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<DIV><FONT face=Arial size=2>Pat,</FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>Is this posting actually meant to be a response to
the article posted by AD? </FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>How is the sad fact that insurance companies such
as Conseco are regularly cheating the elderly by denying them the coverage they
paid for, tied to the "public school system dumbing down their
classrooms?"</FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>We could of course have a discussion on the
Constitutional separation of powers, and while that is an interesting and
important concept, I view it as a non-sequitur departure from the point of
the article. </FONT></DIV>
<DIV><FONT face=Arial size=2></FONT> </DIV>
<DIV><FONT face=Arial size=2>Sue </FONT></DIV>
<BLOCKQUOTE
style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
<DIV style="FONT: 10pt arial">----- Original Message ----- </DIV>
<DIV
style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B>
<A title=pkraut@moscow.com href="mailto:pkraut@moscow.com">Pat Kraut</A>
</DIV>
<DIV style="FONT: 10pt arial"><B>To:</B> <A title=vision2020@moscow.com
href="mailto:vision2020@moscow.com">vision2020</A> </DIV>
<DIV style="FONT: 10pt arial"><B>Sent:</B> Monday, March 26, 2007 7:45
AM</DIV>
<DIV style="FONT: 10pt arial"><B>Subject:</B> Re: [Vision2020] NY Times:
Aged,Frail and Denied Care by Their Insurers</DIV>
<DIV><BR></DIV>
<DIV><FONT face=Arial size=2>While the dems dilly dally with who the AG is
this country has some real problems...such as insurance run amok. The dems do
not seem to realize the last vote was against the repubs not for dems and they
are diminishing so much power from the office of the president it is
dangerous. They and you may not like Bush but the next president is going to
have to work within the same protocol that they are trying to force on Bush.
They really do not get what they are doing. And so many citizens of the US are
so unaware of the truth of the Constitution that they do not understand. I
blame the public school system because of the dumbing down of they classrooms.
</FONT></DIV>
<DIV> </DIV>
<DIV> </DIV>
<DIV> </DIV>
<DIV>----- Original Message ----- </DIV>
<BLOCKQUOTE
style="PADDING-RIGHT: 0px; PADDING-LEFT: 5px; MARGIN-LEFT: 5px; BORDER-LEFT: #000000 2px solid; MARGIN-RIGHT: 0px">
<DIV
style="BACKGROUND: #e4e4e4; FONT: 10pt arial; font-color: black"><B>From:</B>
<A title=deco@moscow.com href="mailto:deco@moscow.com">Art Deco</A> </DIV>
<DIV style="FONT: 10pt arial"><B>To:</B> <A title=vision2020@moscow.com
href="mailto:vision2020@moscow.com">Vision 2020</A> </DIV>
<DIV style="FONT: 10pt arial"><B>Sent:</B> Monday, March 26, 2007 6:51
AM</DIV>
<DIV style="FONT: 10pt arial"><B>Subject:</B> [Vision2020] NY Times:
Aged,Frail and Denied Care by Their Insurers</DIV>
<DIV><BR></DIV>
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<DIV class=timestamp>March 26, 2007</DIV>
<DIV class=kicker></DIV>
<H1><NYT_HEADLINE type=" " version="1.0">Aged, Frail and Denied Care by
Their Insurers </NYT_HEADLINE></H1><NYT_BYLINE type=" "
version="1.0"></NYT_BYLINE>
<DIV class=byline>By <A title="More Articles by Charles Duhigg"
href="http://topics.nytimes.com/top/reference/timestopics/people/d/charles_duhigg/index.html?inline=nyt-per">CHARLES
DUHIGG</A></DIV><NYT_TEXT></NYT_TEXT>
<DIV id=articleBody>
<P>CONRAD, Mont. — Mary Rose Derks was a 65-year-old widow in 1990, when she
began preparing for the day she could no longer care for herself. Every
month, out of her grocery fund, she scrimped together about $100 for an
insurance policy that promised to pay eventually for a room in an assisted
living home. </P>
<P>On a May afternoon in 2002, after bouts of <A
title="Recent and archival health news about blood pressure."
href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/bloodpressure/index.html?inline=nyt-classifier">hypertension</A>
and <A title="Recent and archival health news about diabetes."
