NIC Chats
NIC Chats
Lynne Katzmann - Episode 14
Lynne Katzmann, founder and CEO of Juniper Communities – a nationally recognized premier senior living provider – explains how her leadership style has changed over time, but her commitment to creating a better environment for the people she serves remains consistent. Katzmann talks about the challenges of being an entrepreneur and the importance of the “three P’s” – passion, planning, and perseverance. Holding your passion close, planning for the consumer of today and of tomorrow, and persevering through the numerous problems that arise.
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Welcome to NIC Chats, ideas and inspiration from senior living leaders with host Beth Mace NIC's, chief economist, and director of outreach. Get to know some of the people influencing senior living today and perhaps learn a thing or two from their experiences.
Beth Mace:Hello and welcome to the NIC Chats podcast. My name is Beth Mace and I'm the chief economist and director of the research and analytics team here at NIC. Thank you for joining us today. The focus of the NIC Chats podcast is talking to interesting people that have ideas I think you'd really like to hear about. As you listen today, I hope that you'll find some humor, insight, inspiration, and hopefully what I call an aha moment when something pithy or insightful is said and a light bulb may go off for you. So let me tell you a little bit about the structure of today's event. First, I'm gonna tell you three statements about my guest. Two of those will be true. And then throughout the podcast you'll learn, which is true and which is false. Second, There are three standard questions w ithin each podcast for each speaker and the first w ill be"What's a large challenge facing our industry." Second,"What's one thing that we can do to grow talent in our industry." And third"What's an innovative way or idea to strengthen our industry." Now, as they say on with the show. So I'm delighted today that our NIC Chats podcast is with Lynne Katzmann. Lynne is the founder and president of Juniper Communities. Lynne, thank you so much for joining us today.
Lynne Katzmann:My pleasure. It's great to be here, Beth. This is fun.
Beth Mace:Yes, I agree. So, as I mentioned, I'm gonna have three statements about Lynne two are true and one is not. So one is that Juniper has a gender balanced board since it's founding. The second is that Lynne helped start an IPO model managed care organization, which today is the largest plan in Puerto Rico. And the third is that Lynne is a CPA. So now you have to listen to the entire podcast, figure out which of these is true and which is false. So as we start Lynne, can you tell us a little bit about Juniper Communities
Lynne Katzmann:I'd be happy to. So I founded Juniper in 1988, quite some time ago. Juniper has changed quite a bit just as the industry has changed as capitals sources have evolved. And as the continuum of care has continued to evolve. Today, Juniper has specifically 29 communities, one more awaiting licensure. So we will be a total of 30, we trust by the end of March. We are in four states: Texas, Colorado, New Jersey and Pennsylvania. We have over 2000 team members and today I believe 2,107 residents. So that's the long and short of what we are. I will add one thing, Beth, before we go on, we spam the continuum. Which is different from some of my colleagues, companies, our buildings include everything from cottages and independent living apartments all the way through skilled nursing short term rehab. And we also do some chronic mental illness intervention.
Beth Mace:That is a wide range of different care models. You must have to be really comfortable with.
Lynne Katzmann:Yes.
Beth Mace:Cause those are all those individuals require different.. needs, of course. So you founded Juniper in 1988. Tell us more about your role as president and how has that changed over time from 1988 to today in terms of changes that you have for responsibilities as well as just broader changes in the industry?
