springbrook standalone hra - redacted bates hw

7/27/2019 Springbrook Standalone HRA - Redacted Bates HW

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//T|/...20Standalone%20HRA/Waiver%20of%20Annual%20Dollar%20Limits%20Application-%20REQUIRES%20ATTENTION.htm[08/08/2011 12:08

rom: Stephanie Kier [[email protected]]ent: Tuesday, November 30, 2010 3:37 PMTo: HHS HealthInsurance (HHS)Cc: DeAnna Backus; Stephanie Kierubject: Waiver of Annual Dollar Limits Application- REQUIRES ATTENTION

mportance: High

Attachments: HRA Waiver application 113010.pdf; Springbrook Standalone HRA amended and restated 1-1-102).pdflease see the attached waiver application along with a copy of the HRA Plan Document for Springbrook.

lease respond directly to DeAnna Backus at Springbrook. Contact information is included on the application.

tephanie L. Kier

ccount Executive

elph Benefit Advisors

150-G Pittsford-Victor Rd.

ittsford, NY 14534

: 585-248-8720 Ext. 245

585-415-4323

Visit us at: http://www.relphbenefitadvisors.com for the latest news and information

elph Benefit Advisors is a member of the Benefit Advisors Network (BAN), the premier national credentialed network of independent employee benefit brokend consulting firms. BAN member firms share investment and human capital in state of the art technology and employee benefit expertise to deliver optimum resultseir clients.

ONFIDENTIALITY NOTICE: The information contained in this electronic communication, including any attachments, is confidential information, is intended only for se of the recipients named above, and may be protected by law. If the reader of this message is not an intended recipient, you are hereby notified that any review

ssemination, distribution or copying of this communication, or any of its contents, is strictly prohibited. If you have received this communication in error, please notimmediately of the error by return e-mail and please permanently remove the original message and any copy of it from your system. Thank you

Springbrook:000001

Document obtained by CompleteColorado.com
http://www.relphbenefitadvisors.com/http://www.relphbenefitadvisors.com/


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Springbrook:000002



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Pages 3 through 15 redacted for the following reasons:- - - - - - - - - - - - - - - - - - - - - - - - - - - -Exemption 4

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//T|/...20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Request%20for%20info%2012.20.10.htm[08/08/2011 12:08

rom: Keels, Lisa (HHS/OCIIO)ent: Monday, December 20, 2010 1:11 PM

To: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Dear DeAnna,

hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements

he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide theollowing information:

Please state the number of people covered under each of the following tiers of coverage:

o $ single coverageo $ o-person coverageo $ family coverage

n order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi

hank you,isa

sa M. Keels, J.D.

.S. Department of Health & Human Services

ffice of Consumer Information and Insurance Oversight

ffice of Oversight

[email protected]

01-492-4168

Springbrook:000004



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//T|/...20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Request%20for%20info%2012.22.10.htm[08/08/2011 12:08

rom: Keels, Lisa (HHS/OCIIO)ent: Wednesday, December 22, 2010 4:46 PM

To: [email protected]: Habit, Sandra (HHS/OCIIO)ubject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Informationear DeAnna,

ust left you a voicemail message to follow up on our conversation and my email below from Monday, December 20th. A

mentioned, in order to complete your application for an annual limits waiver, please let us know how many people areovered under each tier of coverage.

will be out of the office beginning tomorrow, Thursday, December 23, through next week. I will be checking my voicema

eriodically, but I recommend trying to contact me via email if you have any questions. I will be checking my email tomor

nd intermittently next week.

hank you,

sa

rom: Keels, Lisa (HHS/OCIIO)ent: Monday, December 20, 2010 1:11 PMo: '[email protected]'c: Habit, Sandra (HHS/OCIIO)ubject: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Dear DeAnna,

hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide theollowing information:

Please state the number of people covered under each of the following tiers of coverage:o $ single coverageo $ o-person coverageo $ family coverage


hank you,

isa

sa M. Keels, J.D.