href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/diabetes/index.html?inline=nyt-classifier">diabetes</A>
had hospitalized her dozens of times, Mrs. Derks reluctantly agreed that it
was time. She shed a few tears, watched her family pack her favorite
blankets and rode to Beehive Homes, five blocks from her daughter’s farm
equipment dealership.</P>
<P>At least, Mrs. Derks said at the time, she would not be a financial
burden on her family.</P>
<P>But when she filed a claim with her insurer, <A title=Conseco
href="http://www.nytimes.com/mem/MWredirect.html?MW=http://custom.marketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=CNOPRB;CNOWS">Conseco</A>,
it said she had waited too long. Then it said Beehive Homes was not an
approved facility, despite its state license. Eventually, Conseco argued
that Mrs. Derks was not sufficiently infirm, despite her early-stage
dementia and the 37 pills she takes each day. </P>
<P>After more than four years, Mrs. Derks, now 81, has yet to receive a
penny from Conseco, while her family has paid about $70,000. Her daughter
has sent Conseco dozens of bulky envelopes and spent hours on the phone.
Each time the answer is the same: Denied.</P>
<P>Tens of thousands of elderly Americans have received life-prolonging care
as a result of their long-term-care policies. With more than eight million
customers, such insurance is one of the many products that companies are
pitching to older Americans reaching retirement.</P>
<P>Yet thousands of policyholders say they have received only excuses about
why insurers will not pay. Interviews by The <A title="New York Times"
href="http://www.nytimes.com/mem/MWredirect.html?MW=http://custom.marketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=">New
York Times</A> and confidential depositions indicate that some
long-term-care insurers have developed procedures that make it difficult —
if not impossible — for policyholders to get paid. A review of more than 400
of the thousands of grievances and lawsuits filed in recent years shows
elderly policyholders confronting unnecessary delays and overwhelming
bureaucracies. In California alone, nearly one in every four long-term-care
claims was denied in 2005, according to the state.</P>
<P>“The bottom line is that insurance companies make money when they don’t
pay claims,” said Mary Beth Senkewicz, who resigned last year as a senior
executive at the National Association of Insurance Commissioners. “They’ll
do anything to avoid paying, because if they wait long enough, they know the
policyholders will die.” </P>
<P>In 2003, a subsidiary of Conseco, Bankers Life and Casualty, sent an
85-year-old woman suffering from dementia the wrong form to fill out,
according to a lawsuit, then denied her claim because of improper paperwork.
Last year, according to another pending suit, the insurer <A
title="Penn Treaty American"
href="http://www.nytimes.com/mem/MWredirect.html?MW=http://custom.marketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=PTA">Penn
Treaty American</A> decided that a 92-year-old man had so improved that he
should leave his nursing home despite his forgetfulness, anxiety and
doctor’s orders to seek continued care. Another suit contended that a
company owned by the John Hancock Insurance Company had tried to rescind the
coverage of a 72-year-old man when he was diagnosed with <A
title="Recent and archival health news about Alzheimer's."
href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/alzheimers/index.html?inline=nyt-classifier">Alzheimer’s</A>
disease four years after buying the policy.</P>
<P>In court filings, all three companies said the denials had been proper.
They declined further comment on the cases, though Bankers Life and John
Hancock eventually settled for unspecified amounts. </P>
<P>In general, insurers say criticisms of claims-handling are unfair because
most policyholders are paid promptly and some denials are necessary to root
out fraud. </P>
<P>In a statement, Conseco said the company “is committed to the highest
standards for ethics, fairness and accountability, and strives to pay all
claims in accordance with policy contracts.” Penn Treaty said in a
statement, “We strive to treat all policyholders fairly, and to deliver the
best, most efficient evaluation of their claim as possible.”</P>
<P>But policyholders have lodged thousands of complaints against the major
long-term-care insurers. A disproportionate number have focused on Conseco,
its affiliate, Bankers Life, and Penn Treaty. In 2005, Conseco received more
than one complaint regarding long-term-care insurance for every 383 such
policyholders, according to data from the insurance commissioners’
association. Penn Treaty received one complaint for every 1,207
long-term-care policyholders. (The complaints touch on a variety of topics,
including claims handling, price increases and advertising methods.)</P>
<P>By comparison, <A title="Genworth Financial"
href="http://www.nytimes.com/mem/MWredirect.html?MW=http://custom.marketwatch.com/custom/nyt-com/html-companyprofile.asp&symb=GNWPRE">Genworth
Financial</A>, the largest long-term-care insurer, received only one
complaint for every 12,434 policies.</P>
<P>Conseco is among the nation’s largest insurers, collecting premiums worth
