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Kuru - Parkkuu
 Kuru, perustietoa vuodelta 1985 - Perinnealbumi.
 Kurun kirkonkylän keskustaa Kurun metsäopiston katolta kuvattuna 1930-luvun lopulla, jolloin opisto valmistui. Kirkon ympäristö on kahdeksan vuosikymmenen aikana tyystin muuttunut. Suurimman vastakohdan vanhalle kirkolle loi 1960-luvulla rakennettu seurakuntakeskus.
 Kurun kirkko vuonna 1927. Vuonna 1781 Matti Åkerblomin rakentama kirkko kuuluu tyylillisesti länsisuomalaiseen pitkäkirkkoryhmään. Sen länsipäädyssä kohoaa italialaisesta renesanssista vaikutteita saanut kellotorni (sipukikirkko). 1900-luvun alussa kirkko korjattiin perusteellisesti arkkitehti Lars Sonckin laatimien suunnotelmien mukaan.
 Näkymä Kurun kirkon sisätiloista urkulehteriltä.
 Kurun kirkko valmistui vuonna 1781. Kirkon suunnittelusta ja rakentamisesta vastasi eräjärveläinen Matti Åkerblom. Kirkko on muodoltaan länsipäätytornillinen pitkäkirkko, jonka runkohuoneen sivuilla on kaksi matalampaa kylkiäistä. Kylkiäisten alkuperäinen funktio oli toimia sakaristona ja eteisenä, mutta vuoden 1846 remontissa sakaristo siirrettiin alttarin taakse kirkon itäpäätyyn rakennettuun uuteen ulkonemaan. Remontin piirustukset laadittiin intendentin konttorissa. Kirkon kellotapuli on kolmiosainen ja siinä on runsasmuotoinen barokkipääte ja ylimpänä sipulikupoli. Sekä runkohuone että kylkiäiset ovat satulakattoiset. Sisäkatteena on laudoista kasattu tynnyriholvi ja rakenteita tukevat kahteen suuntaan kulkevat parrut. Kirkon sanotaan olevan arkkitehtonisesti 1700-luvun lounaissuomalaisen pitkäkirkkotyypin tyylipuhtaimpia edustajia. Kirkossa on istumapaikat 700 henkilölle. Kirkon 11-äänikertaiset urut on rakentanut B.A. Thule vuonna 1894. Alttaritaluna on J.Z.Blackstadiuksen vuonna 1852 maalaama Ristiinnaulittu. Kirkon kahdesta kellosta toinen on vuodelta 1782 mutta toisen valuvuosi ei ole tiedossa.
 Kurun sakariston piirustus.
 Kurun vaakuna 1956-2008. Kurun kunnanhallitus päätti antaa Parkkuun seudun kyläyhdistys ry:lle oikeuden ja valtuudet valvoa ja päättää Kurun vaakunan käytöstä.
 Kurun vaakuna oli Kurun kunnan tunnus ja puhuva vaakuna; kuru tarkoittaa syvää rotkoa. Vaakunan selitys on ”sinisessä kentässä hopeinen kumokärki.” Vaakunan on suunnitellut Kimmo Kara, ja Kurun kunnanvaltuusto hyväksyi sen kokouksessaan 2. maaliskuuta 1956. Sisäasiainministeriö vahvisti vaakunan käyttöön 8. kesäkuuta samana vuonna. Vaakuna jäi epäviralliseksi kotiseutuvaakunaksi 2009, kun Kuru yhdistyi Ylöjärven kaupunkiin.
 Kurun suojeluskunnan ja lottajärjestön paraati Kurun kirkolla 1930-luvun alkupuolella. Paraati oli järjestetty Kurun suojeluskunnan lipun vihkiäistilaisuutta varten.
 Kurun suojeluskunnan lippu. MCMXXXV = 1935.
 Kurun kirkonkylän kansakoulu 1920-luvun puolivälissä. Tämä Keihäslahden koulun nimellä kulkeva opinahjo on Kurun vanhin. Se perustettiin jo vuonna 1881. Uusrenesanssityylinen koulurakennus on säilynyt ulkoasultaan alkuperäisenä.
 Kurun kunnantalo valmistumisensa jälkeen 1930-luvun alkupuolella. Rakennuksen muodoissa näkyy vielä selvästi 1920-luvulla vallinneita uusklassisia tyylipiirteitä.
 Vuonna 1972 oltiin tässä Kurun Sanomien kirjoituksessa huolissaan jo Kurun kunnan tulevaisuudesta.
 Vuoden 2009 alusta Kurun kunta liitettiin Ylöjärven kaupunkiin.
 Kurun kunta liittyy Ylöjärven kaupunkiin vuoden 2009 alusta alkaen. Ylöjärven kaupunginvaltuusto hyväksyi liitoksen torstai-iltana yksimielisesti. Valtuusto äänesti, tulisiko liitospäätöstä siirtää myöhemmäksi, mutta siirtoehdotus hävisi äänin 6-57. Kurun valtuusto näytti liitokselle vihreää valoa jo runsaat kaksi viikkoa sitten. Tampereen naapurissa sijaitseva Ylöjärvi on runsaan 23 000 asukkaan paikkakunta, kun mukaan lasketaan tämän vuoden alussa Ylöjärveen liittyneen Viljakkalankin asukkaat. Kurussa taas väkeä on vajaat 3 000 henkeä.
 Parkkuun kartta
 Kuru-Wikipedia
 KURUN VIIRI JA KURUN KIRKOSTA KIPSIPAINOS.
 Kurun puukirkko on 1700-luvun suomalaisen pitkäkirkkoperinteen ja lounaissuomalaisen kirkkotyypin sopusuhtaisimpia esimerkkejä ja suomalaisten kansanrakentajamestareiden, Matti Åkerblomin ja Matti Åkergrenin, taidonnäyte. Kurun paanukattoinen ja punamullattu puukirkko sijaitsee Vankaveden rannalla Kurunlahden pohjukassa ja sen vieritse on vuosisatoja kulkenut Näsijärven länsipuolitse vesireittiä myötäilevä maantieyhteys Ruovedeltä Ylöjärvelle. Länsitornillisen pitkäkirkon molemmilla sivuilla on matalat kylkiäiset. Lounaissuomalaista tyyppiä edustava tapuli on salvottu kiinni runkohuoneeseen. Tapulin kellotason ja sipulikupolin välissä on pullistuva välikerros, joka viittaa barokin muotokieleen. Kirkon itäpäädyn sakaristo on rakennettu 1848. Historia Vuoteen 1872 asti hallinnollisesti Ruoveteen kuuluneen Kurun nykyistä kirkkoa edelsi kaksi kirkkorakennusta; ensimmäinen oli rakennettu 1600-luvulla ja toinen oli valmistunut 1778. Se kuitenkin paloi jo seuraavana vuonna salaman sytyttämänä. Kurun kirkon suunnitteli rakentajamestari Matti Åkerblom ja kirkon rakennustöitä johti tämän sisarenpoika Matti Juhonpoika Åkergren 1781. Kustaa Adolfin kirkko vihittiin käyttöön 30. syyskuuta samana vuonna. Kirkon itäpäähän liitettiin uusi sakaristo 1846, jolloin kirkko myös vuorattiin ensimmäistä kertaa. Kirkko peruskorjattiin 1905-1906 arkkitehti Lars Sonckin johdolla.
 Kurun vuonna 2003 julkistama isännänviiri.
 Kurun sanomat torstaina 24.05.2007
 Parkkuu kuvina ja karttoina
 Parkkuu-kuvat
 Kurun kuntaeläin=Majava
 Majava (Castoridae) Majava on virtaavissa vesissä viihtyvä jyrsijä. Sen paksu turkki, räpylämäiset takajalat, litteä häntä ja talttamaiset hampaat tekevät siitä taitavan sukeltajan sekä padonrakentajan. Yhdyskunnissa elävä majava tekee pesänsä puista, oksista sekä mudasta. Sen pesä on suuri ja se kostuu useimmiten 2-3 osasta. Pesän sisääntuloaukko löytyy aina veden alta. Maamme kaksi majavalajia ovat: euroopanmajava ja kanadanmajava. Kuvateksti: Sympaattisen näköisen majavan aherrusta on mukava seurata luonnossa. Padot nostavat vedenpintaa ja samalla majava saa lisää vesiliikkumatilaa pesänsä lähettyvillä. Se liikkuu maalla melko kömpelösti, joten vedenalaiset kasvit muodostavat pääosan sen ravinnosta. Majava syö ulpukoiden juurakoita, vehka- sekä raatekasveja. Majavalla on yhtä hyvä hajuaisti kuin sudella, joten se ei ole helppo saalis petoeläimille. Maalla liikkuessaan se syö koivun, haavan ja pajun kuorta, nuorta pihlajaa, maitohorsmaa, mustikanvarpuja sekä pensaiden lehtiä. Oksan kuoren se syö samalla tavalla kuin ihminen syö maissin tähkää. Sillä on siis varsin näppärät sormet, joilla se kätevästi pyörittelee pksaa syödessään. Talttamaisilla hampaillaan majava kaataa puita ja vie ne patoonsa. Majava kasvaa 10-30 kg painavaksi ja on siis Suomen suurin jyrsijä. Kanadanmajavan turkki on tummanruskea, kun taas euroopanmajavan turkki on harmaanruskea. Lajit erottaa toisistaan suomuisen hännän koon ja muodon perusteella. Kanadanmajavalla on 15 cm leveä häntä ja se on takaosasta pyöreä. Euroopanmajavan häntä on 10 cm leveä ja kapenee kärkeen päin. Muuten nämä kaksi majavalajia ovat hyvin samanlaisia. Kanadanmaja on tuote Suomeen Pohjois-Amerikasta, kun taas euroopanmajava on Suomen alkuperäislajeja. Valtaosa maamme majavista on kanadanmajavia, jotka lisääntyvät tehokkaasti. Kuvateksti: Majavan talttamaiset hampaat ovat sille erinomainen apuväline. Hampaat kuluvat, kun majava jyrsii puun runkoa, mutta ne myös kasvavat kokoajan. Majavat liikkuvat pääosin pimeään aikaan. Niiden silmien päällä oleva läpinäkyvä kalvo helpottaa näkemistä veden alla. Majava osaa sulkea korvansa ja sieraimensa sukeltaessaan . Sukellus voi kestää pisimmillään vajaa 5 minuuttia. Sen sydämen lyöntitiheys harvenee merkittävästi ja lihakset alkavat toimimaan ilman happea. Puuta kaataessa majava saa hännästään erinomaista tukea. Hännästä on myös hyötyä lajitovereiden varoittamisessa. Majava läiskyttää hännällään vedenpintaa, kun se havaitsee lähestyvän uhan. Majava pystyy kantamaan kokonaisen puun. Norsu on ainoa eläin maailmassa, joka pystyy samaan. Majava kerää pensaiden oksia matoksi padon pohjalle. Sitten ne kasaavat kiviä tämän alustan päälle. Majavien padossa on kerroksittain puuta ja virran pohjalta kerättyä ainesta. Vuotokohdat majava tilkitsee mudalla. Padossa olevat risut, kivet ja oksat on aseteltu kolmion muotoon. Veden noustessa korkeammalle majava tekee patoonsa lisää kerroksia. Kun vesi on sopivalla korkeudella ei kerroksia enää tarvitse rakentaa lisää. Maailman pisimmät padot voivat olla jopa yli kilometrin mittaisia. Padon rakentamiseen voi mennä kuukausia. Pato ei pysäytä kokonaan virtaa. Majavan kiima-aika alkaa tammikuun lopulla. Helmikuun aikana vasta sukukypsään ikään tulleet majavat ovat löytäneet parinsa. Edellisvuoden parit pysyvät samoina joka vuosi. Poikaset syntyvät kesäkuuhun mennessä ja niitä on euroopanmajavalla 2-4 kappaletta ja kanadanmajavalla 3-8 kappaletta. Synnytys etenee nopeasti, sillä ensimmäinen poikanen on syntynyt usein jo muutamassa minuutissa. Osa naaraista, jotka eivät tulleet raskaaksi helmikuussa, parittelevat uudelleen keväällä. Synnytykseen valmistautumisen naaras aloittaa siivoamalla pesän. Se kantaa sinne puunlastuja ja kuivia heiniä. Uros ymmärtää poistua pesästä hyvissä ajoin ennen synnytystä. Poikaset syntyvät silmät auki ja hampaat terävinä. Niillä on myös valmiiksi melko paksu turkki . Emo huolehtii poikasistaan ensimmäisten kahden vuoden ajan. Poikaset alkavat melkein heti imemään maitoa ja ne syövät kiinteää ruokaa jo kahden viikon iässä. Poikaset ovat syntyessään 0,5 kilon painoisia. Poikasista kehittyy parissa viikossa taitavia sukeltajia.
