by Bobby Anderson
Staff Writer

For nearly 35 years now Sheila Swearingen has been involved in advocacy.
And for the last 15 years the president of the League of Women Voters of Oklahoma has been deeply involved in helping Oklahomans take full advantage of one of their most precious civil rights – the right to vote.
“I’m very interested in advocacy and getting more people involved in what happens after voting to be honest,” Swearingen said. “I think it’s incredibly important for people to get themselves registered and vote but that’s not the end of it. As citizens we really do, in a democracy, say that we the people are the ones upon who the government rests.”
As Oklahomans get ready to vote in the coming days, Swearingen wants to make sure everyone has the information they need before they head to the polls.
PLUGGED IN
MSNBC, Fox News, NPR, CNN, and hundreds more online – there’s no shortage of media outlets from which to receive information. Twenty-four hours a day, seven days a week voters are bombarded with a non-stop barrage of political information, covering candidates’ every single move.
While the access to information may be unprecedented, Swearingen says it’s not always a good thing.
“It comes back to the individual to take it upon themselves to get non-partisan information,” Swearingen said. “I think people are plugged in but the problem with being plugged in all day is not pulling back and getting the overview, not listening to both sides of the issue and not being able to discern. They may be plugged in and often the media, whether you’re listening to NPR or Fox News it’s appealing to our emotions. I think we need to be using some logic and think deeply about the issues when we go vote.”
GET INFORMED, GO VOTE
The League of Women Voters provides a wealth of information online at www.lwvok.org as well as on Facebook.
The League of Women Voters never supports or opposes any particular candidate.
The message simply is always be informed and exercise your right to vote.
“Take any opportunity get information that is nonpartisan and unbiased,” Swearingen said.
To that end, the League was part of a broad coalition that produced the Oklahoma Voter Guide which is available at libraries across the state.
Online you can go to www.vote411.org fill in your address and it will automatically pull up all the races that will appear on your ballot down to state representative.
The League of Women Voters has chapters in Lawton, Tulsa, Stillwater, Norman and Bartlesville. The group is also in the process of reforming the Oklahoma City Chapter.
“In the Oklahoma City area we have members who are my age, and I’m definitely AARP generation, and we also have millennials,” she said. “What we’re finding is those groups can work really well together if they listen and find out that sometimes they’re on the same page about issues but they may have different ways about communicating those issues.”
Swearingen was recently trained as a precinct official.
“One of the interesting things that was reaffirmed is that you don’t have to vote every single race,” Swearingen said. “If you have a strong preference for a candidate running for county commissioner and you just can’t make up your mind who you want to choose to be the next president you don’t have to vote for president but you can vote for county commissioner.”
“We have a wonderful system in Oklahoma. Our scanners can scan whatever races you choose to vote in. You don’t have to vote the complete ballot. You can pick and choose.”
Volunteers are always needed in helping across the 77 counties and municipalities in getting ballot information. You can go online to the group’s website to learn more.
Starting November 9 Swearingen said the attention will turn to the 2017 legislative session and what issues will likely appear.
Social events are also scheduled throughout the year as well as candidate and issue forums.
Beginning in January school board elections will come into focus and the League will begin pursuing candidate forums.
“We think that school boards are just as important, and in some cases more important than whose going to Oklahoma City,” Swearingen said.
And no matter what party you belong to or whom you support, Swearingen says it’s important to do your part in keeping America great.