more than $4.2 billion in 2006, of which long-term-care policies contributed
21 percent. Penn Treaty focuses primarily on long-term-care products and
collected premiums of about $320 million in 2004, the last year the company
filed an audited annual report.</P>
<P>In depositions and interviews, current and former employees at Conseco,
Bankers Life and Penn Treaty described business practices that denied or
delayed policyholders’ claims for seemingly trivial reasons. Employees said
they had been prohibited from making phone calls to policyholders and that
claims had been abandoned without informing policyholders. Such tactics,
advocates for the elderly say, are becoming common throughout the
industry.</P>
<P>“These companies have essentially turned their bureaucracies into profit
centers,” said Glenn R. Kantor, a California lawyer who has represented
policyholders. </P>
<P>Yet these concerns have been ignored by state regulators, advocates say,
and have gone unnoticed by federal lawmakers who recently passed incentives
intended to promote purchases of long-term-care policies, in the hopes of
forestalling a Medicare funding crisis.</P>
<P>Conseco and Bankers Life “made it so hard to make a claim that people
either died or gave up,” said Betty J. Hobel, a former Bankers Life agent in
Cedar Rapids, Iowa. </P>
<P>“When someone is 70 or 80 years old,” she said, “how many times are they
going to try before they just give up?”</P>
<P><SPAN class=bold>A Race to Sell Policies</SPAN></P>
<P>When Mrs. Derks bought her long-term-care policy from a door-to-door
salesman in 1990, she was unaware that she represented the insurance
industry’s newest gold mine.</P>
<P>Her husband had died eight years earlier of a stroke, leaving her to run
a barley farm in northern Montana, where she lived with her three children
and her aging mother. As she watched her own parent decline, Mrs. Derks
became preoccupied with sparing her children the expense of her final
years.</P>
<P>“She was terrified that she would bankrupt us or get sent to a public
nursing home,” said Ken E. Wheeler, her son-in-law. </P>
<P>At the time, long-term-care policies, which can cover the costs of
assisted-living facilities, nursing homes and at-home care, were becoming
one of the insurance industry’s fastest-growing products. Companies like
Conseco, Bankers Life and Penn Treaty were aggressively signing up clients
who were not in the best health at rates far below their competitors’ in
order to win more business, former agents said. From 1991 to 1999,
long-term-care sales helped drive total revenue gains of roughly 500 percent
each at Penn Treaty and Conseco, including its affiliate Bankers Life. </P>
<P>Cracks in the business, however, soon started to appear. Insurance
executives began warning they had underestimated how long policyholders
would live after entering nursing homes. The costs of treating Alzheimer’s,
<A title="Recent and archival health news about Parkinson's disease."
href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/parkinsonsdisease/index.html?inline=nyt-classifier">Parkinson’s</A>
and diabetes ballooned. </P>
<P>As insurers began realizing their miscalculations, they persuaded
insurance commissioners in California, Pennsylvania, Florida and other
states to approve price increases of as much as 40 percent a year. </P>
<P>By 2002, Conseco’s long-term-care payouts exceeded revenue. Those and
other disappointing results prompted the company to file for bankruptcy,
from which it emerged 10 months later.</P>
<P>That same year, Mrs. Derks entered Beehive Homes, a cheery, 12-bed center
one block from the Prairie View elementary school. In the previous four
years, she had been hospitalized more than two dozen times. She had once
lain unconscious in her living room for a day and a half. Her physician
ordered her into an assisted-living center.</P>
<P>Initially, Conseco told Mrs. Derks’s daughter, Jackie Wheeler, that her
claim would go through smoothly, Mrs. Wheeler said. The family began paying
Beehive Homes’s $1,900 monthly fee. </P>
<P>But three months after submitting her claim, Mrs. Derks received a letter
from Conseco saying she had waited too long, and her earliest costs would
not be reimbursed. Two months later, she received another letter denying her
entire claim because she had not submitted proof of illness. </P>
<P>Yet a copy of Mrs. Derks’s policy, sent to the Wheelers by Conseco in
2004 and reviewed by The Times, mentions no requirement for proof of
illness. The policy requires only that the confinement be ordered by a
physician, and it allows for a notice of claim to be sent “as soon as
reasonably possible.” </P>
<P>Mrs. Derks’s daughter called Conseco and explained that her mother could
not recall the date or people’s names and had started multiple fires by
forgetting to turn off the stove. She sent letters stating that her mother
needed assistance to dress, eat, go to the bathroom and inject insulin. </P>
<P>“This is medically necessary!!!” reads a form signed by Mrs. Derks’s
physician in 2004. “This has been filled out three times! This person needs
assistance!”</P>
<P>Seven months later, Conseco sent another letter, this time denying Mrs.