ffice of Oversight

[email protected]

01-492-4168

Springbrook:000005



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//T|/...0with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Correspondence%2012.23.10.htm[08/08/2011 12:08

rom: Keels, Lisa (HHS/OCIIO)ent: Thursday, December 23, 2010 9:33 AM

To: Stephanie Kier; [email protected]; Kim Sawdey; John BartholfCc: Habit, Sandra (HHS/OCIIO)ubject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Informationhanks, Stephanie.

sa

rom: Stephanie Kier [mailto:[email protected]]ent: Thursday, December 23, 2010 9:32 AMo: [email protected]; Stephanie Kier; Kim Sawdey; Keels, Lisa (HHS/OCIIO); John Bartholfubject: Re: Springbrook Standalone HRA Waiver Application - Request for Additional Information

isa,

Here is the info you requested.

Opt out ( )ingle ($ personamily ($ lease let DeAnna and me know if you need anything else.

tephanie Kierent from my HTC on the Now Network from Sprint!

---- Reply message -----rom: "DeAnna Backus"

Date: Wed, Dec 22, 2010 4:49 pm

ubject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Informationo: "Stephanie Kier" , "Kim Sawdey"

will need assistance on this. Please see below. I wont be back in the office until Wednesday, 12/29.

DeAnna Backus

Assistant Director, Human Resources

pringbrook

607) 286-7171, ext. 268

Email: [email protected]

www.springbrookny.org

rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, December 22, 2010 4:46 PMo: DeAnna Backusc: Habit, Sandra (HHS/OCIIO)ubject: [!! SPAM] FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information

ear DeAnna,


mentioned, in order to complete your application for an annual limits waiver, please let us know how many people are

Springbrook:000006

http://www.springbrookny.org/http://www.springbrookny.org/


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//T|/...0with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Correspondence%2012.23.10.htm[08/08/2011 12:08

overed under each tier of coverage.




hank you,

sa

rom: Keels, Lisa (HHS/OCIIO)

ent: Monday, December 20, 2010 1:11 PM

o: '[email protected]'

c: Habit, Sandra (HHS/OCIIO)

ubject: Springbrook Standalone HRA Waiver Application - Request for Additional Information

ear DeAnna,

hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements of the Pu

ealth Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the following information


$ single coverage$ two-person coverage$ family coverage

n order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once this informa

received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). A

tated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complet

pplication. You will receive an e-mail from HHS notifying you of the waiver decision.

hank you,

sa

sa M. Keels, J.D.



ffice of Oversight

[email protected]

01-492-4168

Clickhere to report this email as spam.

Visit us on the web at http://www.springbrookny.org

Springbrook:000007

https://www.mailcontrol.com/sr/wQw0zmjPoHdJTZGyOCrrhg==http://www.springbrookny.org/http://www.springbrookny.org/https://www.mailcontrol.com/sr/wQw0zmjPoHdJTZGyOCrrhg==


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//T|/...ns%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Completion%2012.27.10.txt[08/08/2011 12:08

rom: Keels, Lisa (HHS/OCIIO)ent: Monday, December 27, 2010 6:50 PMo: Stephanie Kier

Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Springbrook Standalone HRA Waiver Application - Request for

Additional Information

Hi Stephanie,

hanks for your email. The Springbrook HRA application is currently being processed with the information yourovided on Thursday, December 23rd. At this point, your application is complete, and you should be hearing from

HHS soon.

hanks again,isa_______________________________________rom: Stephanie Kier [[email protected]]ent: Monday, December 27, 2010 3:28 PMo: Keels, Lisa (HHS/OCIIO)

Cc: Habit, Sandra (HHS/OCIIO)

ubject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information

isa,

hope you had a wonderful holiday. Per your email below I can see that you are out of the office this week but we checking email periodically. Can you please let me know the status of the HRA Waiver Application forpringbrook? I wanted to reach out to you early this week to make sure Springbrook was all set. Please let me kno

when you get a chance. Thank you.