Eric Olsen Executive Director HELPS nonprofit law firm. www.helpsishere.org

Sometimes seniors with lower incomes find themselves owing past due income taxes. Taxes they can’t afford to pay. As the Executive Director of HELPS, a 501 c nonprofit law firm that assist seniors with debt problems, I regularly talk with seniors distressed about past due taxes owed. Seniors want to pay their taxes, but sometimes there simply is insufficient income. Seniors need to know that laws and regulations have been enacted to assist persons with lower incomes to protect them from tax collection.
Most seniors don’t understand that social security, pensions, VA benefits and other forms of retirement income are protected by federal law. This income cannot be garnished for old debts such as credit cards or past due loans. An exception is the IRS occasionally will garnish 15% of a senior’s social security for past due taxes. However this will not happen without the senior being first notified. Steps can be taken to prevent a garnishment by the IRS.
For seniors that can afford to pay their taxes if the sum is less than $50,000 they can arrange for monthly payments over five years almost automatically. Lower income seniors can often be placed on uncollectable status with the IRS and pay nothing. An existing garnishment by the IRS can even be stopped. Seniors can apply for uncollectable status with the IRS over the phone or online. The IRS website provides budget guidelines to qualify for uncollectable status. These budget guidelines are not normally volunteered when applying for uncollectable status with the IRS. If you say you can pay something each month, the IRS will gladly take your money. Many lower income seniors underestimate their needs and pay a monthly payment they can’t afford to the IRS because they think they have to pay something. When according to IRS budget guidelines they could pay nothing.
Almost all seniors don’t realize that their local state tax collector cannot garnish social security and retirement income for past due state income taxes. Even when this money is deposited into a bank account, as long as it is traceable to social security and pension income it is exempt. If an account is garnished a claim of exemption can be filed for the money to be returned. State taxing agencies unfortunately will never tell seniors their income is protected. Instead they often will badger and intimidate in order to collect from seniors who don’t know their rights. If a state tax collector calls, a lower income senior can simply advise his income is federally protected social security, pension, VA benefits, or disability and they can’t afford to pay the tax.
Sometimes seniors are worried when they receive a “tax lien.” Language in the written lien notice makes them worry they are going to lose their home, car and other possessions. Tax collectors are not in the business of selling peoples homes. It just doesn’t happen in real life. Many seniors have little or no equity in a home for a lien to attach anyway. The taxing agency files the lien and hopes the tax gets paid if and when the home is sold. Tax collectors do not go after personal possessions, especially persons with lower incomes.
Bankruptcy is generally unnecessary for lower income seniors because their income is already protected. However taxes often can be eliminated through bankruptcy. The general rule is that the tax must be over three years old and have been assessed for at least two years in order to be eliminated through bankruptcy.
Certainly we should strive to pay our taxes. However laws and procedures are in place protecting lower income and poor seniors from tax collection. America wants seniors to have the food and medicines they need. If there is a choice between basics and paying taxes, seniors can take steps to stop tax collection action. Seniors income is in almost all instances protected and available for their needs.

Tis the season for toy shopping, but Easter Seals Oklahoma has a request for special toys for their boys and girls. Therapeutic and sensory toys help students with disabilities work on hand-eye coordination, fine and gross motor skills and social interaction. It can also be used to help increase attention and focus during instructional time.
“Teaching a lesson while a child’s hand is actively engaged in a fidget has been shown to result in more information being retained by the child than if the same lesson were taught without the sensory element”, says Mia Dianda, Director of Medical Rehabilitation.
Easter Seals Oklahoma is accepting donations of therapeutic toys such as koosh balls, light up toys, and fidgets. Social and turn taking improvement items are also needed like: Twister, Chutes and Ladders, Mouse Trap, Head-band, toy cars, super heroes, baby dolls, and related items. Donations may be brought to 701 N.E. 13th Street, Oklahoma City, Ok 73104 between the hours of 8:00 a.m. -5:00 p.m. Monday through Friday or donate by calling 405-239-2525.
The Medical Rehabilitation Program at Easter Seals Oklahoma helps individuals with disabilities gain greater independence some thought to be unachievable. It is our goal to empower children with atypical development by helping to build their self-esteem and self-efficacy through therapy services.
For more than 90 years, Easter Seals Oklahoma has provided services to children and adults with disabilities and other special needs and support to their families. Services include an early learning and inclusion academy, adult day health center, medical rehabilitation, and financial assistance. For more information, please visit www.eastersealsok.org.

