The rate information included herein, does not guarantee coverage or change or otherwise interpret the terms of the specific plan documentation, available at the LGBS Benefits Website, which may include additional exclusions and limitations and may require an application for coverage to determine eligibility for the health benefit plan. To the extent the information provided in this summary is inconsistent with the specific plan documentation, the provisions of the specific plan documentation will govern in all cases.

2023 PlanYear WWW.MYBENEFITSHUB.COM/LGBS
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