Cliff's Notes

The Business of Dentistry

Embezzlement? Not Me!

 

Embezzlement is live and well and the dental office is no exception. As a matter of fact, most dental office have been embezzled. Some catch it some don’t, I have heard about it and seen it countless number of times over my 40 year career (I started when I was 8). New team members, long time staff, young or old, it doesn’t matter and who’s fault is it? The boss!

 

The Boss … The identification of faults in any business relies on information supplied by reports from different departments. Management’s job (The Boss) is to review these reports and make sure they match. Checks and balances are necessary to insure that all procedures and protocols are operating efficient-ly and “that the check book balances”! Production reports, daily collections, day sheets & deposit slips must all balance with each other. Trusted long time team members as well as new ones must all be subject to checks and balances. A team member should never feel insulted by verification. As Tom Hayden said to Sonny Corleone “it’s only business”.

The Control Freak … We all have or have had the team member that wants to be in control. They develop ownership of their tasks and get agitated when someone else gets involved or asks question. This situation is not healthy for the practice or the employee. Assuming the person is extremely honest, any inconsistency may cast doubt and dam-age a good relationship with management or other team member and disrupt team harmony. That will effect the patient experience and office production. Then there is the other side of the equation, they don’t want you to look.

Receivables & Deposits … Who opens the mail? Who enters payments into your management software? Who fills out the day sheet? Who fills out the deposit slips? Who goes to the bank to make the deposits? If it is the same person and not a family member, a change is needed. Checks and balances, ask your business financial advisor to help set up the system. Let the accountant be the “bad guy” changing the system. My dad once told me that when it comes to business trust two people, God and yourself and watch God.

Payables … Payables involves so much more than just paying bills. Why do you have the bill? Who authorized the services? Where the services requested in the best interest of the organization? Embezzlement isn’t just diverting receivables, it could be theft of goods and services. I could think of a hundred examples like the front desk that has the snow plow company do their home and add it to the office bill. Or, the assistant that places a $2000.00 supply order to get the “Free Kindle” that is shipped with the order and the assistant is checking in the shipment. Did you need the supplies? Were they priced correctly? Nothing is free. Then there is the accounting manager that has been with you for 10 years submitting bills from nonexistent companies and depositing them into a personal account..

Embezzlement … is alive and well in the dentistry. It is all about prevention. Talk to a professional and please feel free to contact me with any questions or concerns.

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February 25, 2018 Posted by | Uncategorized | Leave a comment

Dental Material Curing Lights Beyond the Sales Pitch!

No, they are not all the same and yes, they can be expensive. A craftsman (craftsperson for the PC crowd) does their best work with the best tools. Just like handpieces you can use a $50.00 tool or a $1500.00 one, the difference will be the quality and predictability of you restorative procedures. Your perception of quality vs cost starts with the sales pitch.

The Sales Pitch … When I attended Restorative Update 2017 with Dr. Stace Lind last October, my thoughts about curing lights and manufacturer claims were confirmed. Dental light cured materials are chemical compositions and the curing process is a chemical reaction. The laws of physics require a certain amount of exposure time of particular light waves for the chemical reaction to take place quickly. If a manufacturer claims that their system will reduce curing time because it is so powerful, you should think twice. Large manufacturers can make that claim when using their materials because the products are developed and tested using their lights. However, no light curing system cures all materials the same way and excessive curing can cause a burn effect. It is important to know how the materials you are using react to your curing lights.

Curing Lights … There are 4 components that separate a $50.00 system and one that costs $1500.00.

  1. The LED Crystals … They need to be flawless. Just like diamonds there are different qualities. Imperfect crystal will burn hotter in fault areas causing that part of the crystal to burn-out. You will not notice this but the light wave will not be balanced and the output will be diminished.
  2. The Crystal Housing … Quality lights incase the LED crystals in metal col- lars. Electricity powers the crystal and they do get hot internally. Plastic and low quality metals will warp reducing the lights ability to function correctly.
  3. The Glass Light Guide … Again quality is the issue. This is a no brainer, flawless glass rods are a must. If the glass is not pure the best light in the world will not preform. As a side note, keep the business end of the light guide clean.
  4. The Timer … This is the most underrated part of a curing light. You don’t want to under or over cure and when your dealing with seconds, 1 or 2 could make a difference. Let’s be honest, when your light is set at 10 seconds, do know if it is 8 or 12? Reliability costs more.