by Bobby Anderson, Staff Writer

Growing up in the tiny borough of Hummelstown, Pennsylvania, Bruce Heikes would travel most weekends and summers to nearby Hershey around midnight to don an apron.
At age 15, he worked for Louis Memmi, who owned G. Memmi and Sons Bakery.
“Man you roll down the window on the way there and you can just smell the chocolate,” Heikes said. “It’s overpowering it smells so good.”
It was in the shadow of the Hershey’s Chocolate empire that Heikes’ career began to rise.
More than 40 years later, Heikes continues to pour his artistry and love for what he does into everything he bakes at Johnnie’s Sweet Creations in Oklahoma City.
The shop at 8419 S Western is not only Heikes’ livelihood, it’s his life.
It’s easy to see when children walk into the shop and a big smile spreads across his face.
“Who wants a cookie?,” he says, with a grin that’s always returned with one just as big.
IN IT FOR THE DOUGH
Growing up, fresh-baked goods were the norm.
The bakery where Heikes learned to bake bread had a delivery truck that made daily rounds to all the supermarkets.
There were no plastic-wrapped, preservative-laden loaves that could sit on store shelves for weeks at a time.
“You’ve got to worry when you take a loaf of bread you just bought and put it on top of the refrigerator where the heat comes up from the back and it keeps for a month,” Heikes said. “They’ve got so many preservatives in there you could die and still keep going for weeks.”
His brother-in-law brought Heikes and his brother, Ron, to Oklahoma to work for Skaggs Albertson’s.
A move to Buy For Less as a bakery and deli manager followed as did a stint in Ingrid’s Kitchen.
He eventually became a food broker for a company that sold bakery products to the warehouse that sells to many Oklahoma grocery stores.
It was a Monday through Friday job, something Heikes never had.
But for some strange reason, he wanted to own a bakery.
Heikes knew the previous owner of Johnnie’s Sweet Creations, who purchased the store in 2000. An illness forced her to put the business up for sale in 2012.
She called up Heikes and he was sold.
A few weeks later so was the business.
Now he makes less money, works Monday through Saturday – Sundays, too now through Christmas this time of year.
“Sometimes I think, why do I do this?,” Heikes said. “But mostly there is so much pleasure in making something good for these people and when they taste it and their eyes roll in their head … that stuff makes it all worthwhile. It really does.”
A RISING BUSINESS
Heikes’ daughters work at the store. His brother’s daughter works there. Both his wife and Ron’s wife – who are registered nurses – come in just before Christmas or Valentine’s Day when the store really needs the extra hands.
“We get such huge orders and I don’t want to turn them down,” Heikes said. “I don’t want to turn them down because of the money but I also don’t want to turn them down because I want to be there for them.”
With more than 40 years manning the ovens Heikes can take a loaf of bread in his hands, give it a squeeze and a quick smell and tell you what’s right – or not.
It’s why his employees come to him when something’s not quite right.
It’s truly an art.
That’s one reason he cringes every time he walks past a grocery store “bakery” aisle.
“I used to sell that stuff as a broker. Those cakes come in a box. They have a year shelf life and all of the icing comes in a bucket,” Heikes said.
Every week Johnnie’s makes six to seven 55-gallon barrels of butter creme icing from scratch.
“I probably go through at least 100 sheet cakes and just multitudes of eight-inch rounds and cutouts – not to mention the weddings,” Heikes said.
Heike’s favorite sweet in the store is his butter pecan brownies. He’s made them for 20 years at home.
“I could not show up to Thanksgiving or Christmas without bringing those butter pecan brownies,” he said with a laugh. “It’s a real simple recipe but it’s so rich and so good and it’s unique. You just don’t find them any other place.”
Ten years from now Heikes will be 67.
He hopes his son, Justin, is working the ovens.
“I hope I could bring him in here – maybe even one of my other sons – and teach him the legacy of doing this and carry this on,” said Heikes, who has eight children.
But whatever the future holds, Heikes doesn’t see himself venturing too far from the ovens.
After all, who doesn’t want a cookie?

The Oklahoma Insurance Department is joining forces to spread a life-saving message to drivers: “Move over. It’s the law.” The message is part of an initiative by the Oklahoma Traffic Incident Management Steering (TIMS) Coalition. The Coalition also includes representatives from the Oklahoma Highway Patrol, Oklahoma Department of Transportation, Oklahoma Sheriffs Association, Oklahoma Emergency Management and many more.
“As the holidays approach and more people will be on the road, we’re asking Oklahoma drivers to be more mindful behind the wheel,” said Oklahoma Insurance Commissioner John D. Doak. “Not only is moving over the law, it will help save the lives of first responders and lower the number of costly traffic delays.”
According to the National Highway Traffic Safety Administration, 52 law enforcement officers were killed in traffic-related incidents last year. Oklahoma Highway Patrol Trooper Nicholas Dees was hit and killed last year along I-40. His mother is featured in a new public service announcement which began airing this month. It can also be viewed here.
“Half of me died because of one man that did not move over for emergency vehicles,” said Shelley Russell, Dees’ mother.
Oklahoma’s Move Over law requires drivers approaching a parked emergency vehicle with flashing lights, including wreckers, to move over to the next lane. If the driver cannot move over, he or she is required to slow down. Troopers suggest drivers reduce speed to 15-20 mph or slower. The penalty for failing to slow down or change lanes is a ticket with a fine of more than $200.
Another benefit of drivers abiding by the Move Over law is a reduction in the number of costly traffic delays. According to the Texas Transportation Institute, for each hour a vehicle is stuck in traffic $21 is wasted per vehicle in time and fuel.
One way to ease the burden of traffic is for drivers to move over if they are involved in a non-injury car accident. This allows drivers to safely exchange insurance information and not block the flow of traffic.
“Many drivers seem to think that moving over is just an optional courtesy when they see flashing lights or have a minor wreck,” Doak said. “It’s not optional. Move over. It’s the law.”