Derks’s claim because her policy “requires a staffed registered nurse 24
hours per day.” Her policy does not mention such a requirement. </P>
<P>Conseco also sent letters denying Mrs. Derks’s claim because her policy
had an “assisted living facility rider,” and because Mrs. Derks “does not
have an assisted living facility rider.” In all, the family received more
than a dozen letters from the company. Many contradict one another, and
frequently cite requirements that are nowhere mentioned in Mrs. Derks’s
policy.</P>
<P>“There was always a new step in the runaround,” Mrs. Wheeler said. “It
felt like everything was designed to make me just go away.”</P>
<P>Over two years, Mrs. Wheeler estimated, she called the company about 100
times. Twice a month, she sent envelopes stuffed with medical records. Some
afternoons, she spent hours making calls. After one conversation, Mrs.
Wheeler slammed down the phone and started to cry. Then she drove to Beehive
Homes, where her mother was surrounded by faded photos of her childhood and
boxes of adult diapers. </P>
<P>“I wouldn’t tell her about the problems we were having with Conseco,
because I knew it would cause her so much worry,” Mrs. Wheeler said.</P>
<P>Eventually, the Wheelers sold part of their John Deere dealership to
raise money to pay for her mother’s care. In October 2006, they sued.</P>
<P>Conseco, asked by a reporter about the company’s handling of the Derks
claim, declined to answer, citing the pending litigation. In court
documents, the company denied Mrs. Derks’s allegations without specifying
why her claim was denied. </P>
<P>“We did everything they asked,” Mrs. Wheeler said. “And this company just
treats us like dirt.”</P>
<P><SPAN class=bold>Tales of Bureaucracy</SPAN></P>
<P>Inside the large Conseco headquarters in Carmel, Ind., scores of
employees receive the flood of documents and calls that arrive each day. At
times, according to depositions and interviews, that deluge became so
overwhelming that documents were lost, calls went unreturned and mistakes
occurred.</P>
<P>Some employees describe vast mailrooms where documents appear and
disappear. One call-center representative said he was afforded an average of
only four minutes to handle each policyholder’s call, no matter how
complicated the questions. Employees said they were instructed not to say
when the company was behind in processing paperwork, even when the backlog
extended to 45 days. Workers were prohibited from contacting each other by
phone, although such calls might have quickly resolved obstacles, according
to depositions.</P>
<P>Conseco, asked in detail about the company’s policies, declined to
respond. </P>
<P>Bureaucratic obstacles were pervasive, according to interviews with 10
former Conseco employees and depositions of more than a dozen others. Robert
W. Ragle, a former Bankers Life branch manager, once contacted the claims
department on behalf of a client, and “they just laughed us off the phone,”
he said. “Their mentality is to keep every dollar they can.” Mr. Ragle was
dismissed by Bankers Life in 2002. He sued for wrongful termination and
settled out of court. </P>
<P>In lawsuits, complaints and interviews, policyholders contend that
Conseco, Bankers Life or Penn Treaty denied claims because policyholders
failed to submit unimportant paperwork; because daily nursing notes did not
detail minute procedures; because policyholders filled out the wrong forms
after receiving them from the insurance companies; and because facilities
were deemed inappropriate even though they were licensed by state
regulators.</P>
<P>In depositions conducted on behalf of angry policyholders, Conseco
employees described bureaucratic obstacles that prevented payment of claims.
Those depositions were sealed in settlement agreements but were obtained by
The Times.</P>
<P>In a 2006 deposition, a Bankers Life and Conseco claims adjuster, Teresa
Carbonel, testified that she denied claims because of missing records but
was prohibited from calling nursing homes or physicians to request the
documents. She also testified that when a claim was denied, she was
forbidden to phone a policyholder, but instead used a time-consuming mailing
system.</P>
<P>Ms. Carbonel’s testimony, recorded during lawsuit on behalf of a
94-year-old policyholder, Rhodes K. Scherer, also disclosed that if
policyholders did not mail requested documents within 21 days, Conseco might
abandon their claim, sometimes without informing them. </P>
<P>In the case of Mr. Scherer, who was institutionalized after a bathroom
fall, it was difficult to obtain a response, Ms. Carbonel said, because the
company’s requests were mailed to his home address, rather than the nursing
center where the company had been notified that he had moved. Ms. Carbonel,
who is no longer with the company, did not return calls. Conseco declined to
comment on her testimony. </P>
<P>In another deposition, Conseco’s then-senior manager for long-term- care
claims, Jose S. Torres, testified that Conseco would sometimes withhold
payments until it received documents not required by customers’ policies. In
Mr. Scherer’s case, Mr. Torres said, the company refused to pay his nursing
home costs unless he sent copies of the home’s license, payment invoices and
medical records, even though those documents had no bearing on approving his
claim. </P>
<P>Mr. Scherer’s claim “was handled not in the best way, but it was handled
according to the processes and procedures placed at the time,” Mr. Torres
testified. “Mistakes are going to be made, you know.”</P>
<P>Other executives testified that when Conseco appeared to have lost
important documents in Mr. Scherer’s claim, no investigation was initiated.