 Kurun kuntakasvi=suopursu
 Suopursu Ledum palustre Lat. synonyymi: Rhododendron tomentosum Heimo: Kanervakasvit – Ericaceae Kasvumuoto: Monivuotinen varpu. Korkeus: 30–100 cm. Varsi pysty, haarova, puutunut, ruskea. Kukka: Teriö säteittäinen, valkoinen, 10–15 mm leveä; terälehtiä 5. Verholehtiä 5, hyvin pieniä. Heteitä 10, pitkiä. Emiö yhdislehtinen, 1-luottinen. Kukinto pysty, pitkäperäinen sarja; kukat voimakkaasti tuoksuvia. Lehdet: Kierteisesti versojen kärjissä, lyhytruotisia, talvehtivia, voimakkaasti tuoksuvia. Lapa tasasoukka, paksu, nahkea, alta ruosteenruskeakarvainen, laita ehyt, taakäänteinen. Hedelmä: Nystykarvainen, tyveltä avautuva, nuokkuva kota. Kasvupaikka: Rämeet, rämekorvet, soistumat, joskus kangasmetsät. Kukinta: Kesä–heinäkuu. Tavallisesti suopursu kasvaa soiden reunarämeillä muodostaen laajoja, melko yhtenäisiä kasvustoja. Käveleminen kukkivan varvikon halki on elämys, paitsi kukkien runsauden, myös huumaavan tuoksun takia. Suopursun tuoksu tulee haihtuvista eli eteerisistä öljyistä, kuten ledoli, palustroli ja myrseeni. Nämä yhdisteet saavat karjan ja luonnon isot nisäkkäät jättämään kasvin rauhaan, ja herkimmille ihmisillekin ne saattavat aiheuttaa päänsärkyä. Kekseliäs kansa on käyttänyt suopursua sen myrkyllisyydestä huolimatta oluen maustamiseen humalan asemesta tai sen lisäksi. Haihtuvat öljyt kiihdyttävät aluksi keskushermostoa, joten pursuoluen nauttijoista tulee sukupuolisesti kiihottuneita tai tappelunhaluisia riitapukareita. Mielialan kuohahdus menee kuitenkin pian ohi ja tilalle tulee apatia. Ja kaiken tämän seurauksena on lievimmilläänkin kaamea kohmelo – pahimmillaan suopursulla voi pilata munuaisensa kertaheitolla. Kasvista tehtyä keitettä on käytetty myös pesuvetenä karkottamaan syöpäläisiä kotieläimistä sekä hiirien häätämiseen talosta. Suopursusta saadaan myös voimakasta keltaista väriainetta. Kasvilla on taloudellisesti harmittaviakin ominaisuuksia: se on pahan kuusen tuholaisen, suopursunruosteen, väli-isäntä. Suopursu on Pohjois-Pohjanmaan maakuntakukka. Suopursusta käytettiin muutaman vuoden ajan tieteellistä nimeä Rhododendron tomentosum ja sitä ennen nykyistä eli Ledum palustre. The Plant List, johon tämän sivuston tieteelinen nimitoimikunta luottaa, liikkui ajassa tällä kertaa taaksepäin ja palauttii suopursumme tieteellisen nimen ennalleen ja siirsi samalla lajin aatelisten alppiruusujen joukosta tavalliseksi metsäkasviksi. Lähisukulainen lapinalppiruusu, Rhododendron lapponicum saa sentään pitää aatelisarvonsa edelleen.
 Kurun Olkitaipaleen Tienarin mäki
 Isoja haapoja tien molemmin puolin kuljettaessa riihelle.
 Isoja vaahteroita kuljettaessa Tienarin mäkeä alas maantielle
 Tienarintalojen ympärillä kasvavat juhannusruusut ja syreenit + vaahterat ja koivut ja ennen 3 puutarhaa. Tienarin kantatalon puutarhan takana pitkä rivi poppeleita.
 Kalevi Ojanen - sukututkimus
 Mukavat naapurit:
 Pentti ja Erja poseeraavat uuden talon vieressä.
 Elma OO:n 50-vuotisjuhlissa vuonna 1975.
 Matti lähdössä Ronimuksen Karin häihin Kurun kirkkoon ja - Seuratalolle. Vanha tykinkuula kuvan vasemmassa laidassa, mitä moni ei nosta suorille käsille.
 Raili Jakaman rannalla.
 Tienarin kantatalon päätalon vintti-ikkuna näkyy ja talon kaksi savupiippua. Heinäladon pärekatto on vaihtunut peltikattoon. Vaahtera on levittäytynyt peittäen esim. puolin kokonaan. Tauno ja Tarja pihassa.
 Kuvat on otettu 1990-luvun puolivälissä ja puustoa on tullut paljon verrattuna 1930-luvun kuvaan, missä ei näkynyt yhtään pihapuuta. Kalevi on ottanut kuvat navetan katolta. Talli -ja puuceerakennus ovat saaneet myös peltikatteen.
 Ja tämä rakennus tehty 148 vuotta myöhemmin kuin vanhiska.
 Aitta 07.08.09
 Maailman valtiot asukaluvuiltaan suurimmasta pieninpään
 Tervetuloa Ojasen sukusivuille
 Ruotsin Uumajasta Suomen Kuruun pappissuvussa.
 Segebade Von Krummenhagenin vaakuna.
 Stralsund, Pommer, Saksa
 Georg ja Mickael von Segebadenien allekirjoitukset.
 Kesäinen päivä otettu luultavasti vuoden 1900 tienoilla, kuva on Kylpylaitoksen puistosta eli nykyisestä Kirjastotalon puistosta. Alun perin tähän piti perustaa puisto nimeltä Vainisen rantapuisto.
 Erich Vaininen, nimismies Pirkkalan Tammerkoskella. Virkatalo oli Tampereen teatterin kohdalla.
 Michael Schultz, Turku s.1741 k.16.06.1793 Aatelinen, varakas porvari - laivanvarustaja - kauppiassuku lähtöisin Saksasta.
 Johan Winter työskenteli 1646 jälkeen kisällinä akatemian kirjanpainajan Johan Vogelin luona tartossa. Heidät vihittiin 05.07.1668 Glanshammerin kirkossa Örebron, Winterin syntynäkaupungin läheisyydessä, kuten hääkirjoitus osoittaa . Vaimo, Christina Esywinintytär Herweg, kuoli 02.08.1691 ja haudattiin Turun Tuomiokirkon saarnastuolin alle pääkäytävän varrelle. (Saarnastuolin ja keskilaivan pääkäytävän välissä on puinen Winterin muistolaatta). Vaimon hautapaikka on ostettu, kuten sen ajan porvareilla oli tapana, 120 taalerilla. Johan Winterin veljenpoika on haudattu kirkon eteläsivulle, ulos. Johan Winter oli suomenkielisen raamatun painaja (ainakin osin), josta maksettiin 13 taaleria. Suomalainen rukouskirja, 3 taaleria ja useita kirjapainotöitä Tuomiokiskolle. Johan Winter syntyi Örebrossa, Ruotsissa ja kuoli 1705 Turussa.
 Kurusta tullessa Kyrönlahden jälkeen vasemmalle ennen Kolunlammea, pääsee Parmaniemeen.
 Ilmakuva, jossa näkyy Parmaniementie ja Parmaniemi melkein tien päässä olikealla puolella.
 Tampereelta tullessa Kolunlammi jää vasemmalle ja lammen jälkeen heti oikealle, viitassa lukee Parmaniemi ja osoitekyltissä Parmaniementie.
 AO:n esi-isä oli Simon Parmala, Teiskon Parmaniemestä ( tie lähtee Kyrönlahdesta, kuuluu nykyään Ylöjärveen) ,jonka poika Simon Simoninpoika Taipale s.25.08.1695 tuli Taipaleeseen vävyksi ja oli isäntänä vuosina 1722-1752, kuoli 04.02.1752
 AO:n esiäiti oli Abigael Georgentytär von Segebade s.1668 Riikassa, joka oli tuolloin Ruotsin vallan alla aina 1700-luvun alkupuolelle asti, jolloin Venäjä valloitti Riian kaupungin. Abigael Georgentytär kuoli 13.03.1758 Teiskon Kuorannassa. Abigaelin isä oli Georg Segebade Saksan Pommerin Stralsundista ja Georgen isä Saksan Krumenhagenista. (George Segebade oli ennen sotilasuraansa rakennusmestari ja armeijan palvelukseen tultuaan hän oli 3 vuotta linnoittamassa Riikaa. Vuodesta 1683 hän oli Porin rykmentin Ruoveden komppanian luutnantti. Vuonna 1695 hän lahjoitti Kurun kirkkoon suomenkielisen raamatun. Hänen virkatalonaan oli vuodesta 1690 Kurun Keihäslahden talo Kuru. Samalla paikalla sijaitsee nykyään Kurun kirkko. Ruotsi aateloi Segebadenin veljekset 06.03.1684 nimellä Segebade von Krummenhagen.
 Mommo, Pihlajalahti, Ruovesi.
 OO:n esi-isä oli Henrik Simoninpoika Ruoveden Pohjankurusta, jonka poika s.1690 Yrjö Henrikinpoika Ruoveden Mommolta muutti Kurun Olkitaipaleen Tienarille isännäksi vuosina 1729-1746, kuoli 30.04.1752
 Juho ja Sanni Tienarin perhe.
 Juho Tienari myi vuonna 1937 Tienarin puoliksi pojilleen Pentille ja Kaarlolle (Kalle). Kalle kaatui talvisodassa 23.02.1940. Sodan jälkeen Kaarlon osuus jäi hänen vaimolleen Aino Tienarille. Osuudet erotettiin sodan jälkeen Tienariksi ja Leijuksi.
 Kalle ja Maria Lahdenpohjan perhe.
 Juhon ja Sanni Tienarin 10 lapsisesta perheestä neljänneksi vanhin lapsi Kaarlo menee naimisiin Aino Lahdenpohjan kanssa 12.12.1937. Kalle ja Maria Lahdenpohjan 3 lapsisesta perheestä Aino on nuorin.
 Kalle (Kaarlo) Tienari suoritti armeijan raskaan Terijoella 1920-luvun alkupuolella.
 Kaarlo Tienari kaatui Impilahdessa 23.02.1940, talvisota päättyi 13.03.1940.
 Kuvassa näkyy miten sankarihautauksissa kirkossa lotat ovat ryhmittyneet penkkirivien päähän ja suojeluskuntapojat kunniavartioon.
 Kansalaissodan haavat arpeutuivat vasta talvisodan kynnyksellä, jolloin kansa yhtenäisenä oli valmis kohtaamaan maahan tunkeutuvan vihollisen. Maamme vapaus jouduttiin lunastamaan kuitenkin raskain uhrein, eikä surusanomilta välttyneet kurulaisetkaan kodit. Kirkkoherra Pietilä siunaamassa talvisodan uhreja viimeiselle matkalleen vuonna 1940.
 Sankarihautaan kannetaan talvisodan uhria Kaarlo Tienaria. Kantamassa ovat eturivissä Artturi ja Aarne Tienari, keskellä Matti ja Pentti Tienari, takana Unto Lahti-Nuuttila ja Jussi Keskinen.