Lynne Katzmann:Well, when you start a company, when you're a baby, lots of changes. You go through s chool and then you go through the tween stage and then teenager, and finally you land in adulthood. I'm somewhere past that at this point in time. So it's changed dramatically. My leadership style has evolved and I hope for the better. I will also say that the industry has changed dramatically over that period of time and so with it has Juniper. When we first started the company, we functioned more or less like a private real estate investment partnership, a private real estate investment trust. And, we bought properties and we leased them to third party operators who manage them or lease t hem from us. Over time... And those were all skilled nursing communities b ecause in 1 988, that's what largely existed. As time went on in the early nineties, w e moved our model to management agreements for two reassons. Number one, we were able to find a greater number of managers, who we thought had the level of quality in the areas we had communities, but equally important was it created a new capital model for us. It enabled us to buy properties at a reasonable price and as they improved in their profitability, we could refinance them and use those dollars to continue to buy other properties. So moving from a lease structure to a management structure provided us with a new stream of capital that we used for further investment, rather than raising new dollars. We then got into construction with assisted living, very different as well. My big learning there, Beth, is that I am great at design, not great at construction management. I don't have the temperament for it. Soon after that, we began to operate our own communities. So by the year 2000, we were an owner operator of all of our properties. In 2012... And that included assisted living as well as skilled at the time. After 2012, we had a capital event. We sold five of our buildings to LTC REIT and provided a capital event for our investors who, many of whom, all of whom frankly had been with us since either 1988 or 1992, we haven't raised much money. We haven't raised money, frankly, since 2002. So it's been a very long time since we've gone back out to the market. And those people have been with us. They've been not only tolerant but patient and we felt it was appropriate to give them a capital event. So we did that. Since then, our portfolio has grown. Last year alone, we grew by 40% and that includes the wide variety of care types along the continuum. So we are an owner operator. We manage on a third party basis. In some limited circumstances, we lease several properties and the majority of our portfolio is owned.
Beth Mace:Okay. So let me go back to... You said that your leadership style had changed and evolve. So we have a lot of listeners on this call. We'll probably be really interested to hear that, especially as a woman. So how has your leadership style changed?
Lynne Katzmann:Let me see if I can put it succinctly into words, Beth, which is generally difficult for me in the best of circumstances. I think I have become more confident and more patient. What has remained the same is my level of passion for innovating in the industry and creating a better environment and life for those people we serve. As a woman... The world has changed a lot and not so much as a woman in leadership. It's rewarding to now go to a conference and feel that you're not the only woman who is at a large capital related conference. It's also good to see that in our industry, which serves predominantly women, I'm not the only woman CEO and I am thrilled that there are so many large companies that are now led by women. So what does that mean? I think that provides, greater opportunity for women to move up within the ranks of higher level management. I think that's extremely important. I think myself... Me as a leader and women in general bring a good understanding of relationship building. Which has become key to success in managing people, human capital, as well as, a changing customer base. And I'm sure we can talk more about that later, but that's...
Beth Mace:Yeah, no, that's a really good answer. I think also in leadership role, you must have a really strong team of people that you trust and you're willing to like delegate. So I know in some cases, leaders have a hard time delegating or trusting others to take care and believing in what their staff can do. So, would you say that's the case?
Lynne Katzmann:It is the case and most of... So we are a small... We call ourselves small and scrappy. We're fairly entrepreneurial and what we do. There aren't a lot of us that are... We call it the corporate leadership team level. There are seven of us, including myself, and most of us have been here at Juniper for more than two decades. There's only one of us who has been here for total of eight years. She was, as she would say, adopted when we bought her community. So the leadership at Juniper has very, very long tenure and it's reflective in our culture, the deep respect we have and our ability to collaborate. And I think that has been very important to not only building a strong culture, but also to our ability to weather the many storms that our industry has experienced in the last 35 years. So, yeah, and my ability to delegate, I have to say it's gotten a lot better. My team would tell you that. I will say that by the time COVID arrived, I was spending most of my time as you well know out and about, in the industry and enjoying that. Once COVID hit the responsibility I had as a CEO and a president, I felt was to my team and to my residents. And so like all of us, I not only stayed at home and hunkered down, but I went back to a very different leadership role. Which involved bringing together a large group of people and if necessary, making very difficult decisions like the ones we did on testing and vaccination.
Beth Mace:Yep, absolutely. So, I mean, I would say for me in aha moment from what you just said was just the importance of a team, the importance of trust in a team and the importance of agility, right? That certainly... You proved beyond a shadow of a doubt of the importance of agility during COVID. So I think of you as one of the most passionate and revolutionary senior leaders in our entire industry, and tell us a little bit for our listeners of your view about the integration of healthcare and senior living, and more specifically your Connect for Life model and its involvement in the Medicare advantage plans launched by the perennial consortium.