Testing Your Light … Different lights have different effects on curing dental materials. It is recommended that you have a radiometer to test output but you also should have a computer based comparison study done. The computerized testing & report are free, done on-site, and will help support the quality of your work. Please feel free to contact me at any time with any questions or concerns.

 

February 11, 2018 Posted by | Uncategorized | Leave a comment

Dental Compressors Expensive!

The dental air compressor is the heart of your practice. Like nothing else in you office, if it goes down everything clinical stops. Unlike their counter parts that you can find at The Home Depot, they are expensive and specifically designed for healthcare. Filters and drying chamber are incorporated to pro-vide clean and dry air to help improve clinical procedures with predictable results.

Clean Dry Air … Why are dental compressors so much more expensive than what you see at a retail store. Clean dry air is extremely important when delivering quality dentis-try. When air is compressed the moisture is squeezed out and settles at the bottom of the tank. A purge valve releases the water when a small puddle forms. The remaining mois-ture is captured by a desiccant filter that needs to be changed annually. This is one thing that is never done in any office I walk into, out of sight out of mind. The filter serves another purpose on older systems, they filter out oil vapor.

Oil type compressors … On top of the compressor tank is an electric motor. The motor, just like the one in your car, requires a lubricant to run smooth and reduce friction wear & tear. The oil does burn out and levels should be checked monthly. This is another thing that is never done. Another big issue is that the oil vapor emitted by the motor is in the ambient air can be picked up by the air intake and drawn into the tank. The oil resi-due builds up in the air lines and totally clean dry air is almost impossible. Today, dental designed compressors are oil less.

Oil Less Compressors … New compressor motors are designed to run without oil. A synthetic lubricant is sealed into the race to reduce friction. Although oil less systems are clinically better, they are a little noisier and don’t last as long. Their life expectancy is reduced by about 20% . Replacing an oil type unit with an oil less will not solve the problem of oil vapor in the air lines, once its there its there, but it will reduce the wear on your operatory equipment.

Compressor size … Dental air compressors come in all different sizes. The motors (heads) are rated by hoarse power and the amount of power you need depends on the number of active users. Multiple users with a small compressor will increase the recov-ery time it takes to repressurize the tank causing the heads to run hot and reducing their life span. A larger compressor will hold its pressure longer and more powerful heads will fill the tank faster. A dental compressor, when fully pressurized, hold 100 psi and when bled to 80 psi the heads turn on. The recovery time is the amount of time it take to reach 100 psi. Your compressor is so important that newer systems incorporate software for central operational control.

Central Operational Control … If you read this far down my rant you will now under-stand were we are going. All of your equipment and management systems will talk to each other. Everything will be tied into a central monitoring and management system. Keep this in mind when buying or replacing dental equipment. Including compressors.

February 7, 2018 Posted by | Uncategorized | Leave a comment

Dental Handpiece Maintenance?

Why are some dental handpieces so expensive? That’s like asking why some cars are so expensive. I was talking to a dentist last week who mentioned that a friend of his buys $35.00 handpieces from China and when they break down after 3-4 months he just throws them away.

What is the difference between that $35.00 high speed and a $1200.00 one? A lot! A craftsman does their best work with the best tools. As a dentist you are a craftsman, you restore human anatomy.

High Speed Handpieces … Carbide burs and diamond stones preform best when used with a quality tool. High Speed handpieces spin at 350,000 rpms, faster than a jet engine. Quality tools are laser balanced, will maintain their centricity under load and minimize or eliminate chatter. Internal components regulate air flow to maintain true cutting speed and torque for predictable performance. Quality pieces are designed ergonomically to be hand held and have a much lower decibel level offering personal health benefits to the user. Everyone has different views about high speeds but just remember, you get what you pay for. Regardless of what you spend, proper care & maintenance will increase the life of the turbine cartridge.

The High Speed Turbine … This is one of the most misunderstood piece of dental equipment. Stainless steel or ceramic bearings ride inside a race (track) that is attached to a cylinder with blades (fins) that capture the air to spin the turbine. Sounds simple, but it is not. The detail engineering and specifications require a regular maintenance plan that will not reduce the life span of this little jet engine and please, keep them away for Disinfectants.