Whoever conceived of the idea for Norman Forward is to be commended. The Quality of Life projects are certainly important to our growing city. But at the same time, we should take time to reflect on Norman, backward though the years to the work accomplished by citizens who built our thriving community.
We need to show our appreciation to those citizens who got up every morning, went to work and paid their taxes to build roads, streets, schools, parks, a hospital and more that we use everyday. Many of those same people are retired, living in Norman, and they voted for Norman Forward with the expectation of a new senior center with space available to offer more activities than can be provided in the current center.
As Norman has grown, working people adapted to many changes in Norman, along with changes within their own families. Some lost spouses, family and friends, and with that, some lost badly needed contacts with people. A senior citizens’ center would be a perfect place to spend a few hours, meet new people, socialize and ward off depression which is prevalent in older citizens.
A forward-looking Norman should say thank you to earlier residents by opening the doors to a new center and making an extreme effort to contact and invite people to take part in the activities. Also, for their health’s sake, we must motivate these citizens to make new friends and remain vibrant.
Since recreation is the primary reason for the Quality of Life NF projects for younger people, city planners should extend the same criteria to seniors. Seniors need to move, too. Many NF projects will be delayed for the next 15 years, but the senior citizens’ project should not be one of them.
Nadine Jewell, Norman

Photography and Text by Terry “Travels with Terry” Zinn  t4z@aol.com

Just when you think you’ve seen it all, and can’t be awed by renown Impressionist painters, comes the Kimbell’s Claude Monet the Early Years: 1858 – 1872.
You will be illuminated to find out that Monet, mostly known for his broad strokes of mixing colors to produce a shimmering visual effect, started out as an accomplished realistic painter. Up until the 1870’s Monet produced a body of work comparable to the best of his artistic times, even though many were rejected at first evaluation by the prestigious Paris Salon.
Most affective is the The Magpie (1868-69) where in an expansive rural snow scape on a canvas of 35 by 52 inches, Monet captures our attention and imagination not only in the frosty landscape but by the technical master class with the many shades of white. Off center a back lit black magpie perches on the top rung of a primitive wooden gate. This lonely image is haunting yet peaceful. From the collection of the Musee d’Orsay, it’s only one of the many paintings pulled together from a variety of collections for this extraordinary exhibition.
Sailboats on the Seine at Petit-Gennevilliers (1874), exhibits Monet’s full fledge Impressionism with the dancing water reflections of sailboats under a wistful cloud filled sky. Other water reflections examples can be seen in Houses on the Bank of the River Zoan (1871-72), and Regatta at Argenteuil (1872).
An added delight is the free with admission hand held audio and visual self-tour appliance. The traditional numbers that coordinates with the art, is enhanced here with a visual image on your device. Not only for the painting you are currently viewing but for visual comparisons to other works of art not on display. Once such educational comparison is with Monet’s, Still Life with Flowers and Fruit (1869), compared to Renoir painting the same still life. It may not be known that Monet and Renoir occasionally painted together with plein air subjects. The two floral bouquets are easily and fascinating compared in this exhibition.
Be sure and take your time in the galleries to imprint on you mind the treasure of art you are among. A number of benches are placed throughout the exhibition giving you time to sit, view, spin, view and spin again, enabling you to take in, compare and imprint in your mind this once in a lifetime experience.
You may also want to stroll through the Kimbell’s main gallery of their permanent collection with samples of many of arts greatest artists. And if you visit the Museum Store adjacent to the Monet exhibit, say hello for me to congenial sales assistant, Alice.
This limited edition exhibition at Fort Worth’s Kimbell Art Museum is on display until January 29th. Admission for Seniors is $16 and Adults for $18 with
Tuesday’s offering half price for all. Visit more information at: kimbellart.org

