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BUILDING A 7-FIGURE
Counseling Practice
Anthony Centore
Ph.D.
BECOMING AN
ENTREPRENEUR
SOMEONE WILLING TO
WORK 80 HOURS A WEEK
TO AVOID WORKING 40
HANDS ON
ENTREPRENEURSHIP
WE NEEDED
NEW RUGS
LOW TYPICAL MOMENTS
CAN I BE AN
ENTREPRENEUR?
CONS PROS
CONS
Difficult
PROS
CONS
Difficult
Risk
PROS
CONS
Difficult
Risk
Work
PROS
CONS
Difficult
Risk
Work
PROS
Flexible
CONS
Difficult
Risk
Work
PROS
Flexible
Creative
CONS
Difficult
Risk
Work
PROS
Flexible
Creative
Own Boss
CONS
Difficult
Risk
Work
PROS
Flexible
Creative
Own Boss
Financial?
A NOTE ON RUGS
WHAT IT TAKES TO
SUCCEED IN PRIVATE
PRACTICE
A TALE OF
2 COUNSELORS
BRIAN
EMMA
ADVANTAGES
ADVANTAGES
Clinical Experience
ADVANTAGES
Clinical Experience
Business Acumen
ADVANTAGES
Clinical Experience Community
Reputation
Business Acumen
ADVANTAGES
Clinical Experience
Investment
Capital
Community
Reputation
Business Acumen
ADVANTAGES
Clinical Experience
Luck
Investment
Capital
Community
Reputation
Business Acumen
CONSTANT FORWARD
MOVEMENT
UN-CATCH 22S
PROGRESS > EFFICIENCY
CFM
WHO’S STORY SOUNDS
MORE LIKE YOU?
NOT A SOLO PRACTICE
GROUP V. SOLO
GO SOLO
SIMPLER
6 FIGURES
HIGHER PROFIT MARGIN
MORE TIME COUNSELING
GO GROUP
SELLABLE
FLY WHEEL
FREEDOM FROM THE
COUCH
LESS ISOLATING
SHOW ME THE MONEY
SHOW ME THE MONEY
A counselor will bill about $75 per session
SHOW ME THE MONEY
A counselor will bill about $75 per session
36 sessions a week = $2,700
SHOW ME THE MONEY
A counselor will bill about $75 per session
36 sessions a week = $2,700
48 weeks a year = $129,600
SHOW ME THE MONEY
A counselor will bill about $75 per session
36 sessions a week = $2,700
48 weeks a year = $129,600
A psychologist will bill about $95 per session
SHOW ME THE MONEY
A counselor will bill about $75 per session
36 sessions a week = $2,700
48 weeks a year = $129,600
A psychologist will bill about $95 per session
= $164,160
SHOW ME THE MONEY
Just therapy, without:
Psychological Testing
Medication Management
Group Counseling
Court Appearances
Other Ancillary Services
SHOW ME THE MONEY
7.6 Counselors, or
6.1 Psychologists
to earn
$1,000,000 in Revenue!
$1,000,000 IN REVENUE!
BUT WAIT!
REVENUE IS NOT PROFIT
SHOW ME THE MONEY
Therapist Compensation
55-70% of Total Revenue
SHOW ME THE MONEY
Therapist Compensation
55-70% of Total Revenue
~ $300,000 - $450,000 left
WHAT CAN YOU BUY WITH
$450,000?
1.08 ct. platinum, fancy vivid blue diamond
775 sq foot apartment, with one bath, in Brookline, MA
Take That, Austin Powers
NOT SO FAST
OPERATIONAL EXPENSES
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
OPERATIONAL EXPENSES
Credentialing, Billing & Credit Card Fees: 7-15%
Rent & Parking: 3-7%
Reception & Scheduling: 3-5%
Office Expenses, Supplies & Postage: 1-3%
Admin Salaries: 0-8%
Marketing: 0-5% (once at capacity)
Research & Development: 0-3%
Clinical Supervision & Professional Development: 0-3%
Software & Electronic Medical Records: 0-3%
Accounting, Bookkeeping & Legal: .5-1%
Travel: 0-1%
Bank Fees: 0-1%
NET PROFIT
-25% TO 25%
RESULTS MAY VARY
RESULTS MAY VARY
1) Take home the same in solo practice
RESULTS MAY VARY
1) Take home the same in solo practice
2) Only money they keep is what they produce
RESULTS MAY VARY
1) Take home the same in solo practice
2) Only money they keep is what they produce
3) Highly profitable, and self-sustaining
RESULTS MAY VARY
1) Take home the same in solo practice
2) Only money they keep is what they produce
3) Highly profitable, and self-sustaining
4) A combination of self and team best
*Sellable & Real Estate
GETTING TO BLACK
BUILT TO SELL
STARTING WITH
THE END
IN MIND
REASONS TO SELL
INCLUDE...
RELOCATE
CAREER CHANGE
TO LIQUIDATE!
RETIREMENT
THINK YOU’RE TOO
YOUNG?
AN “UNSELLABLE
BUSINESS”
DO YOU KNOW WHAT
YOUR BUSINESS IS
WORTH?