Disinfection & Sterilization … If you are not using an automatic handpiece purge unit the chances are that you are not cleaning or lubricating properly. Handpieces need to be cleaned and lubricated before sterilization. Forced pressure lubrication is always better because it will clean the turbine cartridge at the same time it lubricates and by using an autoclavable lubricant you will help protect the moving components from the repeated sterilizer heat. Never use disinfectants of any kind to wipe clean a handpiece. Use plane water, they are made to get wet, and a hand scrub brush if needed. Remove the handpiece from the room before spraying or wiping counters and equipment. The disinfectants release a vapor into the air. This vapor will settle on the handpiece and degrade the metal.

The Metal … Dental handpieces are made of titanium or stainless steel. Titanium is better (and more expensive) because it is lighter in weight and more resistant to sterilization but most are made of stainless steel. However, stainless steel is just that, it stains less. There are different qualities of stainless steel so you will get what you pay for.

Your #1 Tool … A baseball player always uses the best glove, some even sleep with there bats. A Photographer will use the best camera available and a painter will use only the best brushes. Your high speed, low speed, air driven or electric’s are your #1 tools. You use a handpiece of some type on 99.98% of you patients. Quality tools will help you be the best you can be, they are your brushes! You can save money in a lot of places but there are three, where money should not be an issue. (1) Your overhead light (2) The stool you sit on (3) Your handpiece. Please feel free to contact me at any time with any questions or concerns.

January 21, 2018 Posted by | Uncategorized | Leave a comment

“A Picture is Worth a Thousand Words” … Napoleon Bonaparte

A treatment plan presentation begins when the patient calls for an appointment and walks through the front door into your reception room. Your office doesn’t have a waiting room because your patients don’t wait.

A treatment plan presentation is all about communication and that begins with the patient’s perception of you, your team and the physical environment. If the office looks old how does that effect the patients perception of care?

Napoleon Bonaparte was known as the Little General. He really wasn’t that short but he surrounded himself with tall bodyguards. That image also helped hide his military genius from his enemies and retain the loyalty of armies. What professional image does your practice portray?

The Professional Image … When you get to the office do you walk in the front door or the back? When I visit my clients I always use the front door and sometimes I am shocked at what I see. My business background is marketing and operations and Stu Leonard was one of my marketing heroes, he once said “Retail is Detail” and the detail is what you need to pay attention to. I can’t tell you how many times I have picked up wet newspapers and brought them to the front desk or, while I was waiting, picked up a magazine that was 10 months old. It’s so interesting reading about baseball spring training after the season is over. It looks and feels old and competes with your success.

Competing with yourself … This is not good and it is so avoidable. What magazines are in your reception area? What is playing on the flat screen (I hope it’s a flat screen)? Think about this, your 35-45 year old patient is reading about a great newly designed putter or an outrageous hand bag that sell for $250.00. Then you tell that patient that they “should” have an old restoration replaced. What do think they will do? I think they will say “maybe next time”. If they are watching the travel channel in the reception area, what are they thinking about? It’s not veneers or aligners. Keep the focus on oral and systemic health.

Systemic health … This is the core of the patient experience and the picture you want to portray. Your patients don’t understand that you are a physician and part of their health care team. Your reception area should have heath related magazines and oral health related videos on the flat screen. Keeping the patient focused on health will help them better understand your clinical suggestions. The average patient also respects technology and dental imaging because now you can show them pictures and a picture is worth a thousand words.

The Picture … several years ago I started working with client in an affluent New Jersey town. It was a million dollar location but the practice had not been updated in over 20 years. The dentist is an excellent practitioner with a great personality but the new patient count and re-care system was struggling. Reluctantly, the dentist invested over $100k and renovated the practice (with no down time). They scripted the team, focused them on the patient experience and enjoyed meeting over 100 new patients (that all re-appointed) over a 9 month span. The picture is only getting brighter.

Keep Making it brighter … Gandhi once said “we are the language we speak”. New diagnostic tools are becoming more available to dentists. To remain part of the healthcare revolution that is well underway you need to consider utilizing some of these tools. Technology now allows you to use digital imaging along with your words to explain clinical issues. Technology also allows you to offer your patients an analysis of systemic abnormalities and probabilities. You are not “just” a dentist, you are a physician and a key part of your patient’s healthcare team. Stay current, stay relevant and keep making that picture brighter.