incerely,tephanie

tephanie KierAccount ExecutiveRelph Benefit Advisors

rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 23, 2010 9:33 AMo: Stephanie Kier; [email protected]; Kim Sawdey; John Bartholf

Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information

hanks, Stephanie.

isa


isa,

Springbrook:000008



9/23



Opt out ingle pers amily

lease let DeAnna and me know if you need anything else.

tephanie Kierent from my HTC on the Now Network from Sprint!---- Reply message -----rom: "DeAnna Backus"

Date: Wed, Dec 22, 2010 4:49 pmubject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Informationo: "Stephanie Kier" , "Kim Sawdey" will need assistance on this. Please see below. I wont be back in the office until Wednesday, 12/29.

DeAnna BackusAssistant Director, Human Resources

pringbrook607) 286-7171, ext. 268mail: [email protected]


rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, December 22, 2010 4:46 PMo: DeAnna Backus

Cc: Habit, Sandra (HHS/OCIIO)ubject: [!! SPAM] FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Dear DeAnna,

just left you a voicemail message to follow up on our conversation and my email below from Monday, December0th. As I mentioned, in order to complete your application for an annual limits waiver, please let us know how meople are covered under each tier of coverage.

will be out of the office beginning tomorrow, Thursday, December 23, through next week. I will be checking myoicemail periodically, but I recommend trying to contact me via email if you have any questions. I will be checki

my email tomorrow and intermittently next week.

hank you,isa

rom: Keels, Lisa (HHS/OCIIO)ent: Monday, December 20, 2010 1:11 PMo: '[email protected]'

Cc: Habit, Sandra (HHS/OCIIO)ubject: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Dear DeAnna,

hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the

Springbrook:000009



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ollowing information:

lease state the number of people covered under each of the following tiers of coverage:

single coveragetwo-person coverage

family coveragen order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once thisnformation is received and the application is complete, it will be processed by the Department of Health and Humervices (HHS). As stated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 3ays of receiving a complete application. You will receive an e-mail from HHS notifying you of the waiver decisi

hank you,isa

isa M. Keels, J.D.U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office ofOversight [email protected]

01-492-4168

Click here to report this email as spam.


Springbrook:000010



11/23

//T|/...0with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Status%20check%2012.27.10.htm[08/08/2011 12:08

rom: Stephanie Kier [[email protected]]ent: Monday, December 27, 2010 3:28 PM

To: Keels, Lisa (HHS/OCIIO)Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Informationsa,

hope you had a wonderful holiday. Per your email below I can see that you are out of the office this week but will be

hecking email periodically. Can you please let me know the status of the HRA Waiver Application for Springbrook? I wano reach out to you early this week to make sure Springbrook was all set. Please let me know when you get a chance. Tha

ou.

ncerely,

tephanie

tephanie Kier

ccount Executive

elph Benefit Advisors

rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 23, 2010 9:33 AMo: Stephanie Kier; [email protected]; Kim Sawdey; John Bartholfc: Habit, Sandra (HHS/OCIIO)ubject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information

hanks, Stephanie.

sa


isa,


Opt ouingle perso amily lease let DeAnna and me know if you need anything else.

tephanie Kierent from my HTC on the Now Network from Sprint!

---- Reply message -----rom: "DeAnna Backus"

Date: Wed, Dec 22, 2010 4:49 pmubject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Springbrook:000011



12/23


o: "Stephanie Kier" , "Kim Sawdey"

will need assistance on this. Please see below. I wont be back in the office until Wednesday, 12/29.