 Kantajien takana tulee Kaarlon vaimo Aino Tienari vierellään näkymättömissä kävelee urheasti Simo Tienari. Ainon takana kävelee Kaarlon isä Juho Tienari vierellään näkymättömissä Sanni Tienari.
 Suoleluskuntapojat ovat sankarivainajan viimeisen matkan varrella määrätyin välein kunniavartiossa.
 Talvisota - paina tästä
 OO:n esiäiti oli Dordi Åkerman s. noin 1507 Ruotsin Uumajassa, mies Eric Åkerman, josta jäljempänä. He saivat viisi lasta.
 Tegin kaupunginosa Uumajassa (Umeå) Ruotsissa.
 Ojasen sukutarina alkaa Ruotsin Uumajan (Umeå) Tegin kaupunginosasta Eric Åkermanista s.1480, joka toimitti silakkaa (silloin silli-nimellä) Ruotsi-Suomen sotilaille 1500-luvun alussa. Hän toimitti omaa herkkuaan hapansilakkaa. Hapansilakoita eivät sotilaat halunneet maistaa, vaan kantelivat kuningas Kustaa Vaasalle sillin mausta. Kuningas nuhteli Åkermannia ja toimitukset lopetettiin alkuunsa. Tästä Åkerman ei huolestunut vaan otti muiden ihmeeksi nimekseen Sursill= hapansilli. Eric Sursill eli entinen Ångerman kuoli vuosien 1550-1553 välillä.
 Abigael Segebadenin hautapaasi Teiskossa unohdettuna. Abigaelin pojista tuli aatelisia: Senegade von Grummenhagen.
 Vuosi 1914.
 Räätäli Matti Kustaanpoika Ojanen s.07.09.1853 eli OO:n vaari II:n vaimonsa kanssa lapsineen. Matilla oli I-avioliitosta 5 lasta ja tästä II-sta 9 lasta. Matti kuoli 24.04.1936. Matin sisarusparvessa oli yhteensä 8 lasta. Kuvassa Matin lisäksi vaimonsa Eriika Ojanen ja lapset Eero s.04.11.1903, Paavo s.15.07.1906 ja Lyyli s.15.01.1909.
 Matti oli (Juho) Kustaa Matinpoika Tienarin s.04.02.1823 poika. Kustaalla oli 10 sisarusta. Kustaan veljestä Matti Matinpoika Tienarista s.18.10.1817 tuli Tienarin isäntä.
 OO:n vaari vasemmalla ja äiti oikealla. Keitä muut?
 Kalliomäen väki
 Kalle ja Lyyli Ojasen perhe
 Kalle ja Lyyli Ojasen 7 lapsisesta perheestä nuorin poika Osmo Ojanen menee naimisiin 23.12.1943 Aino Tienarin (os.Lahdenpohja) kanssa.
 AO ja OO
 Sisarukset vuonna 1957
 Sisarukset vuonna 2008
 Kunnallisvero ja kansaneläkemaksu v. 1952.
 Lopullinen vero ja kansaneläkemaksu vuoden 1951 tuloista.
 Aino ja Osmo Ojasen talo valmistui vuonna 1965.
 AO, AO:n veljet, vanhemmat ja isovanhemmat. Kuva vuodelta 1916. Ainon vaari Kalle Lahdenpohja s. Kurussa 12.05.1846 ja mummu Maria Lahdenpohja s. Kurussa 24.04.1849. Kyseinen kuva on oletettavasti otettu Kallen 70-vuotispäivänä.
 Edellisen kuvan henkilöt
 Lahdenpohja, Aino Ojasen koti
 Lahdenpohjan sukua ja vuoden 1948 rippikuvat.
 Jenni Virossa
 Jasper ajaa jo autoa.
 Kaksoset Eveliina ja
 Marjon ja Pasin häät 2005
 Minnan ja Jyrin häät 2009


type: wikipedia

text:
 Události
 Probíhající události
 755–763: Povstání An Lu-šana
 Úmrtí
 26. dubna – Štěpán II. – papež
 Hlava státu
 Papež – Štěpán II. (752–757) » Pavel I. (757–767)
 Byzantská říše – Konstantin V. Kopronymos (741–775)
 Franská říše – Pipin III. Krátký (751–768)
 Anglie
 Wessex – Sigeberht » Cynewulf z Wessexu
 Essex – Svvithred
 Mercie – Æthelbald » Offa (757–796)
 První bulharská říše – Vinech
 Externí odkazy
 8. století


type: legislation

jurisdiction: EU

text:
 30.7.2019
 RO
 Jurnalul Oficial al Uniunii Europene
 L 201/1
 REGULAMENTUL DE PUNERE ÎN APLICARE (UE) 2019/1271 AL COMISIEI
 din 25 iulie 2019
 de modificare a Regulamentului de punere în aplicare (UE) 2018/1848 în ceea ce privește cuantumul aflat la dispoziția României pentru rambursarea, în conformitate cu articolul 26 alineatul (5) din Regulamentul (UE) nr. 1306/2013 al Parlamentului European și al Consiliului, a creditelor reportate din exercițiul financiar 2018
 COMISIA EUROPEANĂ,
 având în vedere Tratatul privind funcționarea Uniunii Europene,
 având în vedere Regulamentul (UE) nr. 1306/2013 al Parlamentului European și al Consiliului din 17 decembrie 2013 privind finanțarea, gestionarea și monitorizarea politicii agricole comune și de abrogare a Regulamentelor (CEE) nr. 352/78, (CE) nr. 165/94, (CE) nr. 2799/98, (CE) nr. 814/2000, (CE) nr. 1290/2005 și (CE) nr. 485/2008 ale Consiliului (1), în special articolul 26 alineatul (6),
 după consultarea Comitetului pentru fondurile agricole,
 întrucât:
 (1)
 Regulamentul de punere în aplicare (UE) 2018/1848 al Comisiei (2) stabilește sumele puse la dispoziția statelor membre în vederea rambursării către beneficiarii finali în exercițiul financiar 2019. Aceste sume corespund reducerii disciplinei financiare aplicate efectiv de statele membre în decursul exercițiului financiar 2018 pe baza declarațiilor statelor membre privind cheltuielile efectuate în perioada 16 octombrie 2017-15 octombrie 2018.
 (2)
 În cazul României, declarația detaliată privind cheltuielile nu a ținut seama întru totul de pragul de 2 000 EUR care se aplică disciplinei financiare în conformitate cu articolul 8 alineatul (1) din Regulamentul (UE) nr. 1307/2013 al Parlamentului European și al Consiliului (3). Prin urmare, din motive care țin de buna gestiune financiară, în Regulamentul de punere în aplicare (UE) 2018/1848 nu a fost pusă la dispoziția României nicio sumă pentru rambursare.
 (3)
 România a informat ulterior Comisia cu privire la suma corectă a disciplinei financiare care ar fi trebuit să fie aplicată în România în exercițiul financiar 2018, în cazul în care s-ar fi ținut cont întru totul de pragul de 2 000 EUR. Pentru a se garanta că rambursarea sumelor relevante către fermierii români poate avea loc, Comisia ar trebui să stabilească suma corespunzătoare care este pusă la dispoziția României.
 (4)
 Prin urmare, Regulamentul de punere în aplicare (UE) 2018/1848 ar trebui modificat în consecință.
 (5)
 Deoarece modificarea prevăzută în prezentul regulament afectează aplicarea Regulamentului de punere în aplicare (UE) 2018/1848, care se aplică de la 1 decembrie 2018, prezentul regulament ar trebui să se aplice, de asemenea, începând cu acea dată; prin urmare, prezentul regulament ar trebui să intre în vigoare la data publicării în Jurnalul Oficial al Uniunii Europene,
 ADOPTĂ PREZENTUL REGULAMENT:
 Articolul 1
 În tabelul care figurează în anexa la Regulamentul de punere în aplicare (UE) 2018/1848, după rândul referitor la Portugalia se introduce următoarea mențiune:
 „România
 16 669 111 ”
 Articolul 2
 Prezentul regulament intră în vigoare la data publicării în Jurnalul Oficial al Uniunii Europene.
 Se aplică de la 1 decembrie 2018.
 Prezentul regulament este obligatoriu în toate elementele sale și se aplică direct în toate statele membre.
 Adoptat la Bruxelles, 25 iulie 2019.
 Pentru Comisie,
 Pentru Președinte,
 Jerzy PLEWA
 Director general
 Direcția Generală Agricultură și Dezvoltare Rurală
 (1) JO L 347, 20.12.2013, p. 549.
 (2) Regulamentul de punere în aplicare (UE) 2018/1848 al Comisiei din 26 noiembrie 2018 privind rambursarea, în conformitate cu articolul 26 alineatul (5) din Regulamentul (UE) nr. 1306/2013 al Parlamentului European și al Consiliului, a creditelor reportate din exercițiul financiar 2018 (JO L 300, 27.11.2018, p. 4).
 (3) Regulamentul (UE) nr. 1307/2013 al Parlamentului European și al Consiliului din 17 decembrie 2013 de stabilire a unor norme privind plățile directe acordate fermierilor prin scheme de sprijin în cadrul politicii agricole comune și de abrogare a Regulamentului (CE) nr. 637/2008 al Consiliului și a Regulamentului (CE) nr. 73/2009 al Consiliului (JO L 347, 20.12.2013, p. 608).


text:
Пъстрово е село в Южна България. То се намира в община Стара Загора, област Стара Загора.
 История
 Старото име на Пъстрово е Алаген. Поради опожаряване и гонения по време на османската власт, селото се премества на сегашното си местоположение от североизток. До 1959 г. с. Пъстрово е било с население 1800 души. След този период настъпва масова миграция към градовете Стара Загора, Казанлък и Чирпан, където хората намират работа в Оръжейните заводи, строителството и др., за да остане днес до 60 – 70 души.
 Поминъкът на населението преди и след 9 септември 1944 г. е производство на розово и лавандулово масло. Пъстрово има 16 500 дка земеделска земя, засадена на времето с розови и лавандулови растения, което е причина тук да се построи голяма розоварна. В Пъстрово има засадени 30 дка с розови и около 60 дка с лавандулови насаждения.
 Населението е със средна възраст 70 – 75 години. Няма земеделска кооперация. Земята не се обработва.
 На около 2 километра западно от селото се намират останките на крепостта Градище.
 Културни и природни забележителности
 Културният живот преди 1999 г. е почти замрял. През есента на 1999 година Веселин Велев изработва каменна икона на Св. Богородица и заедно с Господин Тодоров Райков и не без помощта на местното население изграждат параклис „Св. Богородица" в местността „Манастирчето". Оттогава на 28 август на този параклис се дава курбан за здраве и благополучие на населението на селото. Тази дата се превърна в Празник на селото.
 От месец март 2009 г. в селото действа и пенсионерски клуб.
 Други
 Село Пъстрово има писана история. Книгата се казва „Пъстрово – история и съдба на едно българско село“ чиито автор е Иван Тачев Пеев.