Lynne Katzmann:Sure. I'm happy to do that. And thank you for that opportunity. You know, what we do in senior housing is work with a group of people, older adults who wanna live their best life, but typically have a host of different chronic illnesses and also some functional limitations, some challenges. And that's one of the primary reasons they come to us. When the affordable care act was passed in 2010, one of the provisions of that, act was to create value-based care; to inform systems that could be integrated in order to manage care transitions. And I was asked about care transitions, and frankly, I didn't know much about it. So I went out to learn. And what I realized is really the heart of what we have done over the last five to seven years with Connect for Life. And it's very simple. Care transitions is about understanding the people you serve and making sure that you can bring together the services and providers they need to best manage their chronic conditions and their functional challenges, so they don't need to use a higher level of service or care. So simple terms, it means doing things like assessments, like developing interdisciplinary care plans, like having care conferences, like including ancillary providers in your team and circles and individual. It's about monitoring changes on a 24/7 basis. All of which Beth, we in senior living have done forever. It's nothing new, right? It's absolutely nothing new. So Connect for Life originally started as a care transitions model; bringing together all of these different pieces, using technology to create a single playbook where all of the play could encircle the resident and make decisions collaboratively because they had the ability to have all of the information about that resident at their fingertips. And they had the ability to communicate real time. We added an advocate, we call a medical concierge, to make sure that the technology functioned that people were speaking to one another, and that the individual who we were serving had someone that they could call, that they could tap into. And the same was true for our team members. And that became the basis for Connect for Life. So Connect for Life is an integrated care management program that brings together a series of ancillary services; including primary care onsite into the building. And then uses technology and a human being to make sure that everyone is connected to improve early intervention and maintain health for an older adult. And those are all things we've always done in senior living. What we did is changed some of the workflows, identify different roles for some of the people in our wellness departments, move some people around and use technology as that common playbook, that platform to share both data and communication.
Beth Mace:And is that information shared within Juniper or is it shared within and outside of Juniper,
Lynne Katzmann:It's shared with all of the ancillary service providers who are preferred providers to a community and serve the residents who choose them in that community. So it is not information that is kept only within Juniper, but it has access to, for example, the primary care practitioner who, by the way, not only sees the information, but has to input information because they have an important role in making sure that everything functions. So Connect for Life started managing individuals. And what we found is when people went to the hospital and we had a collective record, everyone at the hospital really liked it. They were kind of amazed. They said,"Oh, we never get an up to date MAR from anybody." We don't really know who the primary care practitioner is in the days of hospitalists. And I'm exaggerating to make the point, Beth, obviously that happens in many cases, but we were able to give them real time information and bring together that team so that the hospital became part of that discussion. When someone was discharged from the hospital, we're better able to take them back and make sure that our 30 day readmission rate was nonexistent at best. Obviously it had... In some cases, we did have a 30 day readmission rate, but it was spectacularly low relative to everything else. So then you might say, how do we know that was the case? Well, all of a sudden we realized something different was happening. Our length of stay increased. Our care charges is a percent of total revenue went up and we had very happy hospital providers because we weren't sending people back post discharge the way that many other providers were.
Beth Mace:So your rehospitalization rate was down?
Lynne Katzmann:Oh god, our rehospitalization... So when we did the study, the punchline is our readmission rate was 80% lower than for a similar population living in the community.
Beth Mace:Wow.
Lynne Katzmann:And our hospitalization rate was 50% lower.
Beth Mace:Wow.
Lynne Katzmann:Now those are extraordinary numbers. Why did we think they were correct? Because we didn't do so well on emergency department use. We hadn't figured that one out yet. And that rate was, 15% lower, so lower, but in a much smaller number, which gave us some comfort that the data were actually correct. Yeah.
Beth Mace:So they weren't cooked?
Lynne Katzmann:Right. You gotta have a smell test. It's very important.
Beth Mace:Yep.
Lynne Katzmann:So our next step was to say,"Wow, we're really making a difference." And while Juniper did put in place different workflows and move things around, and we did have the technology underpinnings that not everybody had at that point taken advantage of. What we were doing, we believed, for things that everyone in the industry could do. We then said,"Gee, who's getting all of these savings attributable to our good work?" And we realized Medicare...
Beth Mace:Ah.
Lynne Katzmann:... Was collecting the savings. Not us not. We had no access as a senior housing provider. You have direct access to public dollars. Medicare dollars are public or semi public dollars, yes. And so we said,"Well, how can we do that?" And that was really the basis for why we started Perennial. It was a way to say to people, look what senior housing does. We're extreme. We've always done care transitions. Some of us do it better than others, but we've always done it. It's part of our regulated... It's what we have to do, by regulation in almost every state. So if that's the case and we're providing and we're doing it better and now benefiting hospitals and payers, why can't we get a piece of it?