Shawn Michael Schechter, a Conseco claims supervisor who left the company in
2005 on positive terms, according to the deposition, testified that the
handling of Mr. Scherer’s claim violated the principle of good faith, which
requires insurance companies to treat customers fairly.</P>
<P>“The claim adjuster could have made that very easy and not have put the
burden back onto the policyholder,” he testified. </P>
<P>Mr. Torres did not return calls. Mr. Schechter declined to answer
questions. </P>
<P>Mr. Scherer died in 2004 without receiving benefits from Conseco. His
estate settled with the company in February for an undisclosed amount,
according to a lawyer representing the estate.</P>
<P>Conseco declined to discuss its complaint history or individual cases,
citing confidentiality agreements. In its statement, the company said that
in 2006, Conseco paid nearly $2.3 billion on 9.8 million claims in all types
of insurance sold by the company. </P>
<P>The company added: “Conseco, through training, education and process
improvements in all of its insurance companies, is continuously focused on
enhancing service and resolving any problems expeditiously. The Conseco
Insurance Group’s overall insurance department complaints decreased 20
percent from 2005 to 2006.”</P>
<P>Depositions of executives at Penn Treaty also point to questionable
practices. In a 2005 lawsuit, a Penn Treaty senior vice president, Stephen
Robert LaPierre, testified that the company rejected one claim without
informing the policyholder why, asked for information that was not required
to process a claim, gave incomplete information about a claim’s status and
said the company was delaying payment because of an investigation while
failing to take steps that might have resolved the inquiry.</P>
<P>Mr. LaPierre declined to discuss his testimony. Penn Treaty settled the
lawsuit by paying the policyholder an unspecified amount, the policyholder’s
lawyer said. </P>
<P>Penn Treaty said in a statement that evaluating a company by measuring
its complaints was flawed, and that since 2003, the company has denied an
average of less than 1.7 percent of the up to 8,000 claims it received every
year because of reasons related to policyholder eligibility. “From time to
time, Penn Treaty is compelled to investigate fraud or questionable billing
activities,” the company added.</P>
<P><SPAN class=bold>Few Regulatory Inquiries</SPAN></P>
<P>Few of the cases or complaints filed against Conseco, Bankers Life, Penn
Treaty or other insurers have received much attention, in part because many
lawsuits filed against long-term-care insurers have been settled with the
requirement that depositions, documents and settlement terms be kept
confidential. Frequently, say policyholders’ lawyers, the companies have
been willing to pay millions of dollars in exchange for confidentiality.
</P>
<P>Furthermore, despite the complaints against long-term-care insurers, few
states have conducted meaningful investigations. </P>
<P>Ron Gallagher, a deputy commissioner with the Pennsylvania Insurance
Department, said, “I don’t know that we have a real problem with improper
claim denials.”</P>
<P>Yet data from the National Association of Insurance Commissioners show
that from 2003 to 2005, Pennsylvania received more complaints regarding
Conseco, Bankers Life and Penn Treaty than any other state. Mr. Gallagher
said he might begin a new review of those companies.</P>
<P>Other states with large numbers of long-term-care complaints, including
California, Missouri, Maryland, Indiana and Washington have not begun
investigations, or have reviewed only small numbers of policies.</P>
<P>As a result, other seniors may end up like Mrs. Derks. </P>
<P>While she was waiting for her lawsuit to proceed, Medicaid began
contributing to Ms. Derks’s care. Taxpayers now pay Beehive Homes about $32
daily for her care. </P>
<P>“Long-term-care insurance is supposed to result in less pressure on
Medicaid, not more,” said Ms. Senkewicz, the former executive at the
insurance commissioners’ association. </P>
<P>For Mrs. Derks’s family, things have already broken down. </P>
<P>“How many other people are out there who don’t have a family to fight for
them and have just given up?” asked Jackie Wheeler. “This company should be
ashamed.”</P></DIV></DIV>
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