EBITDA,
MULTIPLE OF REVENUE,
OWNER BENEFIT,
COST OF STARTING FROM
SCRATCH
RECOUP INVESTMENT IN 3
YEARS, AND MAKE A
LIVING ALONG THE WAY
12 WAYS TO BUILD VALUE
BRAND
GROW FAR BEYOND SOLO
DON’T LEAVE POTENTIAL
UNREALIZED
“Potential co-operative marketing with
other health related professionals in same
location. Potential to expand professional
referral network, expand hours/days of
operation or add complementary services.
Huge potential to leverage social media
marketing for targeted local advertising.”
CONSIDER AN EARN OUT
FINANCE THE BUYER
FOCUS ON NEW CLIENTS
WHICH WOULD YOU PAY
MORE FOR?...
A practice with four clinicians performing a
total of120 sessions per week, and 8 new
client inquiries per month.
A practice with two clinicians, performing a
total of 60 sessions per week, and 80 new
client inquiries per month.
CREDENTIALING
COMMITTED STAFF
practice and begins to implement some basic rules of
operation for the administrative staff. They revolt!
The staff destroys documents, cancels appointments,
refuses to answer the phone, and creates a hostile work
environment (they were also, as it was later discovered,
stealing from the company). The new owner has no
choice but to fire the entire staff, and hire a new
administrative team.
compensating them heavily for completing basic
administrative tasks the previous owner did not want to
do. The new owner realizes that the practice cannot
survive without the clinicians forgoing their
administrative duties (along with the extra cash-cow
income). The counselors do not respond well to
receiving what they perceive as “a cut in pay”, and
several leave the practice. Revenues drop by over 40%,
and the practice doesn’t recover for over a year.
ASSETS
A GOOD LEASE
A BAD LEASE
The practice has a 5-year lease in a bad location. The buyer
would prefer to move the office, but breaking the lease
will be too expensive.
A BAD LEASE
The practice has a 5-year lease in a bad location. The buyer
would prefer to move the office, but breaking the lease
will be too expensive.
The lease is non-transferable, and the landlord wants a
20% rent increase from any new tenant/owner.
A BAD LEASE
The practice has a 5-year lease in a bad location. The buyer
would prefer to move the office, but breaking the lease
will be too expensive.
The lease is non-transferable, and the landlord wants a
20% rent increase from any new tenant/owner.
The lease terminates within a year, and the landlord plans
to raise the rent more than 5%. Or, the landlord isn’t
interested in committing to new lease terms at the
present time, creating a big ol’ question mark for the
buyer.
A BAD LEASE
The practice has a 5-year lease in a bad location. The buyer
would prefer to move the office, but breaking the lease
will be too expensive.
The lease is non-transferable, and the landlord wants a
20% rent increase from any new tenant/owner.
The lease terminates within a year, and the landlord plans
to raise the rent more than 5%. Or, the landlord isn’t
interested in committing to new lease terms at the
present time, creating a big ol’ question mark for the
buyer.
The space is simple TOO BIG for the practice.
HONEST & OPEN
DESIRABLE LOCATION
FINISH STRONG
...AND LETTING GO.
BUILDING THE TEAM
...is tomorrow
BUILDING THE TEAM
...is tomorrowFinding
BUILDING THE TEAM
...is tomorrowFinding
Recruiting
BUILDING THE TEAM
...is tomorrowFinding
Recruiting
Interviews
BUILDING THE TEAM
...is tomorrowFinding
Recruiting
Interviews
Contractors v.
Employees
BUILDING THE TEAM
...is tomorrowFinding
Recruiting
Interviews
Contractors v.
Employees
Avoiding
Nightmare
Counselors
BUILDING THE TEAM
...is tomorrowFinding
Recruiting
Interviews
Contractors v.
Employees
Avoiding
Nightmare
Counselors
Why Practices
Lose Their Best
Clinicians
BUILDING THE TEAM
...is tomorrowFinding
Recruiting
Interviews
Contractors v.
Employees
Avoiding
Nightmare
Counselors
Why Practices
Lose Their Best
Clinicians
Offer Letter /
Contract
BUILDING THE TEAM
...is tomorrowFinding
Recruiting
Interviews
Contractors v.
Employees
Avoiding
Nightmare
Counselors
Why Practices
Lose Their Best
Clinicians
Offer Letter /
Contract
On-boarding and
Training
BUILDING THE TEAM
...is tomorrowFinding
Recruiting
Interviews
Contractors v.
Employees
Avoiding
Nightmare
Counselors
Why Practices
Lose Their Best
Clinicians
Offer Letter /
Contract
On-boarding and
Training
Creating a
Pipeline
CREATING CULTURE
ZAPPOS
COUNSELING PRACTICES
STRUGGLE
Contractors
Contractors
Rogue Clinicians
Contractors
Rogue Clinicians
Psychiatrist
Contractors
Rogue Clinicians
Psychiatrist
Owner-clinician
NOT A LUXURY
TINA FEY
“Don’t hire anyone you wouldn’t want to run into in the
hallway at three in the morning.”
STARTS WITH HIRING
But doesn’t end there...