Beth Mace:Exactly. Right?
Lynne Katzmann:Why can't we get paid for the good work we're doing? Because the people we serve are sicker and sicker and not all of them have the resources they need to cover the cost of services that we provide.
Beth Mace:So for those listening, the opportunity for you, as a senior housing operator for revenue, would be that you're increasing the length of stay for your residents. If they go out or they come back that much faster. And then there's also an opportunity to get a piece of their overall savings within the value added programs.
Lynne Katzmann:Correct. There's actually three ways of increasing what you get; again, it's length of stay, it's ancillary charges. If you are able to manage care better, you can enable people to stay longer when they stay longer, they typically have additional services they need that you can charge for. So length of stay care charges. And then lastly, a revenue source through a managed care organization or a payer.
Beth Mace:Right. So I know you've been really successful at that. And you were pioneering in that. So thank you for sharing that and for, you know, helping the industry and being a pioneer in this way. So, is there a step to try to bring this out to a broader organization or broader use in the industry? Sort of the plans that you've put in place?
Lynne Katzmann:Yeah. You know, Perennial has a number of options where people can join, but essentially the one point I would make is there are... Perennial is one example of an operator owned plan.
Beth Mace:When you say plan, can you be more specific?
Lynne Katzmann:Sure. A Medicare advantage plan and specifically what's known as a special needs plan.
Beth Mace:An ISNP.
Lynne Katzmann:An ISNP but there... In addition to ISNPs there's something known as an IESNP, an institutional equivalent special needs plan. Often people who are in memory care, on the AL side, will often qualify under the ISNP regulations. There's also something called a CSNP, which is a chronic condition special needs plan, and a DSNP, which is largely for dual eligibles.
Beth Mace:Understood. Okay, great.
Lynne Katzmann:So all of those things are options for people under Medicare Advantage. Since Juniper started Perennial together with several other operators. We... There were new options that are available. You can work with a variety of other payers; either those that are insurance companies or those that contract with insurance companies. It's a little more... You've got a little bit more work to do when you do that, but it's typically, another vehicle that some people will choose as a way to access the value that we create.
Beth Mace:Great. Okay. So now I'm gonna go to those truths and those lies that we talked about at the beginning. So is it true or is it not true that you helped start an IPO model managed care organization, which today is the largest plan in Puerto Rico?
Lynne Katzmann:Yes, it is true. So fun.
Beth Mace:So I'm not surprised given what you're doing right now at Juniper, that that would all be within your wheelhouse, so to speak... That you would've done that. So that's awesome.
Lynne Katzmann:It's fun. Being in Puerto Rico was the most fun.
Beth Mace:Yeah. I'm sure. Who doesn't like that? I agree. So now we're gonna switch a little bit to more about your personal story.
Lynne Katzmann:Sure.
Beth Mace:So tell us about your career path and any lessons that you learned that you might wanna share with the younger people that might be listening to this call. Any tricks of the trade along the way?
Lynne Katzmann:So a long time ago, I was asked by the junior league of Houston to come talk to women, a group of women. And I was asked a similar question, and I'm going to give you an answer that is similar to one I gave then. You know, I think my advice was be passionate about what you do. There are three Ps: passion, planning and perseverance. Being successful in an entrepreneurial endeavor, unless you're very lucky, is hard. It takes, a different type of... You are where the buck stops. And whether you think that going into it or not, it's a different world when all decisions ultimately end with you, both good and bad.
Beth Mace:Yep. Yep.
Lynne Katzmann:So in that case, really caring about what you do makes a huge difference. And there's a..."Good to Great." I don't know if you've ever seen the book"Good to Great."
Beth Mace:I have.
Lynne Katzmann:In that book, they talk about the hedgehog concept. And one of the things they say is you need to know what you're passionate about. Not only do you need to know, but you need to hold that close and that needs to be a constant guiding light, a reference point. So passion is one; knowing what you're passionate about, maintaining that passion over time, I think is critical for leadership planning. And planning has changed over time. We used to think about planning in the old world of strategic planning. You did a five year plan. I think one of the things we've learned in the couple of years is that planning requires, as you put it before, more agility, Beth. These days, one needs to be thoughtful. One needs to use all of the resources available, and one needs to be current in one's thinking. And I think in senior housing, that means understanding the consumer of today and the consumer of tomorrow, just as one example. And the last thing I would say... The third piece. So we've got passion planning and the third thing is perseverance. None of this is easy.