Mr. Terry Zinn – Travel Editor
Past President: International Food Wine and Travel Writers Association
http://realtraveladventures.com/author/zinn/
www.new.okveterannews.com – www.martinitravels.com

by Bobby Anderson, Staff Writer

More than two years of work and planning by multiple AllianceHealth Midwest departments culminated recently in a prestigious accolade that will benefit patients throughout the metro.
For the first time, the hospital received full Chest Pain Center with PCI (Percutaneous Coronary Intervention) Accreditation from the Society of Cardiovascular Patient Care.
To receive accreditation, AllianceHealth Midwest demonstrated its expertise and commitment to quality patient care by meeting or exceeding a wide set of stringent criteria and completing on-site evaluation by a SCPC review team.
AllianceHealth Midwest is the only hospital in the state of Oklahoma to receive this level of accreditation.
“This accreditation is another large step in our commitment to providing superior emergency and cardiac care to the residents of Midwest City and Eastern Oklahoma County” said Damon Brown, CEO, AllianceHealth Midwest. “This accreditation was made possible because of the dedicated work and commitment of a multi-disciplinary team that included employees, physicians and paramedics.”
Cardiology Director and Chest Pain Coordinator Mark Macklin, RN, BSN has spent the last 12 of his 22 years in nursing in cardiac care after an emergency medicine and trauma background.
“The most important reason to pursue this is it’s the right thing to do for patient care,” Macklin said. “It’s a standardized system for evaluating and treating patients from the lowest risk patients to the care and treatment of the STEMI patient.”
“It encompasses the entire gamut of cardiology and chest pain.”
It is estimated that over 60% of all cardiac arrests are directly caused from an acute myocardial infarction.
The addition of the Resuscitation designation to Chest Pain Center with PCI accreditation enhances outcomes because the facility will have initiated early strategies such as early recognition, CPR and defibrillation, early intervention with Primary PCI simultaneously with post arrest hypothermia treatment.
“It standardized our practice, making sure we used evidence-based practice, best practice protocols and we’re all doing it the same way, every time with no deviation,” said Amy Baden, RN, BSN, MBA, and AllianceHealth’s network director of cardiology services. “It’s our roadmap that every patient will be given the exact same care no matter who their cardiologist is.”
Baden said that resuscitation element is one all employees are trained in.
“Any type of employee is also educated in the signs and symptoms of an early heart attack,” Baden said. “From a kitchen worker to a nurse on the floor – even the valets – have all been educated. It’s a multi-faceted education process.”
That education has been introduced to the surrounding communities. AllianceHealth Oklahoma, in partnership with the American Heart Association, donated CPR kits to high schools throughout Oklahoma.
Locally, AllianceHealth Midwest donated one to the Mid-Del School District and one to the Choctaw school district.
Nurses are also going into the schools and educating students and teachers on how to properly perform CPR.
Macklin said each week the board room was filled with representatives for nearly all departments.
“We were empowered to do that,” Macklin said. “Our administration and the board signed off … and we went in there every Monday with a sense of empowerment that we need to get from here to there and who’s best to drive the bus to get there.”
“Some days it was our Chief Nursing Officer (Gloria Ceballos, PhD, RN) who could roll out to all of nursing what needed to be done. Sometimes it was the Chief Medical Officer (Dr. Rockey Talley) who needed to get our hospitalist team on board with the protocols we were rolling out. It changed from Monday to Monday to get from where we started to where we ended.”
“It really kind of brought our whole hospital around that table with a single focus.”
By achieving SCPC’s Chest Pain Center with Primary PCI with Resuscitation Accreditation status, AllianceHealth Midwest demonstrated expertise in the following areas and others:
– Integrating the emergency department with the local emergency medical system
– Effectively treating patients at low risk for acute coronary syndrome and no assignable cause for their symptoms
– Supporting community outreach programs that educate the public to promptly seek medical care if they display symptoms of a possible heart attack
Baden said with the help of AllianceHealth Midwest’s EMS service door-to-balloon intervention time has dramatically decreased.
“We’ve had STEMI’s that come directly to the cath lab,” she said. “There’s a lot of elements … and we’re trying to rule in these patients quicker. We’re decreasing the amount of damage and decreasing the length of stay.”
“Through this we’re all doing it the same way and the patients are happier. We’re all talking the same talk. Patient satisfaction scores in these units have elevated as well so we’re excited about that.”
The SCPC is the accreditation services arm of the American College of Cardiology.
AllianceHealth Midwest, located in Midwest City on the eastern edge of Oklahoma City, is a 255-bed acute care facility with nearly 300 primary care and specialty physicians.