THINGS THAT WORKED
THINGS THAT WORKED
THINGS THAT WORKED
THINGS THAT WORKED
THINGS THAT WORKED
1) RESPECT AND
GESTURES OF CARING
“Thriveworks, at its core, is its team of
people…We work to engender great loyalty
in the team members of Thriveworks and
hope that we are successful in developing
and maintaining their loyalty to the point
that they elect to stay employed with us for
life.”
2) COMMUNITY
3) MISSION
4) PROGRESS
Thriveworks Rank System
Level 1) Assistant Clinician
Level 2) Fellow Clinician
Level 3) Senior Fellow Clinician
Level 4) Associate Clinician
Level 5) Senior Associate Clinician
Level 6) Senior Clinician
Level 7) Distinguished Candidate Clinician
Level 8) Distinguished Clinician
Level 9) Magna Candidate Clinician
Level 10) Magna Clinician
Level 11) Summa Candidate Clinician
Level 12) Summa Clinician
Managing Clinician
Clinician Emeritus / Emerita
YOUR PRACTICE,
YOUR CULTURE
SPEND MONEY TO MAKE
MONEY
WE GOT NICKELS HOLDING
UP A DOLLAR!
WE GOT NICKELS HOLDING
UP A DOLLAR!
1) YOUR OFFICE BUILDING
2) CLIENT EXPERIENCE
3) MEDICAL BILLING
4) YOUR CLINICAL STAFF
5) GIVING BACK
5) GIVING BACK
5) GIVING BACK
6) ADVERTISING
10 BIGGEST MARKETING
MISTAKES
BIG BLIND SWING
NO TRACKING
“Only half of my advertising is working.”
“The problem is I don’t know which half!”
AWFUL SOCIAL MEDIA
BAD HEADSHOT
TECHNICAL BIO
SPAMMING
GUEST BLOGGING
BAD WEBSITE
BAD WEBSITE
“Counseling for individuels, couples, and Families”
DINGY OFFICE
DINGY OFFICE
“You can tell whether a business cares about
its customers by how nice the bathrooms
are.”
DINGY OFFICE
“You can tell whether a business cares about
its customers by how nice the bathrooms
are.”
How are your bathrooms?
How are your waiting rooms?
NO ADVERTISING AT ALL
I’M ABOUT TO
BLOW YOUR MIND
EVERYTHING IS
MARKETING
THE FINAL 10%
HOW’S IT POSSIBLE?
THE LAST 10% IS THE
HARDEST
ODYSSEUS
WHAT’S YOUR 10%?
ARE YOU QUITTING AT
90%?
ARE YOU QUITTING AT
90%?
“Clients don’t need wi-fi in the waiting room”
ARE YOU QUITTING AT
90%?
“Clients don’t need wi-fi in the waiting room”
“We don’t answer the phone, but most clients will leave a
message”
ARE YOU QUITTING AT
90%?
“Clients don’t need wi-fi in the waiting room”
“We don’t answer the phone, but most clients will leave a
message”
“My notes are for me. My records don’t need to be great.”
ARE YOU QUITTING AT
90%?
“Clients don’t need wi-fi in the waiting room”
“We don’t answer the phone, but most clients will leave a
message”
“My notes are for me. My records don’t need to be great.”
“I don’t want to accept credit cards. Clients can write a
check”
ARE YOU QUITTING AT
90%?
“Clients don’t need wi-fi in the waiting room”
“We don’t answer the phone, but most clients will leave a
message”
“My notes are for me. My records don’t need to be great.”
“I don’t want to accept credit cards. Clients can write a
check”
“That old armchair was my great aunts. I don’t have time
to refurbish it”
ARE YOU QUITTING AT
90%?
“Clients don’t need wi-fi in the waiting room”
“We don’t answer the phone, but most clients will leave a
message”
“My notes are for me. My records don’t need to be great.”
“I don’t want to accept credit cards. Clients can write a
check”
“That old armchair was my great aunts. I don’t have time
to refurbish it”
“I haven’t dug into new research in years. The most
important thing is the relationships with my clients”
OBSESSION
BE 10% OBSESSED
SPACE
SPACE
White glove clean and
organized
SPACE
White glove clean and
organized
No more Poland Spring
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
CLINICAL
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
CLINICAL
More positive psychology
training
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
CLINICAL
More positive psychology
training
Professional development
program
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
CLINICAL
More positive psychology
training
Professional development
program
Measure treatment outcomes
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
CLINICAL
More positive psychology
training
Professional development
program
Measure treatment outcomes
VALUE
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
CLINICAL
More positive psychology
training
Professional development
program
Measure treatment outcomes
VALUE
More value to clients
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
CLINICAL
More positive psychology
training
Professional development
program
Measure treatment outcomes
VALUE
More value to clients
1st/10th appointment gifts
SPACE
White glove clean and
organized
No more Poland Spring
Hallway should smell better
SCHEDULING
Intake process simpler
Sessions in 24 hours
Never double book
CLINICAL
More positive psychology
training
Professional development
program
Measure treatment outcomes
VALUE
More value to clients
1st/10th appointment gifts
Most desirable place
10% IS
100%
THE END

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