 Източници
 Села в област Стара Загора
 Населени места в община Стара Загора


jurisdiction: US

text: b" Report Template Version = 03-01-05_rev.07\n\n\n\n\nDepartment of Health and Human Services\n\n OFFICE OF \n\n INSPECTOR GENERAL \n\n\n\n\n\nSTATUS OF THE RURAL HEALTH \n\n CLINIC PROGRAM\n\n\n\n\n\n Daniel R. Levinson\n\n Inspector General \n\n\n August 2005\n\n OEI-05-03-00170\n\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n Office of Inspector General \n\n http://oig.hhs.gov\n\nThe mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452,\nas amended, is to protect the integrity of the Department of Health and Human Services\n(HHS) programs, as well as the health and welfare of beneficiaries served by those\nprograms. This statutory mission is carried out through a nationwide network of audits,\ninvestigations, and inspections conducted by the following operating components:\n\nOffice of Audit Services\nThe OIG's Office of Audit Services (OAS) provides all auditing services for HHS, either by\nconducting audits with its own audit resources or by overseeing audit work done by others.\nAudits examine the performance of HHS programs and/or its grantees and contractors\nin carrying out their respective responsibilities and are intended to provide independent\nassessments of HHS programs and operations in order to reduce waste, abuse, and\nmismanagement and to promote economy and efficiency throughout the department.\n\nOffice of Evaluation and Inspections\nThe OIG's Office of Evaluation and Inspections (OEI) conducts management and\nprogram evaluations (called inspections) that focus on issues of concern to the\ndepartment, the Congress, and the public. The findings and recommendations contained\nin the inspections reports generate rapid, accurate, and up-to-date information on the\nefficiency, vulnerability, and effectiveness of departmental programs. The OEI also\noversees State Medicaid fraud control units, which investigate and prosecute fraud and\npatient abuse in the Medicaid program.\n\nOffice of Investigations\nThe OIG's Office of Investigations (OI) conducts criminal, civil, and administrative\ninvestigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries\nand of unjust enrichment by providers. The investigative efforts of OI lead to criminal\nconvictions, administrative sanctions, or civil monetary penalties.\n\nOffice of Counsel to the Inspector General\nThe Office of Counsel to the Inspector General (OCIG) provides general legal services to\nOIG, rendering advice and opinions on HHS programs and operations and providing all\nlegal support in OIG's internal operations. The OCIG imposes program exclusions and\ncivil monetary penalties on health care providers and litigates those actions within the\ndepartment. The OCIG also represents OIG in the global settlement of cases arising\nunder the Civil False Claims Act, develops and monitors corporate integrity agreements,\ndevelops compliance program guidances, renders advisory opinions on OIG sanctions to\nthe health care community, and issues fraud alerts and other industry guidance.\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n\xce\x94 E X E C U T I V E S U M M A R Y \n\n\n\n OBJECTIVE\n To follow up on previous Office of Inspector General (OIG)\n recommendations concerning the appropriate location of Rural Health\n Clinics (RHC).\n\n\n BACKGROUND\n In 1996, OIG and the Government Accountability Office (GAO) issued\n reports that raised concerns about the inappropriate growth and\n location of RHCs. Both offices recommended changes that would ensure\n that RHCs are located in areas that would otherwise be underserved.\n Because of these reports, Congress, as part of the Balanced Budget Act\n of 1997 (BBA), amended section 1861(aa)(2) the Social Security Act to\n remove the permanent designation of RHCs and require timely review\n of shortage-designation areas. However, to date, the Centers for\n Medicare & Medicaid Services (CMS) has no regulations implementing\n the BBA\xe2\x80\x99s required changes.\n\n To be eligible for RHC status, a clinic must be located in a \xe2\x80\x9crural\xe2\x80\x9d and\n \xe2\x80\x9cunderserved\xe2\x80\x9d area. The Rural Health Clinic Services Act of 1977 (the\n Act) defines \xe2\x80\x9crural\xe2\x80\x9d as an area that the Bureau of the Census (Census)\n categorizes as a nonurbanized area. An \xe2\x80\x9cunderserved\xe2\x80\x9d area is one that\n the Health Resources and Services Administration (HRSA) designated\n as medically underserved or experiencing a physician shortage. For\n shortage areas to be eligible under the RHC Program, the BBA required\n that HRSA review and update these areas every 3 years.\n\n Under Medicare and Medicaid, RHCs receive cost-based reimbursement\n or a capped amount that is normally higher than a typical physician\n office visit. Payments for RHC services continue to increase and\n exceeded $630 million in calendar year 2002.\n\n\n FINDINGS\n Two hundred seventy-nine RHCs are located in areas that HRSA has\n not designated as shortage areas or that Census has designated as\n urbanized areas. Sixty-one percent (169) of these RHCs are located in\n areas that HRSA has not designated as shortage areas. The remaining\n 39 percent (110) are located in urbanized areas defined by Census.\n Under the BBA, these RHCs would no longer maintain their\n designations as RHCs unless they receive exceptions as essential\n providers. CMS issued final regulations for the exception process.\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M i\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nE X E C U T I V E S U M M A R Y\n\n\n However, because of a conflict with the Medicare Prescription Drug,\n Improvement, and Modernization Act of 2003, CMS withdrew the\n regulations. In the absence of regulations, it is unclear how many of\n these 279 RHCs would meet the essential provider exception.\n Another 946 RHCs are located in shortage-designated areas that\n HRSA has not reviewed or updated within a 3-year period. The BBA\n requires RHCs to be located in shortage areas that HRSA has\n designated or updated within the last 3 years. However, HRSA has not\n updated the shortage area designations for 26 percent of Health\n Professional Shortage Areas and 94 percent of the Medically\n Underserved Areas (MUA) where RHCs are located. As a result,\n 28 percent (946) of all RHCs are located in areas that do not meet the\n 3-year HRSA review requirement.\n Rural and shortage criteria do not effectively identify areas that are\n truly rural and medically underserved. Although most RHCs are\n located in areas that meet the RHC Act\xe2\x80\x99s definition of rural,\n approximately 39 percent of RHCs are located in areas that Census\n considers urban because Census uses a broader definition of urban\n areas that includes urban clusters. HRSA\xe2\x80\x99s health care shortage-\n designation methods do not adequately measure medical underservice\n in that they exclude certain primary care practitioners and rely on an\n Index of Medical Underservice that GAO identified as being unreliable.\n Current criteria result in RHC participation in areas with already\n existing health care delivery systems. RHCs are not required to\n demonstrate how they will improve access for Medicare and Medicaid\n beneficiaries. Consequently, RHCs can establish themselves near\n existing medical infrastructure with ease. For example, 90 percent of\n RHCs had three or more primary care provider sites within 25 miles of\n their locations. Two hundred sixteen RHCs (6 percent) are located in\n counties in metropolitan areas with populations over 1 million.\n\n\n RECOMMENDATIONS\n Over 7 years have passed since the enactment of the BBA and many of\n the problems identified in the previous OIG and GAO reports continue\n to exist. Attempts by CMS and HRSA to issue regulations to address\n the problems identified by these reports have not been successful.\n Because of the involvement by both HRSA and CMS with the RHC\n Program, OIG makes recommendations to both of these agencies.\n\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M ii\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nE X E C U T I V E S U M M A R Y\n\n Recommendations for HRSA\n HRSA should review shortage designations within the requisite\n 3-year period. Because the RHC Program\xe2\x80\x99s success in providing care to\n the rural underserved depends on the timeliness of HRSA\xe2\x80\x99s\n designations, HRSA should review its designations made more than\n 3 years ago to assess the need for continued designation.\n HRSA should publish regulations to revise its shortage-designation\n criteria. HRSA should issue regulations that would improve its\n shortage-designation criteria. These regulations should consider\n expanding the definition of a practitioner to appropriately account for\n the care that nurse practitioners and physician assistants provide.\n HRSA should also consider revising the MUA\xe2\x80\x99s Index of Medical\n Underservice to include more precise measures of health status.\n Recommendations for CMS\n CMS should issue regulations to ensure that RHCs determined to be\n essential providers remain certified as RHCs. While we recognize\n that CMS did issue final regulations for the RHC Program and had to\n withdraw them, the lack of final regulations allows RHCs that no longer\n meet eligibility criteria to continue to receive cost-based reimbursement\n or a capped amount.\n CMS should seek legislative authority or administratively require\n RHC applicants to document need and impact on access to health\n care in rural underserved areas. Because current law limits CMS\xe2\x80\x99s\n ability to define rural and shortage areas, CMS could better ensure\n access to care for Medicare and Medicaid beneficiaries by imposing\n access requirements in addition to location requirements. In its\n comments to GAO\xe2\x80\x99s 1996 report, the Department of Health and Human\n Services agreed that the shortcomings of the RHC certification process\n would be best addressed by reviewing other factors, such as need and\n community impact, in addition to the shortage designation and rural\n location.\n\n\n AGENCY COMMENTS\n HRSA concurred with our recommendations that it should review\n underserved designations that it has not updated in the last 3 years and\n that HRSA should publish regulations to revise its shortage designation\n criteria. HRSA also provided technical comments for which we made\n revisions where appropriate.\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M iii\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nE X E C U T I V E S U M M A R Y\n\n\n CMS concurred with the recommendation that it issue regulations to\n ensure that RHCs determined to be essential remain certified as RHCs.\n CMS is further considering our recommendation that CMS should seek\n legislative authority to require RHCs applicants to document need and\n impact on access to care as a requirement to receiving certification as an\n RHC.\n\n\n OFFICE OF INSPECTOR GENERAL RESPONSE\n We appreciate both HRSA\xe2\x80\x99s and CMS\xe2\x80\x99s response to our report. It is\n important that HRSA is implementing an automated application and\n review process that will reduce the review time for determining whether\n areas meet the underserved criteria. It is also important that CMS is\n committed to reissuing proposed and final regulations that would allow\n it to terminate those clinics that do not meet the basic location\n requirements unless they demonstrate that the clinics are essential\n community providers for their service areas.\n\n We continue to believe that requiring current and prospective RHCs to\n provide additional evidence of community need would further the goal of\n assuring that RHCs are directed and maintained in rural communities\n with critical shortages of primary care providers. The establishment of\n further criteria would help limit the creation of new RHCs in areas with\n a concentration of viable providers but, more importantly, it would\n encourage the establishment of RHCs in areas with unmet need.\n\n\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M iv\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n\xce\x94 T A B L E O F C O N T E N T S \n\n\n\n\n EXECUTIVE SUMMARY ....................................\ni\n\n\n INTRODUCTION ........................................... 1\n\n\n\n\n FINDINGS ................................................. 8\n\n RHCs located in noneligible areas . . . . . . . . . . . . . . . . . . . . . . . . . . 8 \n\n\n Shortage designations are untimely. . . . . . . . . . . . . . . . . . . . . . . . . 8 \n\n\n Criteria continue to cause problems. . . . . . . . . . . . . . . . . . . . . . . . . 9 \n\n\n Current criteria result in RHC concentration . . . . . . . . . . . . . . . . 11 \n\n\n\n\n R E C O M M E N D A T I O N S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 \n\n\n\n E N D N O T E S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 \n\n\n\n\n A P P E N D I X E S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 \n\n A: RHCs by Rural-Urban Continuum Codes. . . . . . . . . . . . . . . . . 19 \n\n\n B: Agency Comments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 \n\n\n\n A C K N O W L E D G M E N T S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 \n\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n\xce\x94 I N T R O D U C T I O N \n\n\n\n OBJECTIVE\n To follow up on previous Office of Inspector General (OIG)\n recommendations concerning the appropriate location of Rural Health\n Clinics (RHC).\n\n\n BACKGROUND\n In 1996, OIG issued a report that concluded that RHCs might not be\n located in appropriate locations. Based on these findings, OIG\n recommended that RHCs be located in shortage areas with accurate and\n up-to-date designations and that RHCs no longer meeting these criteria\n should lose their certification. Finally, OIG recommended that in\n addition to meeting the rural underserved designations, the Centers for\n Medicare & Medicaid Services (CMS) should require RHCs to document\n health care needs and anticipate how their establishment will impact\n this need in their community. Because of this report and a report\n issued by the Government Accountability Office (GAO), Congress\n required, as part of the Balanced Budget Act of 1997 (BBA), several\n changes to improve the RHC Program, which is codified at section\n 1861(aa) of the Social Security Act. This inspection reviews the RHC\n Program since passage of this law.