DeAnna Backus


pringbrook

607) 286-7171, ext. 268



rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Wednesday, December 22, 2010 4:46 PMo: DeAnna Backusc: Habit, Sandra (HHS/OCIIO)ubject: [!! SPAM] FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information

ear DeAnna,


mentioned, in order to complete your application for an annual limits waiver, please let us know how many people are

overed under each tier of coverage.




hank you,

sa


o: '[email protected]'

c: Habit, Sandra (HHS/OCIIO)


ear DeAnna,

hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements of the Pu

ealth Service Act (PHS Act) Section 2711. In order to expedite your application, please provide the following information


$ single coverage$ two-person coverage$ family coverage

n order to complete your application, please provide this information by 5:00 pm, December 21, 2010. Once this informa

received and the application is complete, it will be processed by the Department of Health and Human Services (HHS). A

tated in our September 3, 2010 Sub-Regulatory Guidance, HHS will issue a decision within 30 days of receiving a complet

pplication. You will receive an e-mail from HHS notifying you of the waiver decision.

Springbrook:000012

http://www.springbrookny.org/http://www.springbrookny.org/


13/23


hank you,

sa

sa M. Keels, J.D.



ffice of Oversight

[email protected]



Springbrook:000013



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//T|/...ications%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Question%201.3.11.txt[08/08/2011 12:08

rom: Stephanie Kier [[email protected]]ent: Monday, January 03, 2011 8:42 AMo: Keels, Lisa (HHS/OCIIO)

Cc: Habit, Sandra (HHS/OCIIO)ubject: RE: Springbrook Standalone HRA Waiver Application - Request for

Additional Information

mportance: High

Hi Lisa,

Can you please tell me the status of the waiver for Springbrook?


----Original Message-----rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Monday, December 27, 2010 6:50 PM

o: Stephanie KierCc: Habit, Sandra (HHS/OCIIO)

ubject: RE: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Hi Stephanie,

hanks for your email. The Springbrook HRA application is currently being processed with the information yourovided on Thursday, December 23rd. At this point, your application is complete, and you should be hearing from

HHS soon.

hanks again,

isa_______________________________________rom: Stephanie Kier [[email protected]]ent: Monday, December 27, 2010 3:28 PMo: Keels, Lisa (HHS/OCIIO)


isa,

hope you had a wonderful holiday. Per your email below I can see that you are out of the office this week but w

e checking email periodically. Can you please let me know the status of the HRA Waiver Application forpringbrook? I wanted to reach out to you early this week to make sure Springbrook was all set. Please let me knowhen you get a chance. Thank you.

incerely,tephanie


Springbrook:000014



15/23


rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 23, 2010 9:33 AMo: Stephanie Kier; [email protected]; Kim Sawdey; John Bartholf


hanks, Stephanie.

isa


isa,


Opt ouingle pers amily

lease let DeAnna and me know if you need anything else.

tephanie Kierent from my HTC on the Now Network from Sprint!---- Reply message -----rom: "DeAnna Backus"

Date: Wed, Dec 22, 2010 4:49 pmubject: FW: Springbrook Standalone HRA Waiver Application - Request for Additional Informationo: "Stephanie Kier" , "Kim Sawdey" will need assistance on this. Please see below. I won't be back in the office until Wednesday, 12/29.

DeAnna BackusAssistant Director, Human Resources

pringbrook607) 286-7171, ext. 268mail: [email protected]


rom: Keels, Lisa (HHS/OCIIO) [mailto:[email protected]]

ent: Wednesday, December 22, 2010 4:46 PMo: DeAnna Backus

Cc: Habit, Sandra (HHS/OCIIO)ubject: [!! SPAM] FW: Springbrook Standalone HRA Waiver Application - Request for Additional Information

Dear DeAnna,

just left you a voicemail message to follow up on our conversation and my email below from Monday, December0th. As I mentioned, in order to complete your application for an annual limits waiver, please let us know how meople are covered under each tier of coverage.