January 17, 2018 Posted by | Uncategorized | Leave a comment

Time, Technology, Money … 2018(Not Necessarily in That Order)

Many of my clients know my feelings about getting up in the morning. We all get up for one of three reasons, fortune, glory, or the betterment of humanity. Well, it all starts with fortune. Unfortunately there is another saying “it takes money to make money” and that is what prevents most people from trying to reach out and grab the gold ring.

Reaching Out for the Gold Ring … Developing a business plan and trusting yourself with the implementation and the financial investment required is the hardest part. Most of us don’t have the ability to do it all so the investment in a quality team is the first thing to be addressed. Another old saying is “pay peanuts, get monkeys” and that means you will pay more for quality. Most dental practices that have difficulty expanding don’t look at the business foundation and how well it is supported. Without the blocks to build on you will not be able to keep up with the changes over the next decade. The longer you wait to engage, the more expensive it will be. You need to factor in the “learning curve”.

The Learning Curve … It takes a certain amount of time to learn and master a technique or a software program. The new world of dentistry is all about the network and how diagnostic and business management systems integrate. Understanding and utilizing this integration is very important and that means quality in-office training and support.

Training and Support … Yes, it can be expensive but it is essential for your ROI. Unfortunately most dental offices do not realize that some technology integrates better with certain other technologies. Buying a digital radiography system that needs a software bridge to your practice management system creates another step for information to transfer. The Digital trainer may not be familiar with the bridge and that could be a week spot in your production chain. Popular brands usually work well together but a smooth implementation depends on quality training and continued support. Now you have come full circle and need the team to train.

The Team … You need to choose a team leader that could be in command with regard to procedure and protocol. Operational systems need to be maintained for a healthy work flow and maintaining consistency is hard. You can’t keep an eye on everything while you caring for your patients. Morning huddles and monthly team meetings are necessary to keep your team focused and involved.

Focused & Involved … “Involved” is the key word. Always keep your team involved with any changes you plan on making. Before you implement something new (i.e. an impression scanner or software) explain your plan to your team and ask their opinion. Your decision may have been already been made and the order placed, but by consulting (not informing) with your team you can address any fears and concerns that could derail a smooth integration. People don’t like change and some are afraid of a challenge for fear of failing. Bonus systems should be considered as rewards for team performance, that gives everyone a common goal. You can’t keep giving raises, we’ll discuss that next week. Please feel free to contact me at any time with any questions or concerns.

January 7, 2018 Posted by | Uncategorized | Leave a comment

The Word is “Diligence” in 2018 … Eyes Wide Open!!

This will be the last Cliff’s Notes for 2017. Thank you for reading my rants and I hope that somewhere along the line you found something that helped. In the coming year we will all be facing new challenges and some of them we won’t be prepared for. It is im-portant to keep your eye down the field and focused on the goal line. Navigating the maze of changes facing the healthcare industry over the next 2 years (20182020) will be essential to your success.

The Next 2 Years … Why 2 years? In today’s market place technology is fueling technology and it has become impossible to predict what markets will be the flavor of the day. To stay relevant your approach to the market (your patient base de-mographics) needs to be updated. In most cases a business owner (dentist) is too con-sumed with day to day operations to stay focused on changes in their market so they need to invest a little money and consult with experts. A good leader knows when to say “I don’t know”. You need to be a team leader.

Leadership 101 … Leadership is a skill. Some people are born with it and others learn and earn it. Some of the greatest leaders started in the mailroom. My definition of lead-ership is getting your team to do what they don’t want to do and enjoy doing it. Listen to everyone and respect their opinions. You don’t need to agree but you do need to listen. A good leader has to know what can be done but doesn’t have to know how to do it because they have a motivated team along with checks and balances.

A Motivated Team … What motivates people? The most logical answer is money but respect and appreciation rank high on the list. The money your team costs is not an expense, it is an investment. Allowing a competent loyal team member to apply their natural skills to assigned tasks can generate a big return on that investment. Like all investments, there are ups and downs but as long as the upside is recognized and the downside is not chastised but understood as a learning opportunity the ROI will contin-ue to increase.

Natural Skills … When managing a team, recognizing a team members attributes and focusing them on tasks that fit will only enhance your workflow. Getting that person to enjoy the task and understanding why you think that they are the best for the job is the important part so remember to communicate it. Also remember to implement all the checks & balances.