\n The Rural Health Clinic Program\n The Rural Health Clinic Services Act of 1977 (RHC Act), Public\n Law 95-210, authorized the RHC Program in 1977. According to House\n Report No. 95-548(I), the purpose of the RHC Program was to address\n the problem of an inadequate supply of physicians serving Medicare and\n Medicaid beneficiaries in rural areas. At the time, many rural\n communities were unable to attract or sustain primary care physicians,\n and had come to rely on mid-level practitioners, such as physician\xe2\x80\x99s\n assistants and nurse practitioners for primary care services. However,\n Medicare and Medicaid did not generally reimburse the services\n delivered by these nonphysician practitioners. The RHC Act authorized\n Medicare and Medicaid reimbursement for services provided by\n nonphysician primary care practitioners in RHCs.\n\n For operating in rural underserved areas, the RHC Act provides clinics\n certified as RHCs a payment rate for the care of Medicare beneficiaries\n equal to the lower of their reported costs or a predetermined capped\n amount. The capped amount in 2003 was $66.72 per encounter,\n compared to $51.13 for a typical office visit to a physician.\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 1\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nI N T R O D U C T I O N\n\n\n CMS is responsible for overseeing the RHC Program. To be eligible,\n applicants must meet two criteria related to location. First, the clinic\n must be located in an area that meets the RHC Act\xe2\x80\x99s definition of rural.\n Second, the RHC Act requires that the clinic be located in a Health\n Resources and Services Administration (HRSA) designated shortage\n area.\n\n As of May 2003, there were 3,340 RHCs located in 1,500 counties in\n 44 States. The number of RHCs in the States ranged from Texas with\n the most RHCs at 336, to Rhode Island with only 1 RHC. In calendar\n year 2002, Medicare spent approximately $312 million and Medicaid\n spent approximately $321 million on RHC services.1\n Definition of Rural\n Under the RHC Act, clinics applying for the RHC Program must not be\n located in an urbanized area as defined by the Bureau of the Census\n (Census).2 Census defines \xe2\x80\x9curbanized areas\xe2\x80\x9d as those with a population\n of over 50,000; consequently, CMS considers all areas with populations\n under 50,000 as rural.\n\n For the 2000 Census, Census established a new designation for\n midsized areas to better distinguish the nation\xe2\x80\x99s urban and rural areas.\n In March 2002, Census issued final regulations to expand its definition\n of \xe2\x80\x9curban\xe2\x80\x9d to include all territory, population, and housing units located\n within an:\n o \t urbanized area \xe2\x80\x93 areas with populations of 50,000 or more, or\n\n o \t urban cluster \xe2\x80\x93 areas with populations of more than 2,500, but\n less than 49,999.\n These new, broader definitions do not apply to the RHC Program\n because the language of the RHC Act specifies that clinics cannot be\n located in an \xe2\x80\x9curbanized area\xe2\x80\x9d and makes no mention of \xe2\x80\x9curban\n clusters.\xe2\x80\x9d\n Definition of a Shortage Area\n The RHC Act also requires that clinics be located in a HRSA designated\n shortage area. HRSA is responsible for identifying areas with shortages\n of primary care physicians and health care services. HRSA designates\n shortage areas for the purpose of directing placement of providers or\n program funding for nearly 30 departmental programs focused on\n alleviating access problems in such locations.\n\n\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 2\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nI N T R O D U C T I O N\n\n\n For the RHC Program, CMS relies on two of HRSA\xe2\x80\x99s methods to identify\n shortage areas. One designates Health Professional Shortage Areas\n (HPSA), and the other designates Medically Underserved Areas (MUA).\n\n In applying the HPSA designation, HRSA identifies areas in which\n there is a shortage of medical professionals in relation to the population\n or which contains a population group that HRSA determines has such a\n shortage. HRSA developed the HPSA system in 1978 as a way to\n designate areas for placement of National Health Service Corps\n providers. Section 332 of the Public Health Service Act requires HRSA\n to review HPSA designations annually. HRSA implemented this\n requirement by requiring HPSAs to provide new data every 3 years. As\n a result, in any given year HRSA reviews new data for one-third of the\n HPSAs.\n\n In 2002, Congress passed the Health Care Safety Net Amendments of\n 2002 (Public Law 107-251), which amended section 332 of the Public\n Health Service Act to provide an automatic HPSA designation for clinics\n meeting the \xe2\x80\x9ccharges for services\xe2\x80\x9d requirements. To meet the \xe2\x80\x9ccharges\n for services\xe2\x80\x9d requirements, a clinic must: (1) prepare a fee schedule\n with adjustments made on the basis of the patient\xe2\x80\x99s ability to pay, and\n (2) not deny health services to individuals because of inability to pay.\n For an RHC to obtain automatic HPSA designation, HRSA requires an\n RHC to submit a Certificate of Eligibility and reflect \xe2\x80\x9ccharges for\n services\xe2\x80\x9d requirements in its Policies and Procedures Manual. An\n automatic HPSA designation is valid for 6 years and is renewable for\n additional 6-year periods.\n\n The MUA method identifies areas not receiving adequate health\n services for a variety of reasons, including provider shortages.\n Developed in 1973, based on an amendment to the Public Health\n Service Act, HRSA uses the MUA designation primarily to identify\n areas eligible to participate in the Community Health Center program.\n HRSA calculates an Index of Medical Underservice using four factors.\n These four factors are: (1) primary care physician-to-population ratio,\n (2) infant mortality rate, (3) percentage of population below the poverty\n level, and (4) percentage of the population aged 65 and older.\n\n In addition, HRSA may designate areas as underserved at the request\n of a State\xe2\x80\x99s Governor. The Governor can select these areas based on\n unusual local conditions.\n\n States are responsible for submitting a list of MUAs and Governor-\n designated areas to HRSA for approval. HRSA is responsible for\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 3\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nI N T R O D U C T I O N\n\n\n surveying and updating HPSAs. Unlike HPSAs, MUAs and Governor-\n designated areas are not subject to statutory requirements for regular\n review and update.\n\n In 1996, Congress passed the Health Centers Consolidation Act\n requiring HRSA to consolidate its HPSA and MUA definitions into one\n system known as \xe2\x80\x9cmedically underserved population.\xe2\x80\x9d On\n September 1, 1998, HRSA published in the Federal Register a Notice of\n Proposed Rulemaking [62 Federal Register 46537-46555], proposing\n updates to the HPSA and MUA designations. This update would have\n required a 3-year review for all shortage area designations. However,\n according to HRSA, due to the volume of comments received expressing\n concerns that the proposed new methods would eliminate many\n providers currently participating in departmental programs, it\n withdrew the proposed regulations.\n\n As of June 2005, HRSA has yet to issue final regulations on the\n shortage-designation process. HRSA has not issued any further\n guidance regarding shortage designations.\n Previous Assessments of the RHC Program\n In July 1996, OIG issued a report entitled \xe2\x80\x9cRural Health Clinics:\n Growth, Access, and Payment\xe2\x80\x9d (OEI-05-94-00040). The report\n concluded that RHCs might not be located in true shortage areas\n because some designations were outdated or inappropriate.\n Additionally, the report recognized that, as intended by the law, RHCs\n might provide increased access to care in some areas. However, there\n were no reliable data to measure the effect of RHCs on access to care.\n Based on these findings, OIG recommended that CMS, along with\n HRSA, modify the certification process to increase State involvement\n and ensure the strategic placement of RHCs. OIG also recommended\n that RHCs be located in shortage areas with accurate and up-to-date\n designations and that those no longer meeting the criteria lose their\n certification. Finally, OIG recommended that in addition to meeting the\n rural underserved designations, CMS should require RHCs to document\n the need for health care services and anticipate how their establishment\n will impact the communities\xe2\x80\x99 need.\n\n CMS and HRSA agreed with most of OIG\xe2\x80\x99s recommendations. CMS\n indicated that it would rely on HRSA to publish new regulations to\n revise the current shortage area designation system. HRSA accepted\n this responsibility and stated that, in addition, it would collaborate with\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 4\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nI N T R O D U C T I O N\n\n\n CMS in determining how to increase State involvement in the\n certification process.\n\n In November 1996, GAO issued a report that echoed many of the OIG\xe2\x80\x99s\n findings and recommendations. \xe2\x80\x9cRural Health Clinics: Rising Program\n Expenditures Not Focused on Improving Care in Isolated Areas\xe2\x80\x9d\n (HEHS-97-24) stated that the RHC Program had grown rapidly, but not\n in locations where Medicare and Medicaid populations were having\n difficulty obtaining primary care. GAO found the growth was\n concentrated in areas with established health care systems and RHCs\n were not decreasing the distance patients traveled to obtain health care.\n GAO concluded that broad eligibility criteria allowed RHCs to\n proliferate in areas where the need was minimal.\n\n As did OIG, GAO recommended a legislative change that would restrict\n RHC certification to clinics in areas either with no other Medicare or\n Medicaid providers or to clinics demonstrating that existing providers\n will not accept new Medicare or Medicaid patients and that the clinics\n will expand access to these patients. In response, the Secretary of the\n Department of Health and Human Services (HHS) stated that current\n RHC Program eligibility criteria for defining rural and underserved\n areas do not go far enough to ensure that the program is directed and\n maintained in rural communities with critical shortages of primary care\n providers. The Secretary requested that HRSA improve its designation\n process for HPSAs and MUAs and require clinics applying for RHC\n certification to provide documentation of the need for health care\n services in the target community.\n Improvements to the RHC Program: The Balanced Budget Act of 1997\n Based on OIG and GAO work on the RHC Program, Congress amended\n the provision of the RHC Act that allowed RHCs to remain permanently\n designated (known as the \xe2\x80\x9cgrandfather\xe2\x80\x9d provision) even if they no longer\n met the rural and shortage area criteria. This change required CMS to\n establish criteria to determine if those RHCs no longer meeting location\n requirements continue to be essential to the delivery of primary health\n care. The BBA also required that RHCs be located in areas that HRSA\n has reviewed within the previous 3-year period.\n\n In December 2003, CMS issued regulations implementing the changes\n required by the BBA in its final regulations for RHC certification\n [68 Federal Register 74791-74818 (12/24/2003)]. CMS withdrew the\n final regulations based on a provision in the Medicare Prescription\n Drug, Improvement, and Modernization Act (MMA) of 2003 (Public Law\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 5\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nI N T R O D U C T I O N\n\n\n 108-173), which required that regulations take no longer than 3 years\n from the time an agency proposes them until they are final. CMS is\n planning to issue a new Notice of Proposed Rulemaking requesting\n public comments on regulations implementing the changes required by\n the BBA.\n\n\n METHODOLOGY\n Data Collection\n For our data collection, we pulled information on all certified RHCs\n active as of May 2003 using CMS\xe2\x80\x99s Online Survey Certification and\n Reporting (OSCAR) system. To determine an RHC location, we\n obtained address information from OSCAR for all active RHCs. We also\n obtained address information for general short term hospitals, including\n Critical Access Hospitals (CAH) and Federally Qualified Health Centers\n (FQHC). FQHCs are clinics receiving grants under the Public Health\n Service Act or meeting the requirements for receiving a grant. We also\n reviewed Medicare\xe2\x80\x99s Participating Physician Directory for selected\n counties.\n\n From Census, we obtained files from the Topologically Integrated\n Geographic Encoding and Referencing system for each of the counties in\n which an RHC was located. Using the Geographic Information System\n of SAS\xc2\xae, we geographically encoded the physical location of RHCs,\n general short term hospitals (including CAHs), and FQHCs. This\n encoding process determines the latitude and longitude of the location\n based on the street address, city, State, and zip code.\n Analysis\n To determine if RHCs meet the rural location requirement, we created\n county maps from the Topologically Integrated Geographic Encoding\n and Referencing files that displayed the urbanized areas. We also\n plotted urban clusters for 1,500 counties in which RHCs are located.