Springbrook:000015



16/23


will be out of the office beginning tomorrow, Thursday, December 23, through next week. I will be checking myoicemail periodically, but I recommend trying to contact me via email if you have any questions. I will be checki

my email tomorrow and intermittently next week.

hank you,isa


o: '[email protected]'Cc: Habit, Sandra (HHS/OCIIO)


Dear DeAnna,

hank you for speaking with me today and for your application for the Waiver of the Annual Limits Requirements he Public Health Service Act (PHS Act) Section 2711. In order to expedite your application, please provide theollowing information:

lease state the number of people covered under each of the following tiers of coverage:

single coveragetwo-person coverage

family coverage


hank you,isa

isa M. Keels, J.D.U.S. Department of Health & Human Services Office of Consumer Information and Insurance Oversight Office ofOversight [email protected]

01-492-4168

Click here to report this email as spam.


Springbrook:000016



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//T|/...Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Response%20to%20second%20status%20check%201.3.11.htm[08/08/2011 12:08

rom: Keels, Lisa (HHS/OCIIO)

ent: Monday, January 03, 2011 10:25 AM

o: 'Stephanie Kier'

c: [email protected]

ubject: FW: Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits

Requirements 12-30-2010

ttachments: Updated Jan 1 Approval Letter .pdf

mportance: High

i Stephanie,

n response to your email from his morning, the Springbrook HRA waiver application was approved. DeAnna Backus shoul

ave received the approval letter (attached to this email) on Thursday, December 30th.

s stated below, please confirm receipt of the letter by replying to Sandra Habit ([email protected]).

hank you,

sa

rom: Habit, Sandra (HHS/OCIIO)ent: Thursday, December 30, 2010 5:36 PMo: '[email protected]'ubject: Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010mportance: High

ood Afternoon,

hank you for submitting an application for a Waiver of the Annual Limits Requirements of the PHS Act

ection 2711 for Springbrook Standalone HRA. HHS has reviewed your application and made its

etermination. Please see the attached letter.

lease confirm receipt of this letter by replying to this e-mail.

lease let me know if I can be of further assistance.

incerely,

andy Habit

epartment of Health and Human Services


01-492-4175

[email protected]

Springbrook:000017

mailto:[email protected]:[email protected]:[email protected]:[email protected]


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//T|/...ions%20with%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/SpringbrookApproval.htm[08/08/2011 12:08

rom: Habit, Sandra (HHS/OCIIO)ent: Thursday, December 30, 2010 5:36 PM

To: '[email protected]'ubject: Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-30-20

mportance: High

Attachments: Updated Jan 1 Approval Letter .pdf

ood Afternoon,






incerely,

andy Habit



01-492-4175

[email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publiclysclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu

r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e

f the law.

Springbrook:000019

mailto:[email protected]:[email protected]


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Springbrook:000021



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//T|/...ith%20NO%2012600%20Response%20[YELLOW]/Springbrook%20Standalone%20HRA/Approval%20receipt%201.3.11.htm[08/08/2011 12:08:

rom: DeAnna Backus [[email protected]]ent: Monday, January 03, 2011 10:51 AM

To: Habit, Sandra (HHS/OCIIO)ubject: RE: Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-3010i Sandra,

did receive this email, and have forwarded it on to Stephanie Kier at Relph Benefits.

hank you!

DeAnna Backus


pringbrook

607) 286-7171, ext. 268



rom: Habit, Sandra (HHS/OCIIO) [mailto:[email protected]]ent: Thursday, December 30, 2010 5:36 PMo: DeAnna Backusubject: [!! SPAM] Springbrook Standalone HRA Approval Letter for a Waiver of the Annual Limits Requirements 12-30-2010mportance: High

ood Afternoon,






incerely,

andy Habit



01-492-4175

[email protected]

NFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly

sclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distribu

r copied to persons not authorized to receive the information. Unauthorized disclosures may result in prosecution to the full e

f the law.

Springbrook:000022

http://www.springbrookny.org/mailto:[email protected]:[email protected]://www.springbrookny.org/


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springbrook standalone hra - redacted bates hw

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