Checks & Balances … “Oh what a tangled web we weave when first we practice to deceive” My dad once told me to trust only 2 people, God and yourself, but watch God. We laughed a lot about that but what he was saying is that mistakes, whether ac-cidental or on purpose, do happen. A system of checks and balances throughout your organization is a priority to protect you, your family and your team. I can’t tell you the number of times I have suspected inconsistencies within a dental team but due to legal considerations I am not permitted to raise suspicion on anyone. However, I can suggest workflow and financial audit trails.

The Challenge … Your 2018 needs to be more organized and controlled than ever before to remain or be more successful. The start is a 1 hour business operational re-view. Please feel free to contact me with any questions or concerns.

  May the New Year bring health and prosperity to your world

December 31, 2017 Posted by | Uncategorized | Leave a comment

Will Your Dental Practice Survive?

 

What a great question. We all dream of long and successful careers but forces beyond our control often derail or demoralize the dream. Just 10 years ago the industry leaders were all preaching “fee for service” and look how fast that changed. Now it is all about managing the patients insurance to maximize benefit expenditures. Regulation, annual registrations, OSHA, HIPAA and more are consuming time and revenue. What is going to happen over the next 10 years, where will your dental practice be? You could be a windshield or a bug.

The Windshield and the Bug … Your driving along the NJ Turnpike and SPLAT! After a moment of silence, you hit your washer switch and the mess is gone. But what just happened, the bug didn’t see you coming and the windshield was put in place to prevent a collision with your face. The healthcare industry is flying down the highway and you don’t want to be the bug. It is time to start thinking, the changes are inevitable.

Changes … The climate has been changing for billions of years. Like a wave it has peaks and valleys and as long as the earth exists I don’t see that changing. The practice of dentistry has also been changing over the years. 20 years ago the federal government enacted the “Clean Water Act” and we couldn’t dump developer and fixer down the drain. For those of us of more tender years, that’s what we used to develop xray film. Today, students graduating dental school don’t know how to develop film or what a PeriPro is. They also never heard of a NuvaLight or the difference between dispersed phase and spherical blend amalgams. Change happens and the last 25 years has been amazing, so where are we going and where are you now?

Where are You Now? … Another great question! The introduction of 3D printers into dentistry is the next step. The software is ready, the equipment is ready, and now the materials are starting to come into the dental market place. In a short while you will be able to “print out” temporary crowns and (invisalign style) aligning brackets. Yesterday’s future is today, it’s time to engage.

It’s Time to Engage … As a modern dentist you need to invest time in learning new techniques and procedures. As a modern business owner you need to reinvest in your business and utilize the new technologies to support clinical advancements. From digital impression scanners to CBT to insurance management, it all starts with your information (computer) network.

Your Information Network … You used to have a computer network but today you need to change that terminology and think of it as an “information network”. The paperless world is here and your network needs to be able to handle and store all the data that will be required to maintain your dental practice records. This will cost money as upgrades and support services become necessary and you have to include these costs into you quarterly and annual budgets. This starts with a comprehensive review of your computer hardware and a discussion of what will be needed over the next 5 years. This is a “today” conversation with an informed professional. How far are you behind the curve. Please feel free to contact me with any questions or concerns.

  

October 29, 2017 Posted by | Uncategorized | Leave a comment

Dental OSA Screening, The Bridge to Primary Care

You have been to all the seminars and the experts told you how much mon-ey you could make fabricating an OSA oral appliance but they don’t bring up the patient deductible that usually leads to a nontreatment plan. The effort in screening and patient rejection made the program irrelevant when mixed in with the rest of the day so after a couple of months you forgot all about it. If this happened to you, you missed the big picture.

The Big Picture … A dental sleep medicine program is part of “Total Systemic Health”. Your patients think of you as just a dentist when you should be part of their personal healthcare team. The screening process for OSA takes about 2 minutes of a hygiene exam and it should be part of your preventive protocol.

Prevention Protocol … Medicine is reactive, dentistry is proactive. The average healthy patient sees their dentist 4 to 6 times more often than they see their primary care provider. People go to their medical doctor when they have symptoms and need to be treated but dentistry is positioned to identify abnormalities before symptoms develop. It’s all about screening. The possibility of early detection has been noted by the insurance industry.