\n Using the geographically encoded information, we plotted the location of\n RHCs, general short term hospitals (including CAHs), and FQHCs\n relative to urbanized areas and urban clusters in a county.\n\n To determine whether RHCs are located within shortage-designation\n areas, we accessed HRSA\xe2\x80\x99s Geospatial Data Warehouse, which captures\n the designation of underserved areas. Using this data warehouse, we\n were able to determine whether a clinic was located in a HPSA, MUA,\n Governor-designated area, or a combination of the three. Also using\n HRSA data, we were able to determine the most recent certification of\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 6\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nI N T R O D U C T I O N\n\n\n the shortage area for HPSAs, MUAs, and Governor-designated areas.\n We also obtained the current list of RHCs that have received automatic\n HPSA designation based on the Health Care Safety Net Amendments of\n 2002.\n\n To compare the location of RHCs in relation to other primary care\n providers in a service area, we plotted the addresses of our selected\n primary care provider types within a 25-mile radius. We selected\n 25 miles because it is one of the tests HRSA applies to determine a\n service area. This mileage translates into approximately 30 minutes of\n travel time accessing interstates and primary roads. Although HRSA\n also calculates 30 minutes travel time using other road conditions3, we\n selected the 25-mile test as a reasonable proxy for a service area.\n\n To understand the complexities of the RHC Program\xe2\x80\x99s location criteria,\n we reviewed all relevant laws and regulations. We also interviewed\n staff in CMS central office, selected CMS regional and State officials,\n and HRSA officials about the RHC Program.\n Scope\n This inspection only reviewed RHC Program eligibility criteria related\n to the location of clinics. We did not review other criteria RHCs must\n meet to receive RHC status.\n\n In our analysis of the number of primary health care sites within a\n 25-mile service area, we only included short term hospitals (including\n CAHs), FQHCs, and RHCs to provide a conservative estimate of the\n types of primary care facilities available in the area. Our estimates are\n conservative in that we did not analyze the number of primary care\n practitioners (i.e., doctors, nurse practitioners, or physician assistants)\n at each of the provider sites in an area.\n We did not attempt to measure the adequacy of service in an area or to\n evaluate how an area\xe2\x80\x99s service compared to HRSA\xe2\x80\x99s shortage-\n designation criteria. Finally, we did not attempt to determine whether\n RHCs had an impact on access to health care in rural underserved\n areas, as it was beyond the scope of our study.\n\n Our review was conducted in accordance with the \xe2\x80\x9cQuality Standards\n for Inspections\xe2\x80\x9d issued by the President\xe2\x80\x99s Council on Integrity and\n Efficiency.\n\n\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 7\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n\xce\x94 F I N D I N G S \n\n\n\n\nTwo hundred seventy-nine RHCs are located in Sixty-one percent (169) of these\n areas HRSA has not designated as shortage RHCs are located in areas that\n areas or Census has designated as urbanized HRSA has not designated as\n shortage areas. The remaining\n areas\n 39 percent (110) are located in\n urbanized areas defined by Census.\n\n While some of these RHCs will meet the eligibility criteria once HRSA\n reviews and continues the area\xe2\x80\x99s shortage designation, other RHCs will\n have to seek an exception for continued certification as an essential\n provider. CMS published regulations that would have allowed RHCs\n that no longer meet the eligibility criteria to apply for exceptions as\n essential providers. However, CMS withdrew these regulations because\n of a conflict with the MMA.\n\n Although the BBA requires that\nAnother 946 are located in shortage-designated RHCs be located in shortage areas\n areas that HRSA has not reviewed or updated that are reviewed every 3 years, we\n within a 3-year period found that 28 percent of RHCs are\n located in areas where status has\n not been reviewed within this timeframe. Since HRSA\xe2\x80\x99s designations\n for some areas have not been reviewed within a 3-year period, it is\n unknown whether these areas still satisfy criteria for a qualifying\n shortage designation for the RHC Program.\n HRSA has not reviewed 94 percent of the MUAs where RHCs are located\n within the previous 3-year period.\n Ninety-four percent of MUAs with RHCs do not meet the 3-year update\n requirement set forth in the BBA. HRSA does not have a required\n schedule for updating MUAs.\n\n HRSA has not reviewed 59 percent of all MUA designations with RHCs\n in over 25 years. The length of time since an area\xe2\x80\x99s original MUA\n designation raises questions about the area\xe2\x80\x99s continued need for such a\n designation.\n HRSA has not reviewed 26 percent of HPSA designations where RHCs are\n located within the required 3-year period.\n Since January 2001, HRSA has not established or reviewed 26 percent\n of the HPSAs wherein RHCs are located. HRSA fails to meet the BBA\xe2\x80\x99s\n requirement for HPSA updates and does not comply with its own HPSA-\n specific requirement for 3-year updates. HRSA requires each HPSA to\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 8\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nF I N D I N G S\n\n\n submit an updated application every 3 years for review, yet 26 percent\n had not been reviewed during the required 3-year period.\n\nRural and shortage criteria do not effectively Problems with the RHC program\n were noted in the past and\n measure the areas that are truly rural and\n unsuccessful attempts were made\n underserved\n by CMS and HRSA to correct them.\n Our recent work in this area indicates that these problems still exist.\n CMS is limited by the RHC Act\xe2\x80\x99s definition of rural.\n Although most RHC locations are appropriate given the RHC Act\xe2\x80\x99s\n limited definition of rural, approximately 39 percent of RHCs are\n located in areas that Census considers urban using its expanded\n definition of urban areas. Only RHCs located in \xe2\x80\x9curbanized areas,\xe2\x80\x9d as\n defined by Census, would not meet the statutory requirement to be\n certified as RHCs. All other RHCs, including RHCs located in areas\n defined by Census as \xe2\x80\x9curban clusters,\xe2\x80\x9d meet the statutory criteria to be\n certified. Census uses the term \xe2\x80\x9curbanized area\xe2\x80\x9d as only one component\n of its definition of urban. The Census\xe2\x80\x99s complete definition of urban also\n includes \xe2\x80\x9curban clusters,\xe2\x80\x9d which are areas with a population between\n 2,500 and 49,999.4\n Applying other Federal criteria that measure urban influence reveals\n that RHCs are currently located in areas with significant urban\n influence. For example, in defining rural for the Medicare program,\n CMS has consistently used the definition of a Metropolitan Statistical\n Area as established by the Office of Management and Budget (OMB).\n Using OMB\xe2\x80\x99s definition, 25 percent of current RHCs are located in\n metropolitan areas that would not qualify as rural under OMB\xe2\x80\x99s\n criteria.\n Using the Department of Agriculture\xe2\x80\x99s Rural-Urban continuum codes,\n we found 834 RHCs located in metropolitan areas. Of these RHCs,\n 216 are located in counties in metropolitan areas with populations in\n excess of 1 million, 317 are located in counties in metropolitan areas\n with populations between 250,000 and 1 million, and 301 are located in\n counties in metropolitan areas with populations under 250,000. At the\n other end of the spectrum, we found only 413 RHCs, or 12 percent of all\n RHCs, located in completely rural counties not adjacent to a\n metropolitan county. These codes distinguish \xe2\x80\x9cmetropolitan (metro)\n counties by the population size of their metro area, and nonmetropolitan\n (nonmetro) counties by degree of urbanization and adjacency to a metro\n\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 9\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nF I N D I N G \nS\n\n\n area or areas.\xe2\x80\x9d5 See Appendix A for a complete breakdown of RHCs\n categorized by Rural-Urban continuum codes.\n CMS relies on HRSA\xe2\x80\x99s health care shortage-designation systems which do\n not adequately measure underservice.\n According to GAO, the accuracy of HRSA\xe2\x80\x99s shortage-designation\n systems used for RHC certification is questionable for two reasons.\n First, HRSA\xe2\x80\x99s systems do not consider all primary care resources when\n determining the need for additional practitioners. Second, the MUA\xe2\x80\x99s\n Index of Medical Underservice does not yield current and effective\n information on an area\xe2\x80\x99s supply of health care services.\n\n HRSA has yet to revise the shortage-designation systems, despite the\n fact that both the Health Centers Consolidation Act of 1996 and the\n BBA require such improvements. HRSA\xe2\x80\x99s 1998 proposed regulations\n would have implemented the required changes, but HRSA withdrew\n those proposed regulations and has yet to release a new rule. As a\n result, the RHC Program is still relying on shortage-designation\n systems that do not accurately reflect the availability of health care\n professionals and medical services in an area.\n The ratio HRSA uses to measure physician shortages overstates them.\n Although the RHC Act expanded the definition of primary care provider\n to include nurse practitioners and physician\xe2\x80\x99s assistants, the current\n MUA and HPSA systems\xe2\x80\x99 ratio of practitioners-to-population excludes\n these mid-level practitioners from its calculations. Originally, HHS\n planned to include these practitioners as 0.5 equivalent of a full-time\n physician, but excluded them because the scope of practice varied so\n much by State. GAO\xe2\x80\x99s 1995 report found that because HRSA\xe2\x80\x99s\n methodology omits nurse practitioners and physician\xe2\x80\x99s assistants, the\n measure might overstate the need for additional physicians in HPSAs\n by 50 percent or more. In 1998, HRSA proposed once again to include\n these health care professionals as 0.5 of a full-time physician in the\n ratio, but as noted above, withdrew the proposed rule.\n HRSA\xe2\x80\x99s Index of Medical Underservice has been shown to be an ineffective\n measure of the availability of medical services. According to GAO\xe2\x80\x99s\n 1995 report, HRSA\xe2\x80\x99s Index of Medical Underservice used to designate\n MUAs is ineffective for two reasons. First, the methodology HRSA used\n to develop the index is not based on \xe2\x80\x9ca clearly defined concept of medical\n underservice.\xe2\x80\x9d6 Second, HRSA\xe2\x80\x99s system for designating an MUA\n compares an area\xe2\x80\x99s current conditions to a median score on an index of\n medical underservice set in 1975. The threshold score for the MUA\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 10\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nF I N D I N G S\n\n\n status has remained the same, except for minor changes made in\n 1981 when HRSA adjusted the weights for the infant mortality rate and\n population-to-physician ratio.\n\n MUAs based on a score that uses standards from 1975 may not\n accurately reflect the availability of medical services in an area. For\n example, an analysis done by GAO found that less than half of the\n counties designated by HRSA as MUAs would qualify as MUAs using\n 1990 data.\n\n Current eligibility criteria result in RHC CMS\xe2\x80\x99s current eligibility\n criteria do not require\n participation in areas with already existing\n new RHCs applicants to\n health care delivery systems\n demonstrate how they\n will improve access for Medicare and Medicaid beneficiaries.\n Consequently, RHCs can easily establish themselves near existing\n medical infrastructure. For example, 90 percent of RHCs had three or\n more primary care provider sites within 25 miles of their locations. Ten\n percent of RHCs had 21 or more primary care sites located within\n 25 miles. These primary care sites include general short term hospitals\n (including CAHs), FQHCs, or other RHCs. We found that only 3 percent\n of RHCs have no other primary care within 25 miles of their locations.\n The following figure demonstrates an example of the concentration of\n RHCs and other primary care providers.\n\n Figure 1, representing an actual county, demonstrates an example of\n the concentration of short term hospitals (including CAHs), FQHCs, and\n RHCs. In this example, there are 13 short term hospitals, 26 RHCs,\n and 12 FQHCs located in the county, which has an area of\n approximately 6,000 square miles. All RHCs are located within 25\n miles of five or more primary care sites.\n\n\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 11\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n F I N D I N G S\n\n\n\nFigure 1\nExample of concentration of RHCs, FQHCs,\nand hospitals\n\n\n\n\n Source: Office of Inspector General analysis of OSCAR and Census data, 2005\n\n\n\n Another example is a county that has a total population of\n approximately 62,000, with 7 primary cities ranging in population from\n 700 to 8,000. Approximately 10,000 of the total county\xe2\x80\x99s population are\n Medicare eligible and there are approximately 6,000 Medicaid\n beneficiaries. The county has seen a 15.5 percent increase in population\n from 1990 to 2000. HRSA designated the county as a HPSA that was\n last updated in September 2001.