Beth Mace:No.
Lynne Katzmann:And, you know, I think everyone can relate to the need for perseverance and resilience over the last couple of years. But when you start a company there were enumerable things which come up, which you could have never planned for, even if you tried. And the key is being able to get through them positively to realize... To learn from your mistakes, and to find solutions to those problems. And that's what perseverance is about. So those are the three Ps. That's... Those are the lessons I've learned. I think I put them into writing, but I find I practice them every single day.
Beth Mace:So I would add one, but I would make it a"b." And I would put that for"brilliance." In terms of... You shine, you you're brilliant. You're smart. You're creative. In fact, I don't know if our audience would know that you actually earned a PhD from London School of Economics number of years ago. You had a thesis that was focused on Germany. German sickness... Insurance program. So yeah, you've never been a slacker put it that way.
Lynne Katzmann:No, but that was all about perseverance. Don't ask how many years it took me to get my degree.
Beth Mace:That's okay. That's okay."B" for brilliance on that one. So real briefly, cuz we're gonna have to wrap up in a little bit here.
Lynne Katzmann:Sure.
Beth Mace:So why senior housing? What made you passionate about senior housing?
Lynne Katzmann:Well, it's interesting. When I finished undergrad and I went abroad. When you go to a British school, you study problems of then a discipline and I knew I wanted to help people and I chose healthcare over education and applied my thinking to that problem from an economic perspective and other perspectives to do the work that I did. And so being in a helping profession was right there for me. And I think the rest of the story is about opportunity and I was in the right place at the right time. I was working on Medicare demonstration projects. I helped write a state health plan for Oregon back in the early the eighties after I finished in Europe. And, then I happened to go to a dinner party and I met the most incredible individual and his family: who the next day said,"Hey, you know, healthcare, I'm a geologist. Why don't you come to New York and help me run a public company?"
Beth Mace:Oh geez, there you go.
Lynne Katzmann:That's... So opportunity knocked and I follow. That company happened to be in retirement communities and skilled nursing. And so that's how I got my start in the business.
Beth Mace:That's interesting. So, you know, I know that labor is a huge issue for most of us in this industry. So I'm just listening to you, you know, I think for a young person trying to figure out what they wanna do with their life. I mean, you've sort of exemplified, you know, what the opportunity is, their ability to have passion and commitment and sort of love the work that you're doing. So, I think that's really important for our listeners to think about. You know, when we're trying to figure out culture an meaning for people in their life that, you know, sort of the three Ps that you spoke about, actually, would be really helpful in trying to sort of set your sites if you're trying to figure out a career path. So thank you for that.
Lynne Katzmann:And I think passion and purpose. Purpose is a big word in our industry now in terms of our... The consumer of the older adult. Everybody's talking about those people having purpose, we all need purpose. It's not just our residents, but it's also our team members. And together as a community, when you're passionate about a particular purpose, it makes a difference. So.
Beth Mace:Okay. So Lynne, we only have a few minutes here. So I wanna do a real quick sort of Round Robin, almost really quick answers for you. So"Forgotten Middle" that's a study that NIC did a number of years ago, and how focusing really on housing for middle income seniors. Is that something that Juniper is targeting that group of middle income seniors?
Lynne Katzmann:We've always done middle market, to some degree. I will say Perennial Advantage's is middle market strategy.
Beth Mace:Okay.
Lynne Katzmann:For us, it's freeing up dollars to offset some of the costs that the middle market can't do. Can't pay for.
Beth Mace:Active adult. Are you focusing on active adult? Sort of the new buzzword. The new, sort of grouping of care and housing options for older Americans? Are you working on that active adult?
Lynne Katzmann:We are just starting to think about it. We're not actively working on it. But I will tell you that it's part of a continuum. As you know, we've been all across the continuum of age segregated real estate. And, I wouldn't be surprised if we added that to our portfolio at some point.
Beth Mace:Technology: through the pandemic, looking into the future. I know you're really into technology. You study a lot of it. Is there one specific piece of technology that you think, is gonna help to shape the industry in the next few years?