The Insurance Industry … Most large insurance carriers have more money than banks. Delta Insurance is the only one that is dental only, the rest offer medical insurance. If a dental practice can identify abnormal systemic conditions before symptoms develop, treatment would save tens of thousands of dollars per incident and tens of millions annually. You will start to notice that as insurance reimbursements continue to decline, new diagnostic codes will become available for processing. Dental practices will be rewarded for preventive medicine. It all starts with patient screening.

Patient Screening … This is a team task. The screening process is nothing more than asking a few simple question while your team is taking the patients blood pressure. I hope you are check-ing BP because that is the ground floor of any total systemic health program. Questions about head aches, indigestion, snoring, or any aches and pains should be discussed with your patient.

Your Patient … Yes, they are your patients and just like your MD counterparts you need to be able to direct them to other specialist and provide your insight to their primary care providers. In the next few months you will be hearing about salivary tests that can gage the probability of your patient developing all sorts of systemic conditions. Imagine being able to inform a patient that they have a 70% chance of developing heart disease and providing that information to their primary care provider. You could save lives. But OSA screening is also a practice builder.

OSA Practice Building … Medical deductibles are high and dental OSA treatment plans are usually rejected but a condition has been diagnosed. With the patient’s permission the results of the test should be forwarded to their primary provider via registered mail and revisited at their next appointment. The chances are that the CPAP prescribed is not being used opening the door for the oral appliance. Please feel free to contact me for more details on systemic programs.

     

October 24, 2017 Posted by | Uncategorized | Leave a comment

Beware the Tax Man … Q4 is Here!

Did a tax advisor tell you that you made too much money and have to pay the government “real money”. You got got smacked for being successful. Well, this may be your last chance to do it right. Hopefully, you will have to write a check because you had a good year, but who’s name is on the check is the question. If you haven’t scheduled your Q3 review I suggest you do it today. You also need to know how your business will be effected by the impending changes in tax reform.

Tax Reform … It’s coming and you should prepare now for next year or figure out what to do if it is retroactive to the beginning of this year. One thing for certain is that federal money will not be giving freely to states and that means that the states will have to find the lost revenue in other places or begin trimming services. Trimming services is political suicide so don’t expect that to happen. The federal attempt to plugging up some of the holes in the ship (the low hanging fruit) may start with the investment tax credit.

The Investment Tax Credit … Was put in place to stimulate factory production by allowing the buyer to claim several years of depreciation on certain durable goods in a given tax year if those items are used to conduct business . The US congress needs to reauthorize this special rule (IRS Sec. 179) every year and if not done by December 31st the deduction will go away in 2018. Everyone needs to reinvest in their business so it is important that you have this conversation with your tax advisor. The federal government’s tax package will also have a dramatic effect on the States.

The States Low Hanging Fruit … The Consumer Use Tax is a large part of the states lost revenue. In NJ as a general consumer you are required to report all tax liability after exceeding the $500.00 ceiling. That allows for around $7000.00 in out of state purchases. However, a NJ business of any kind is liable after $1.00. The hard part is understanding what is considered non-taxable in the state being as there is no published list. Any seller that collects state sales tax assumes the non-taxable liability. It is important that you discuss the Use Tax requirement with your tax advisor.

Your Tax Advisor … If you are reading this publication the chances are that you own a business or are involved in running one. A quality tax advisor (accountant) is essential in running a business. If your accountant just crunched numbers and tells you what you owe, your probably leaving real money on the table. Quality consultants in all areas of business can be expensive so do your due diligence and ask question. Accountants are not expenses, they are investments and should produce a measurable ROI.

ROI (Return on Investment) … When running a business every thing you do, every check you write, every new patient you spend time with is an investment. The monetary return over an annual time frame needs to be measurable or the investment may not be worth the time or energy. I have seen clients change accounting services because they were too expensive. Maybe they just never utilized services or maybe services were never offered, either way both effect the ROI. One of the most common mistakes a business owner makes is to giving into emotion and the fear of change. A quality leader will invest time in gathering information and making difficult informed decision.

Informed decisions … Making informed decision is essential for success. Please feel free to contact me with any questions or concerns.

 

October 17, 2017 Posted by | Uncategorized | Leave a comment