by Bobby Anderson
Staff Writer

Integris Canadian Valley Hospital is using technology to make a giant leap forward in improving outcomes of its stroke patients.
And thanks to a computer screen on wheels with high resolution cameras patients are getting the help they need anytime day or night.
Christine McMurray, RN-PCCN, serves as an administrative supervisor at Canadian Valley, and has served as the clinical coordinator for getting the new telestroke program off the ground.
“It’s kind of like a fancy-FaceTime where the physicians we have, the neurologists can beam in on the screen … and lenses can zoom all the way into their pupils and check pupil responses,” McMurray said.
Attached is a wired stethoscope that allows both the onsite clinician as well as the remote clinician to hear lung and heart sounds in real-time for those patients presenting with stroke symptoms.
The robot is controlled remotely and can be moved around the patient. The 360-degree microphone also captures sound from all directions inside the room.
The attached monitor screen allows both patient and doctor to have a face-to-face conversation as well as examination even if the doctor is hundreds of miles away.
“We were taking all of our stroke patients that required tPA to Southwest Medical and Baptist,” McMurray said. “Now what we can do after they are seen in the ER with telestroke we can give them tPA on a stable patient and bring them here for a neurology consult.
“Now, rather than shipping them out of Yukon they can stay here in town, in the community and neurology will beam in if there are no complications within 24 hours … they can prescribe the discharge medications, change any anti-coagulations medicines without physically being here but being present.”
Integris Canadian Valley Hospital Chief Nursing Officer Teresa Gray, RN, BSN, MBA said the technology offers immediacy for both doctor and patient.
“The doctor can basically do a full assessment from any device – iPhone, iPad, computers from anywhere anytime,” Gray said. “This technology allows for when you may not have services 24/7 in your facility and the patient has a change in their condition or you need a different level of care we have immediate access.”
“When you talk about neurology in the state of Oklahoma and there is a shortage of neurologists, this allows them to provide access to smaller communities that may not normally have neurologists and various high-level specialities that are hard to recruit. This gives the opportunity to bring that kind of service back to the smaller communities.”
Stroke is the fourth-leading killer in the United States and the leading cause of long-term disability.
Approximately 800,000 people experience a stroke each year in the US. Successful management of acute ischemic stroke is extremely time-dependent.
According to the American Heart Association, ideally, the only Food and Drug Administration-approved treatment for acute ischemic stroke should be administered within 3 hours of the onset of stroke symptoms.
The American Heart Association estimates that only 3% to 5% of ischemic stroke patients are treated with thrombolysis (a clotbuster known as tPA).
“They don’t have to be transferred out anymore. They don’t have to wait for a bed,” McMurray said of the major benefits of telestroke. “Baptist and Southwest have both been on delay several times. Then they have to go to the ER and they are put on hold there or are waiting in a hallway. Where here we’ve got eight ICU beds and they can come right over. They are treated with the same protocols and the same order sets. Everything is the same. If there is any problem all the physician has to do is come in over (Telestroke).”
The program is done in collaboration with the hospital’s hospitalist program which follows the plan of care throughout the course of a patient’s stay.
McMurray said the technology has already been used by the hospital’s two hospitalists to dial in remotely to check on other non-stroke patients who are experiencing changes in condition or acuity.
On average, Gray said Canadian Valley transfers out 7-8 stroke patients per month with lower-level patients not requiring tPA kept.
Gray said Canadian Valley continues to evolve its service offerings as it becomes the mainstay for healthcare for those living in Western Oklahoma.
“This is something cardiology and nephrology can use – any of our services that are not onsite 24/7,” Gray said. “That’s what we hope to expand is increase our complexity of patients, add additional services to the community we haven’t had and incorporate new technology.”