Lynne Katzmann:I think technology middleware, which integrates data and software is going to revolutionize how we do business. I will say that in my mind technology digital, the way we work. Technology is our new operating platform. It really is the foundation for communication and data, and will continue to be. In order for that to function, you need to have integration of people, of workflow, of tasks. You need interoperability and that's what the middleware, products are aiming to do.
Beth Mace:Okay. Largest challenge facing our industry right now: labor or something else?
Lynne Katzmann:People's inability to accept change.
Beth Mace:Oh, okay. What do you mean by that?
Lynne Katzmann:Well, you know, I think that our world is changing dramatically and I, again, I'll speak for myself. Over the last couple of years, the level of uncertainty that we feel from COVID and the variety of surges of COVID. Climate change. Now we experience that directly at the end of the year with a massive fire in Boulder County, Colorado, where we had to very quickly evacuate a memory care community. That's going to continue to grow. And now we have war Ukraine. What next?
Beth Mace:I know.
Lynne Katzmann:You know? I wrote an article recently and I harken back to a song that comes out of my Jewish tradition. It's called dayenu:"It would've been enough." So all of this would've been enough. So with that level of uncertainty, I think it's hard for people to know which direction to go. But in my view is that we have to accept change. We have to work with change. And probably the most difficult thing we have to do is learn to manage change on a continuous basis.
Beth Mace:Yeah. Agility again, there's that word? Okay. And one innovative way... I think maybe you talked about that with your middleware, one innovative way to move the industry forward.
Lynne Katzmann:Yeah. So I'm thinking about something Beth, and this isn't fully baked, so bear with me. But you think a lot about capital and NIC is about bringing together capital with real estate to better serve older adults. I'm thinking about three different types of capital these days. I'm thinking about the traditional capital economics money. I'm thinking about human capital, and I'm also thinking about social capital. And by that I mean connectedness, cooperation, the networks and attitudes that promote coordination and collaboration that will enable us to move forward. So, to me, that's an interesting of thinking about our world and about how leaders need to consider the different challenges and opportunities in front of them
Beth Mace:In social capital would be, in our industry specifically, it would be relating to the worker as well as relating to the residents that live there, right. The integration of those groups.
Lynne Katzmann:Yes. And it's more than that. If you think about intergenerational social capital, if you think about integrating with the community. So if you look at a number of the new developments around the country, think about what they're doing. They're placing themselves in areas where age segregated housing is part of a broader community and opening their doors. So I think there's a number of ways of looking at that social component. It's the integration and the connectedness of people and systems.
Beth Mace:So interesting. Well, I could talk to you for quite a long time, as you know, as we have sometimes done, but I do wanna wrap up in a minute. So in our two truths and a lie, we had also said that you have a gender based board. Is that really... Since you're founding? A gender based board, that's such a, such a concept.
Lynne Katzmann:Yeah. And when we have more time and another glass of wine, Beth, I'll tell you how we ended up with that when we were forming the company, cuz it's a funny story. But yes, we do have a gender based board. We always have and if I'm around, we always will.
Beth Mace:That's fantastic. That's fantastic. Okay. And then are you a CPA?
Lynne Katzmann:God, no.
Beth Mace:God, no. There we have it. All right. Well this is great. Is there anything you wanna wrap up with to share with our audience on? I know, you've touched on so many topics, but is there anything in particular that we haven't touched on that you'd like to share?
Lynne Katzmann:Yeah, I think these times have been tough, but there's great hope and opportunity. I am 65 this year and I can surely say that I'm looking forward to a very different thing... A different way of living as I spend the next 30, some odd years, I hope, of my life living. I trust it will be different. And I believe that we have the opportunity to shape that for ourselves, for the current generation that uses our services and for the next generations. The time is now, the opportunity is here and I'm really excited about that.
Beth Mace:Well, your enthusiasm is always contagious, so thanks for that. But I also did wanna thank you, cuz for those who don't know Lynne's on our board at NIC, and you put a lot of time into our board with lots of great idea. I do wanna thank you for that as well. And thank you for your time today and I'll see you soon.
Lynne Katzmann:Thank you, Beth.
Beth Mace:Okay.
Lynne Katzmann:This is great. Take care.
Beth Mace:Thank you, Lynne. Bye.