\n\n Using OSCAR data, we identified 13 RHCs located across the\n approximate 700 square miles of the county. These clinics are in\n addition to 110 primary care physicians with 1 or more locations within\n the county and 4 general short-term hospitals. The average distance\n between each RHC in the county is 15.5 miles considerably less distance\n than the traditional 25-mile or 30-minute travel time test HRSA\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 12\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nF I N D I N G S\n\n\n employs to determine appropriate service areas. All 13 RHCs have at\n least 3 other RHCs located within 15 miles of their locations.\n\n\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 13\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n\xce\x94 R E C O M M E N D A T I O N S \n\n\n\n\n\n The RHC Program\xe2\x80\x99s criteria related to location are not specific enough\n to ensure that the program\xe2\x80\x99s outcomes coincide with its goal to provide\n increased access to care for those Medicare and Medicaid beneficiaries\n living in rural communities with a shortage of primary care providers.\n Congress specifically created the RHC Program to benefit areas where\n population densities were insufficient to attract and retain physicians.\n Yet, it appears the current rural and shortage definitions may not direct\n placement of RHCs to areas of greatest need or prevent the addition of\n RHCs in areas with sufficient care.\n Our analysis, as well as the 1996 OIG and GAO evaluations of the RHC\n Program, demonstrates that the RHC Program\xe2\x80\x99s basic eligibility\n requirements related to location may not address issues of Medicare and\n Medicaid beneficiaries\xe2\x80\x99 underservice in the way Congress intended. As\n it stands, CMS provides no quantifiable assurance that the Federal and\n State dollars spent each year on the RHC Program improve access to\n care in underserved areas.\n\n The efforts of Congress, CMS, and HRSA to improve the RHC eligibility\n criteria have been unsuccessful. There are still issues related to the\n effectiveness of the shortage and rural location criteria resulting in\n RHCs participation in some service areas with extensive networks of\n health care providers.\n Recommendations for HRSA\n\n HRSA should review the underserved designations for the areas that have\n not been updated in the last 3 years.\n The RHC Program\xe2\x80\x99s success in providing care to the rural underserved\n depends on HRSA\xe2\x80\x99s actions to review and update its shortage\n designations. Specifically, we recommend that HRSA review the areas\n with shortage designations more than 3 years old to assess the areas\xe2\x80\x99\n designations.\n\n HRSA\xe2\x80\x99s proposed rules of 1998 would have required a 3-year review of\n all shortage designations to ensure that programs using these\n designations receive accurate, updated information to make funding\n decisions. Due to the importance of these designations to the RHC\n program as well as to other departmental programs, HRSA should give\n priority to the review of shortage areas older than 3 years.\n\n\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 14\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nR E C O M M E N D A T I O N S\n\n\n HRSA should publish regulations to revise its shortage-designation criteria.\n To operate as effective eligibility criteria for the RHC Program, HRSA\xe2\x80\x99s\n shortage-designation methods need improvement. We recommend that\n HRSA revise the designation methods\xe2\x80\x99 criteria to improve the way it\n identifies shortage areas. In this revision, HRSA should develop new\n measures of health status and new methodologies for the designation\n systems. Additionally, HRSA should implement the requirement to\n review all designations every 3 years for all the programs that use the\n HPSA and MUA criteria.\n Recommendations for CMS\n CMS should issue regulations to ensure that RHCs determined to be\n essential providers remain certified as RHCs.\n Over 7 years have passed since the enactment of the BBA and many of\n the problems identified in the previous OIG and GAO reports continue\n to exist. While we recognize that CMS published final regulations for\n the RHC Program and had to withdraw them, the lack of regulations\n may be allowing RHCs that no longer meet eligibility criteria to\n continue to receive cost-based reimbursement.\n CMS should seek legislative authority or administratively require RHC\n applicants to document need and impact on access to health care in rural\n underserved areas.\n We believe the apparent ease with which the RHCs meet current\n location criteria has created payment incentives to locate RHCs in\n service areas that already have extensive health care delivery systems\n for Medicare and Medicaid beneficiaries. Because current law limits\n CMS\xe2\x80\x99s ability to define rural and shortage areas, CMS could better\n ensure access to care for Medicare and Medicaid beneficiaries by\n requiring clinics to meet other RHC eligibility factors in addition to the\n location requirements.\n\n This recommendation is consistent with prior OIG and GAO\n recommendations. In its comments to GAO\xe2\x80\x99s 1996 report, HHS agreed\n that the shortcomings of the RHC certification process would be best\n addressed by reviewing other factors, such as need and community\n impact, in addition to the shortage designation and rural location.\n Despite this statement, CMS has not added additional eligibility criteria\n for RHC certification. CMS has not developed any performance\n measures related to RHC Program goals, making it difficult to assess\n what impact, if any, RHCs have on improving beneficiaries\xe2\x80\x99 access to\n care.\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 15\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nR E C O M M E N D A T I O N S\n\n\n The final regulations that CMS withdrew indicated that the agency\n intended to implement our recommendation for some existing RHCs,\n but not for new applicants. Section 4205(d) of the BBA requires CMS to\n terminate RHC status for clinics no longer located in rural or\n underserved areas, except for those RHCs that are determined to be\n essential to the delivery of primary care. Under the regulations that\n CMS withdrew, clinics receiving essential provider status would have\n had to meet certain conditions designed to demonstrate how the clinic\xe2\x80\x99s\n presence affects the health care of the community. For example, an\n RHC would have had to show that it is the only participating primary\n care provider actively accepting and treating Medicare, Medicaid, and\n low-income beneficiaries within 30 minutes travel time, or that it treats\n a majority of these beneficiaries compared to other providers in close\n proximity, including other RHCs.\n\n We believe that requiring current and prospective RHCs to provide\n additional evidence of community need would further the goal of\n assuring that RHCs are directed and maintained in rural communities\n with critical shortages of primary care providers. The establishment of\n further criteria would help limit the creation of new RHCs in areas with\n a concentration of viable providers, and more importantly, it would\n encourage the establishment of RHCs in areas with unmet need.\n\n\n AGENCY COMMENTS\n HRSA concurred with our recommendations that it should review\n underserved designations that it has not updated in the last 3 years and\n that HRSA should publish regulations to revise its shortage-designation\n criteria. HRSA also provided technical comments for which we made\n revisions where appropriate.\n\n CMS concurred with the recommendation that they should issue\n regulations to ensure that RHCs determined to be essential remain\n certified as RHCs. CMS is further considering our recommendation\n that it should seek legislative authority to require RHCs applicants to\n document need and impact on access to care as a requirement for\n receiving certification as a RHC. See Appendix B for the full text of the\n agency comments.\n\n\n OFFICE OF INSPECTOR GENERAL RESPONSE\n We appreciate both HRSA\xe2\x80\x99s and CMS\xe2\x80\x99s response to our report. It is\n important that HRSA is implementing an automated application and\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 16\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\nR E C O M M E N D A T I O N S\n\n\n review process that will reduce the review time for determining whether\n areas meet the underservice criteria. It is also important that CMS is\n committed to reissuing proposed and final regulations that would allow\n it to terminate those clinics that do not meet the basic location\n requirements unless they demonstrate that the clinics are essential\n community providers for their service areas.\n\n We continue to believe that requiring current and prospective RHCs to\n provide additional evidence of community need would further the goal of\n assuring that RHCs are directed and maintained in rural communities\n with critical shortages of primary care providers. The establishment of\n further criteria would help limit the creation of new RHCs in areas with\n a concentration of viable providers, and more importantly, it would\n encourage the establishment of RHCs in areas with unmet need.\n\n\n\n\n OEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 17\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n\xce\x94 E N D N O T E S \n\n\n\n\n\n 1 The reported Medicaid spending is underestimated because of\n incomplete data.\n\n 2 Public Law 95-210.\n\n 3 HRSA standard uses 20 miles to approximate 30 minutes of travel\n under normal conditions on primary roads and 15 miles for travel on\n flat terrain or interstate highways.\n\n 4 An urban cluster consists of a contiguously settled core of census\n block groups and census blocks with populations between 2,500 and\n 49,999.\n\n 5 http://www.ers.usda.gov/briefing/rurality/RuralUrbCon.\n\n 6 \xe2\x80\x9cHealth Care Shortage Areas: Designations Not a Useful Tool for\n Directing Resources to the Underserved\xe2\x80\x9d (GAO/HEHS-95-200,\n September 1995), p. 50.\n\n\n\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 18\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n A P P E N D I X ~ A \n\n\n\n\n\n RHCs by Rural-Urban Continuum Codes\n\n Rural Health\n 2003 Rural-Urban Continuum Codes Clinics\n\n 216\n County in metro area with 1 million population or more\n 317\n County in metro area of 250,000 to 1 million population\n\n 301\n County in metro area of fewer than 250,000 population\n Nonmetro county with urban population of 20,000 or more,\n 281\n adjacent to a metro area\n Nonmetro county with urban population of 20,000 or more,\n 153\n not adjacent to a metro area\n Nonmetro county with urban population of 2,500-19,999,\n 823\n adjacent to a metro area\n Nonmetro county with urban population of 2,500-19,999,\n 588\n not adjacent to a metro area\n Nonmetro county completely rural or less than 2,500 urban\n 248\n population, adjacent to metro area\n Nonmetro county completely rural or less than 2,500 urban\n 413\n population, not adjacent to metro area\n\n Overall Total 3,340\n Source: Online Survey Certification and Reporting and Department of Agruculture Rural-Urban\n Continuum Codes, 2004\n\n\n\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 19\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n A P P E N D I X ~ B \n\n\n\n\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 20\n\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n A P P E N D I X ~ B \n\n\n\n\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 21\n\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n A P P E N D I X ~ B \n\n\n\n\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 22\n\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n A P P E N D I X ~ B \n\n\n\n\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 23\n\n\x0c Report Template Version = 03-01-05_rev.07\n\n\n\n\n A G E N C Y C O M M E N T S\n \xce\x94 A C K N O W L E D G M E N T S \n\n\n\n\n This report was prepared under the direction of William C. Moran,\n Regional Inspector General for Evaluation and Inspections in the\n Chicago regional office, and Ann Maxwell, Assistant Regional Inspector\n General. Other principal Office of Evaluation and Inspections staff who\n contributed include:\n\n Thomas Komaniecki, Project Leader\n\n Madeline Francescatti, Program Analyst\n\n Anna Fleming, Program Analyst\n\n Natalie Coen, Program Analyst\n\n Rupal Patel, Intern\n\n Seema Dargar, Intern\n\n Bambi Straw, Program Specialist\n\n Tricia Davis, Director, Medicare & Medicaid Branch\n\n\n\n\nOEI-05-03-00170 S TAT U S OF THE R U R A L H E A LT H C L I N I C P R O G R A M 24\n\x0c"


type: caselaw

text:
On January 10th, 1930, H.D. Affleck, plaintiff and appellee, was riding as a guest in an automobile owned and driven by Fred Lange, defendant and appellant, on the Reisterstown Road, at or near its intersection with Milford Avenue, when it collided with an automobile driven by Lester See, resulting in serious injuries to the appellee, for which he sued and recovered a judgment, from which this appeal is taken.
 The appellant, on the day of the accident, had gone to Westminster on business and had asked the appellee to go with him "for company's sake." On their return to Baltimore, as they approached Milford Avenue, which breaks off from the westerly side of the Reisterstown Road south of Pikesville, they saw a car coming north on their left, or east side of the road, with which they collided at the junction of the two roads. The See car, as it approached Milford Avenue, had slowed down, the driver intending to cut across the Reisterstown Road and turn into Milford Avenue. Lange said he did not notice the other car until he was within twenty or twenty-five feet of it. He "might have seen him further down but didn't pay no attention to that individual car." The road was straight, with no evidence that there was anything on it to obstruct his view.
 The questions submitted by the appellant for decision are the refusal of the trial court to instruct for the defendant for want of legally sufficient evidence, and two exceptions to rulings on evidence.
 The appellant's sole reliance for the contention that his prayer for an instructed verdict should have been granted is the decision in Burhans v. Burhans, 159 Md. 370, 150 A. 795, 797, in which the evidence was that the defendant, in suddenly turning her car to avoid hitting a dog, ran the car *Page 697
 into a culvert, resulting in the injuries there complained of. In the opinion in that case, written by Judge Pattison, it was said: "Because of the peril of the position in which she was placed by the presence of the dog in the road so near to her car, and the possible consequence resulting from a collision with it, she is not held to the same accuracy of judgment as is required of her under ordinary circumstances. And though a course of action other than that which she pursued might have been more judicious, she is not to be held liable for her error of judgment in pursuing the course she did, if in so doing she acted with such care and caution as ordinarily prudent persons would have exercised under the stress of like circumstances. 42 C.J., page 890, sec. 592;Massie v. Barker, 224 Mass. 420, 113 N.E. 199; Leslie v.Catanzaro, 272 Pa. 419, 116 A. 504." In the instant case, however, the evidence fails to disclose any such emergency as the driver faced in the Burhans case. The paved or improved portion of the Reisterstown Road at the point of the accident was twenty-one feet wide, so that there was a distance of ten and a half feet on each side of the center line. In addition, there was a space of several feet of solid dirt road on each side of the pavement. The appellant's testimony was that See "was cutting over, angling over to get over to make that turn he wanted to make, I presume, a left-hand turn there." See's car was, "I judge, several feet past the dividing line; that is, when we came together." But he also testified: "If I would have turned possibly a little more to the right it might be possible that the accident could have been avoided." In other words, if he had done what he could and should have done there might not have been a collision, regardless of his charge of negligence against the driver of the other car. If the defendant was negligent and that negligence caused or contributed to the passenger's injuries, the defendant is responsible, even though another, and a stranger to the suit, did contribute to the injury. Gordon v. Opalecky,152 Md. 536, 550, 137 A. 299; Cumberland Westernport Transit Co.v. Metz, 158 Md. 424, 149 A. 4, 565. *Page 698
 Edward M. Evans, Jr., whose sister owned the car driven by See, testified: "We had gotten about * * * four feet off of the center of the road to the left of the center of the road when the car coming south (appellant's) I didn't see it * * * until it was about fifteen feet away from me." Asked whether the See car was "moving or had it stopped," he said, "I know if it was moving it was going very slow." Not sure whether it was moving at all.
 David I. Morris, who had charge of a gas station at the intersection of the Reisterstown Road and Milford Avenue, and who was the only person, aside from the occupants of the two cars, who saw the collision, and whose attention was attracted when he "heard brakes go on real hard," saw the cars when they met at or near the center of the road, and testified that the skid marks of the appellant's car began fifty feet before the cars met, and when within four or five feet of the point of the collision the front wheels turned to the left; that is, toward See's car.
 It is provided, amongst other requirements, by section 195 of article 56 of the Code, that, "upon approaching * * * a crossing of intersecting public highways * * * and in traversing such crossing * * * the person operating a motor vehicle or motorcycle shall have the same under control and shall reduce its speed to a reasonable and proper rate"; and by section 209, as amended by Acts 1929, ch. 224, that, "all vehicles, motor, horse-drawn or otherwise, when being driven upon the highways of this State shall at all times keep to the right of the center of the highway upon all highways of sufficient width, except upon streets or roads where traffic is permitted to move in one direction only, and except when overtaking and passing another vehicle, and unless it is impracticable to travel on such side of the highway."
 In the instant case there is no evidence that the appellant's car crossed or projected beyond the center line of the Reisterstown Road, and there is evidence that the other car did extend over the center on the appellant's right of way. But the evidence is that, while the appellant was maintaining his right of way on which the other car had encroached, the appellant, *Page 699
 by turning his car slightly to the right, might have gone safely by and have avoided the collision. Carpenter v. CampbellAutomobile Co., 159 Iowa 52, 140 N.W. 225; Huddy onAutomobiles (7th Ed.), sec. 347. See had slowed down to make the left turn into Milford Avenue, and a jury might readily have inferred that he was waiting for the appellant to go by before completing the turn into Milford Avenue, and that there was plenty of time and space for the appellant, in the exercise of that control and judgment which the law requires of the driver of a motor vehicle on a public highway, to turn out of the way of danger, and it is in this respect that this case differs from the rule in the Burhans case, supra, which the appellant urges this court, we think erroneously, to apply. See may have been negligent, but, without the concurring negligence of the appellant, of which there was legally sufficient evidence, the collision, with its resulting injury to the appellee, might not have occurred. Whether the injury to the appellee was caused or contributed to by the appellant was, under the facts stated, a question for the jury, and the prayer for an instructed verdict for the appellant was properly refused. Gordon v. Opalecky,supra; Cumberland Westernport Transit Co. v. Metz, supra.
 The appellant reserved two exceptions to rulings of the court on the evidence. The first was on the refusal of the court to strike out the answer of the witness Morris, as to the position of the cars when they collided, the concluding part of the answer being, "you could see the mark on the road just as plain as it could be where they turned in to the left and his hind wheels went right straight along, but the left had jumped up off the road and his hind part slided around to the right"; the court, before ruling, saying: "The answer of this witness, as I comprehend it, is based partly on what he saw as the car was moving, and partly on what he saw of the marks on the road. Is that correct, Mr. Witness?" The motion was then overruled and exception noted. The witness had already testified that he saw the cars come together and saw the marks made in the road by the appellant's car, and stepped off the distance from the point where the wheels *Page 700
 began to slide to the point of the collision. This was not objectionable as the expression of an opinion based on statements of others or on an assumption of fact, but was a recital of facts all within the witness' observation and knowledge. Baltimore, C. A. Ry. Co. v. Turner, 152 Md. 216, 223, 224, 136 A. 609. He identified the marks immediately after they were made as those caused by the sliding or skidding of the appellant's car.Cumberland and Westernport Transit Co. v. Metz, 158 Md. 424,452, 149 A. 4, 565. Objection was made in the brief by the appellant to the form of the court's inquiry of the witness, but as the record shows it was not objected to at the trial, it cannot be ruled on here.
 The remaining exception is substantially a repetition of that to the motion just considered, and what we have said of it also applies to this exception.
 Finding no error in the rulings at the trial, the judgment will be affirmed.
 Judgment affirmed, with costs.
 *Page 1


type: contracts

text:
 Fontos jogi nyilatkozat
 |
 22003D0090
 Hivatalos Lap L 272 , 23/10/2003 o. 0026 - 0026
 Az EGT-Vegyesbizottság 90/2003 határozata(2003. július 11.)az EGT-megállapodás II. mellékletének (műszaki előírások, szabványok, vizsgálatok és tanúsítás) módosításárólAZ EGT-VEGYESBIZOTTSÁG,tekintettel az Európai Gazdasági Térségről szóló, az Európai Gazdasági Térségről szóló megállapodás kiigazításáról szóló jegyzőkönyvvel módosított megállapodásra (a továbbiakban: a Megállapodás), és különösen annak 98. cikkére,mivel:(1) A Megállapodás II. mellékletét a 2002. szeptember 27-i 129/2002 EGT-vegyesbizottsági határozat [1] módosította.(2) A 93/42/EGK tanácsi irányelv stabil emberi vér- vagy plazmakészítményeket tartalmazó orvostechnikai eszközök tekintetében történő módosításáról szóló, 2000. november 16-i 2000/70/EK európai parlamenti és tanácsi irányelvet [2] be kell építeni a Megállapodásba,A KÖVETKEZŐKÉPPEN HATÁROZOTT:1. cikkA Megállapodás II. melléklete XXX. fejezetének 1. pontja (93/42/EGK tanácsi irányelv) a következő francia bekezdéssel egészül ki:"- 32000 L 0070: Az Európai Parlament és a Tanács 2000. november 16-i 2000/70/EK irányelve (HL L 313., 2002.12.13., 22. o.)."2. cikkA 2000/70/EK irányelv izlandi és norvég nyelvű szövegei, melyeket az Európai Unió Hivatalos Lapjának EGT-kiegészítésében közzé kell tenni, hitelesek.3. cikkEz a határozat 2003. július 12-én lép hatályba, amennyiben a Megállapodás 103. cikkének (1) bekezdése szerint előírt összes értesítést eljuttatták az EGT-Vegyesbizottsághoz [3].4. cikkEzt a határozatot az Európai Unió Hivatalos Lapjának EGT-re vonatkozó részében, illetve EGT-kiegészítésében közzé kell tenni.Kelt Brüsszelben, 2003. július 11-én.az EGT-Vegyesbizottság részérőlaz elnökH. S. H. Prinz Nikolaus von Liechtenstein[1] HL L 336., 2002.12.12., 29. o.[2] HL L 313., 2000.12.13., 22. o.[3] Alkotmányos követelmények nem merültek fel.--------------------------------------------------


text:
The Creed Brothers sind ein amerikanisches Tag Team, bestehend aus den Brüdern Drew Kasper und Jacob Kasper. Sie stehen zur Zeit bei World Wrestling Entertainment unter Vertrag. Ihr bislang größter Erfolg war der Erhalt der NXT Tag Team Championship.
 Wrestling-Karriere
 Erste Anfänge (bis 2020)
 Während des Besuches der High School in Lexington traten bereits beide Brüder im Amateur-Wrestling an. Jacob Kasper besuchte die Duke University, wo er Soziologie studierte und 2018 seinen Abschluss machte. Während seiner Zeit an der Duke University nahm er am College Wrestling für die Duke Blue Devils teil. Er war zweifacher National Collegiate Athletic Association (NCAA) All-American und dreimal NCAA Academic All-American und gewann 2018 die Schwergewichtsmeisterschaft der Atlantic Coast Conference. Er stellte einen Blue-Devils-Rekord für die meisten Siege in einer einzigen Saison auf und belegte den zweiten Platz für die Gesamtsiege seiner Karriere. Er nahm an den Olympischen Spielen 2016 in den Kategorien Griechisch-Römisch und Freestyle teil und belegte den fünften Platz. 2017 trainierte er mit dem Mixed Martial Artist Daniel Cormier, um ihm bei der Vorbereitung auf seinen Kampf mit Jon Jones bei UFC 214 zu helfen. 2018 begann er als Assistenz-Wrestling-Trainer für die Duke University zu arbeiten.
 Drew Kasper besuchte die Otterbein University in Westerville, Ohio, wo er Sportwissenschaft im Hauptfach studierte und 2020 seinen Abschluss machte. Während seiner Zeit an der Otterbein University trat er im College-Wrestling für die Otterbein Cardinals mit einem Gesamtrekord von 108–13 an. Er war zweimaliger NCAA All-American. In seinem letzten Jahr hatte Kasper einen perfekten 30-0-Rekord und war die Nummer eins in den Vereinigten Staaten, nahm jedoch nicht an den NCAA-Meisterschaften 2020 teil, da diese infolge der COVID-19-Pandemie abgesagt wurden.
 World Wrestling Entertainment (seit 2020)
 Im Oktober 2020 unterschrieb Jacob bei WWE, nachdem er von Gerald Brisco entdeckt worden war. Im Februar 2021 unterschrieb sein Bruder Drew bei der WWE. Im Juni 2021 bekamen die Brüder die Ringnamen Brutus Creed and Julius Creed. Am 24. August 2021 gaben sie ihr In-Ring-Debüt und schlossen sich gleichzeitig dem Stable von Roderick Strong namens Diamond Mine an. Am 15. Februar 2022 gewannen sie das Dusty Rhodes Tag Team Classic. Hierfür besiegten sie MSK Wes Lee und Nash Carter.
 Am 4. Juni 2022 gewannen sie bei NXT In Your House (2022) die NXT Tag Team Championship. Hierfür besiegten sie Pretty Deadly Elton Prince und Kit Wilson. Die Regentschaft hielt 92 Tage und verloren die Titel, schlussendlich am 4. September 2022 bei einem Titelvereinigungsmatch an Elton Prince und Kit Wilson.
 Wrestling-Erfolge
 World Wrestling Entertainment
 NXT Tag Team Championship (1×)
 Dusty Rhodes Tag Team Classic (2022)
 Sonstige Promotions
 NCAA All-American (4×)
 ACC Heavyweight Championship (1×)
 NCAA Academic All-American (3×)
 Southern Scuffle Heavyweight Division Gewinner (2017, 2018)
 Einzelnachweise
 Weblinks
 Brutus Creed Profil auf wwe.com
 Julius Creed Profil auf wwe.com
 Tag Team
 Sport (Vereinigte Staaten)
 NXT Tag Team Champion