September 11-13, 2025 | Dallas, Texas | the Cooper Hotel Conference Center & Spa
WE'RE BACK!!!
Join AAOSH for our Annual Session 2025 in Dallas, Texas, at the Cooper Hotel Conference Center & Spa on September 11-13, 2025!
Don't Wait; Seats are Limited!
Learn More with These Quick Links:
TICKET TIERS & GROUP RATES
Get a year on us!
Get your first year of AAOSH Membership for free when purchasing your Annual Session 2025 ticket Today!*
Already a Member? This deal will extend your membership due date by a full year.
Please choose one of the following ticket tiers:
Professional (DDS, MD, DO, DMS) $1095Auxiliary Professionals (RDH, PA, APRN, RN, RDA, MA) $795
Faculty & Staff $695
Corporate/Business Owners $650
Retired Professionals $650

Whole-Office Learning!
(They get their first year of membership free, too!)*:
Bring 1 to 3 Guests or Team Members $695 pp
Bring Guest or Team Members 4+ $650 pp
The purchase of a Scientific Sessions 2025 ticket includes your first year of AAOSH Membership for free. After the first year, the credit card used during purchase will be automatically billed for the annual AAOSH Membership renewal at the current membership rate.
For the "Bring a Team Member" ticket option, please note that you are required to purchase one team member ticket per person. Additionally, each "Bring a Team Member" ticket must be accompanied by at least one professional or auxiliary ticket. The credit card used for team member ticket purchases will be securely kept on file for automatic renewal of AAOSH memberships for each team member.
If a team member leaves your practice or if you need to update any memberships or event tickets, please contact us promptly at support@aaosh.org to ensure that changes are made accurately.
Please review all terms and conditions before finalizing your purchase.
CONFIRMED SPEAKERS

Mark L. Cannon, DDS, MS, is a Professor in the Division of Dentistry at Northwestern University's Feinberg School of Medicine and an Attending Physician at Ann & Robert H. Lurie Children’s Hospital of Chicago. He is the founder of Associated Dental Specialists of Long Grove and serves as Research Coordinator for the pediatric dental residency at Lurie Children’s.
With over 40 years of experience in pediatric dentistry, Dr. Cannon is an internationally recognized lecturer and published expert on topics ranging from evolutionary oral medicine to microbiomes, bioactive materials, and pediatric oral health innovation. He holds multiple patents and has presented at leading institutions and global conferences.
Dr. Cannon is also a past president of the AAOSH Board of Directors and remains a passionate advocate for integrative, science-based oral-systemic healthcare.
His Lecture at Annual Session 2025 in Dallas:
Date: Friday, September 12, 2025
Time: 1:30-2:45 PM
Location: the Core Connection Main Ballroom
Title: "What's Happening?! Update in Oral & Systemic Health."
Synopsis of Lecture:
Coming Soon
Learning Objectives:
Coming Soon
Practical Applications:
Coming Soon
AGD Code: 130 (Electives)
Core Curriculum Category: Success for the Oral Systemic Practice
Conflict of Interest:
Professor Emeritus at Ann and Robert Lurie Children's Hospital
Past AAOSH Lectures from Dr. Cannon:


Dr. Chris Kammer is a past president and founder of the American Academy for Oral Systemic Health. Dr. Kammer’s work has been presented at numerous dental conferences, conventions, and seminars and has been published in leading dental journals. He is also on the technology team for the Dental Products Report. In recent years, he has been a passionate educator in the media and in professional forums about the importance of the oral systemic approach.
His Lecture at Annual Session 2025 in Dallas:
Date: Saturday, September 13, 2025
Time: 8:15-9:30 AM (Keynote Speaker)
Location: the Core Connection Main Ballroom
Title: "Natural Medical Management of Oral and Systemic Disease: No Shots, No Drills, No Surgeries, No Rx Pills!"
Synopsis of Lecture:
Coming Soon
Learning Objectives:
Coming Soon
Practical Applications:
Coming Soon
AGD Code: 730 (Oral Medicine, Oral Diagnosis, Oral Pathology)
Core Curriculum Category: Periodontal Disease & Biofilm Diseases of the Mouth
Conflict of Interest:
Owner of Victorious Dental
Past AAOSH Lectures from Dr. Kammer:

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Dr. Susan Maples leads a successful, total health, insurance-independent dental practice in Holt, Michigan. She brings preventive and restorative dental expertise, a passion for mouth-body total health, a master’s degree in business/marketing, and 30+ years of experience in private practice. She is the creator and founder of Total Health Academy, a complete online solution for dental teams to integrate all aspects of Total Health Dentistry, and the author of BlabberMouth! 77 Secrets Only Your Mouth Can Tell You To Live a Healthier, Happier, Sexier Life, developer of the Hands-On Learning Lab™ and SelfScreen.net. Susan currently serves on the Governing Board of the American Academy of Oral Systemic Health (AAOSH).
Her Lecture at Annual Session 2025 in Dallas:
Date: Saturday, September 13, 2025
Time: 11:30 AM -12:30 PM
Location: the Core Connection Main Ballroom
Title: "The HPV and Oral Pharyngeal Cancer Epidemic: It’s Our Turn to Talk and Act!"
Synopsis of Lecture:
For decades, tobacco and alcohol were seen as the primary culprits behind oral cancer. But the landscape has shifted dramatically. Today, Human Papillomavirus-related Oral Pharyngeal Cancer (HPV-OPC) accounts for approximately 73% of all oropharyngeal cancers—a staggering statistic that's growing at an alarming rate of 30% annually.
While traditional risk factors such as smoking, alcohol, and acid reflux still play a role, high-risk HPV strains are now known to be more aggressive—even in isolation—and detectable through salivary diagnostics. The connection to oral sex as a major transmission route is a topic often avoided, but it’s time for our dental profession to step up.
With half of all new HPV infections occurring between ages 15 and 24, we are in a unique and essential position to make a difference at every age, through early preventive discussions, sophisticated early detection strategies and education. This engaging and eye-opening course will equip you with the data, strategies, and language to confidently navigate this evolving health crisis—even when the conversations feel a little uncomfortable.
Learning Objectives:
- Describe the rising incidence of HPV-related oral and oropharyngeal cancers and the key lifestyle risk factors driving this trend.
- Explain the link between HPV transmission—particularly through oral sex—and its connection to the development of HPV-OPC.
- Recognize the role of the 9-valent HPV vaccine as a prevention strategy in children and adults.
- Employ salivary diagnostics in early risk detection of HPV-related oral cancers.
- Communicate effectively about tobacco cessation, acid reflux, and other modifiable risk factors during routine dental visits.
- Integrate a thorough 3- to 5-minute oral cancer screening protocol into preventive care appointments to enhance early diagnosis and improve patient outcomes.
Practical Applications:
Coming Soon
AGD Code: 730 (Oral Medicine, Oral Diagnosis, Oral Pathology)
Core Curriculum Category: Cancer and Autoimmune Disorders
Conflict of Interest:
N/A
Past AAOSH Lectures from Dr. Maples:


Lora Hooper, BSDH, RDH, EFDA, is an oral-systemic health leader with over 28 years of clinical experience in dental hygiene. A graduate of The Ohio State University, Lora is the Vice President and Clinical Director of the Integrative Dental Medicine Scholar Society (IDMSS) and a certified Preceptor of the Bale Doneen Method. She is known for her pioneering work in salivary diagnostics, having overseen more than 10,000 tests and personally treated over 3,000 cases.
In 2017, Lora became the first dental hygienist in the U.S. to work alongside a cardiologist in an oral-systemic practice. Today, she serves as a care coordinator at the Prevent Clinic with Dr. Gina Pritchard, bringing her expertise in cellular-level disease prevention and patient care integration to the forefront. A sought-after speaker, podcast guest, and workshop coach, Lora is dedicated to helping dental professionals shift from symptom management to true disease reversal. She is also affectionately known as the “Biohacker of the Oral Microbiome.”
Her Lecture at Annual Session 2025 in Dallas:
Date: Friday, September 12, 2025
Time: 9:35 AM -10:50 AM (Speaking with Dr. DeWitt Wilkerson)
Location: the Core Connection Main Ballroom
Title: "3 Keys to Oral-Systemic Health or Disease: AAOSH's Golden Opportunity!"
Synopsis of Lecture:
Research is now pointing toward a critical relationship between 3 key factors of oral-systemic health or disease... 1) BREATHING, 2) BACTERIA & 3) BLOOD. Healthy nasal breathing and oxygenation promote a healthy, predominantly aerobic, commensal oral microbiome. Pathologic mouth breathing and sleep desaturations promote the proliferation of anaerobic, pathogenic oral microbiome and vascular oxidative stress. When pathogenic bacteria create oral infections and inflammation, we observe “leaky gums and teeth”. Oral pathogens spread into the bloodstream, arterial walls, and organs throughout the body, creating chronic systemic inflammation. AAOSH is where we learn to screen, test, and treat these 3 central factors of health or disease. In this session, we will explore our golden opportunity together!
Learning Objectives:
- Introduce the concept of Airway—> Pathogens —> Plaques
- Learn how to screen and test using High Resolution Pulse Oximetry(HRPO) & Salivary Diagnostics
- Understand the concept of ‘Leaky Syndrome”
Practical Applications:
- Each attendee will understand the detrimental effects of disordered breathing and sleep on oral-
systemic health. - Each attendee will be challenged to begin using HRPO and Salivary Diagnostics in their practices.
- Each attendee will understand the systemic risks of Leaky Syndrome.
AGD Code: 130 (Electives)
Core Curriculum Category: Success for the Oral Systemic Practice
Conflict of Interest:
IDM President of IDM Scholar Society & STATai
Past AAOSH Lectures from Lora:


Kriston Reisnour, RDH, BSDH, CCSH, CSOM, FAAOSH, HIAOMT, is a national speaker, author, and integrated healthcare specialist, currently serving on the AAOSH Board of Directors. With over 30 years of experience in dental hygiene, she has a passion for advancing oral-systemic care through education and implementation.
Kriston previously served as Dental Program Director for the BaleDoneen Method and has worked closely with the Seattle Study Club, bringing real-world insight to her coaching and clinical instruction. She holds advanced credentials in sleep health, orofacial myology, and chronic inflammation, and is a Fellow of AAOSH and an accredited member of IAOMT.
Based in Washington state, Kriston continues to practice clinical hygiene while leading her educational platforms, Intentional Hygiene and Orofacial Myology of PNW.
Her Lecture at Annual Session 2025 in Dallas:
Date: Saturday, September 13, 2025
Time: 9:35 AM -10:50 AM
Location: the Core Connection Main Ballroom
Title: "Your Frustration Begins Where Your Knowledge Ends."
Synopsis of Lecture:
Coming Soon
Learning Objectives:
Coming Soon
Practical Applications:
Coming Soon
AGD Code: 770 (Self-Improvement)
Core Curriculum Category: Behavioral Influences, Increasing Health Literacy, & the Psychology of Healing
Conflict of Interest:
Owner of Intentionalhygiene.com
Past AAOSH Lectures from Kriston:


Dr. Ellie Campbell, originally from Chicago, has a BS and MS from the University of Illinois and a DO from Kirksville College of Osteopathic Medicine. She completed her Family Medicine residency at the Medical College of Georgia and has over 25 years of board certification in Family Medicine, with additional certification in Integrative Medicine. For thirteen years, she has focused on indigent healthcare and has run a solo, concierge-style integrative practice since 2005.
Her specialties include innovative medical practice design, Functional Medicine, Bio-Identical Hormone Replacement Therapy, cardiovascular disease prevention, and burnout solutions. In 2010, she founded the “Consortium of Integrative Care Practitioners of Atlanta,” and, in 2017, launched “Revolution Practice” to teach membership-style practice management.
In her free time, Dr. Campbell enjoys live theater, gardening, and traveling with her husband and three college-age daughters. Learn more about her practice at www.campbellfamilymedicine.com or www.RevolutionPractice.com.
Her Lecture at Annual Session 2025 in Dallas:
Date: Friday, September 12, 2025
Time: 2:50 PM - 4:00 PM
Location: the Core Connection Main Ballroom
Title: "Metabolic Metrics Meet the Mouth: Linking Systemic Inflammation Markers and CGM Data to Dental and Cardiovascular Health."
Synopsis of Lecture:
Coming Soon
Learning Objectives:
Coming Soon
Practical Applications:
Coming Soon
AGD Code: 010 (Basic Sciences)
Core Curriculum Category: Cardiovascular Health
Conflict of Interest:
N/A
Past AAOSH Lectures from Dr. Campbell:

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Dr. DeWitt “Witt” Wilkerson is a nationally recognized leader in integrative dental medicine and a Past President of the American Academy for Oral Systemic Health (AAOSH). He joined Dr. Peter Dawson’s private practice in 1982 and continues to serve as a partner, gaining invaluable clinical experience within a renowned interdisciplinary setting.
Dr. Wilkerson lectures extensively on restorative dentistry, dental occlusion, temporomandibular disorders, airway/dental sleep medicine, and oral-systemic health. He serves as a Senior Faculty Member and Director of Dental Medicine with the Dawson Academy and is also a Past President of the American Equilibration Society (AES). His academic contributions include roles as Adjunct Professor of Graduate Studies at the University of Florida College of Dentistry and former Associate Faculty and Special Lecturer at the L.D. Pankey Institute.
He is the author of The Shift: The Dramatic Movement Toward Health-Centered Dentistry, a powerful call to action for clinicians to embrace whole-body health in their practices.
His Lecture at Annual Session 2025 in Dallas:
Date: Friday, September 12, 2025
Time: 9:35 AM - 10:50 AM (Speaking with Lora Hooper)
Location: the Core Connection Main Ballroom
Title: "3 Keys to Oral-Systemic Health or Disease: AAOSH's Golden Opportunity!"
Synopsis of Lecture:
Research is now pointing toward a critical relationship between 3 key factors of oral-systemic health or disease... 1) BREATHING, 2) BACTERIA & 3) BLOOD. Healthy nasal breathing and oxygenation promote a healthy, predominantly aerobic, commensal oral microbiome. Pathologic mouth breathing and sleep desaturations promote the proliferation of anaerobic, pathogenic oral microbiome and vascular oxidative stress. When pathogenic bacteria create oral infections and inflammation, we observe “leaky gums and teeth”. Oral pathogens spread into the bloodstream, arterial walls, and organs throughout the body, creating chronic systemic inflammation. AAOSH is where we learn to screen, test, and treat these 3 central factors of health or disease. In this session, we will explore our golden opportunity together!
Learning Objectives:
- Introduce the concept of Airway—> Pathogens —> Plaques
- Learn how to screen and test using High Resolution Pulse Oximetry(HRPO) & Salivary Diagnostics
- Understand the concept of ‘Leaky Syndrome”
Practical Applications:
- Each attendee will understand the detrimental effects of disordered breathing and sleep on oral-
systemic health. - Each attendee will be challenged to begin using HRPO and Salivary Diagnostics in their practices
- Each attendee will understand the systemic risks of Leaky Syndrome
AGD Code: 130 (Electives)
Core Curriculum Category: Success for the Oral Systemic Practice
Conflict of Interest:
Owner of Intentionalhygiene.com
Past AAOSH Lectures from Dr. Wilkerson:

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Amy L. Doneen, DNP, co-founded the Bale/Doneen Method and the Heart Attack & Stroke Prevention Center. She is a principal instructor in the Bale/Doneen Method, training other medical, dental, and healthcare providers across the country. She is the owner and medical director of the sought-after private clinical practice in Spokane, Washington, The Heart Attack & Stroke Prevention Center, which serves patients from all over the world. Dr. Doneen is one of the nation's leading specialists in preventing heart attacks, stroke, and diabetes. She is co-author of the bestselling book Beat The Heart Attack Gene.
Her Lecture at Annual Session 2025 in Dallas:
Date: Friday, September 12, 2025
Time: 8:15 AM - 9:30 AM (Keynote Speaker)
Location: the Core Connection Main Ballroom
Title: "The Oral Systemic Connection: Oxidative Stress."
Synopsis of Lecture:
Coming Soon
Learning Objectives:
Coming Soon
Practical Applications:
Coming Soon
AGD Code: 010 (Basic Sciences)
Core Curriculum Category: Brain Health
Conflict of Interest:
Connected to the BaleDoneen Method
Past AAOSH Lectures from Dr. Doneen:
- Enhance and Save Lives By Offering the Cure for Arterial Disease: Dentistry Saves Lives
- Optimal Cardiovascular Prevention - The Oral/Systemic Connection
- Women and Cardiovascular Disease
See Her LIVE Webinar on July 9th!


Dr. Susan Estep, a trailblazer in both cosmetic dentistry and oral-systemic health. Dr. Estep is the founder of Intown Smile Studio in Atlanta, Georgia, where she combines expertise in aesthetic dentistry with a deep commitment to whole-body wellness.
She was one of the visionaries who helped establish the American Academy for Oral Systemic Health (AAOSH) and served as a Past President of our organization. Dr. Estep has been a driving force in promoting the importance of oral health in systemic disease prevention, and we are honored to have her as part of the AAOSH family.
Her Lecture at Annual Session 2025 in Dallas:
Date: Friday, September 12, 2025
Time: 11:30 AM - 12:30 PM
Location: the Core Connection Main Ballroom
Title: "Building an Oral Systemic Practice."
Synopsis of Lecture:
Coming Soon
Learning Objectives:
Coming Soon
Practical Applications:
Coming Soon
AGD Code: 130 (Electives)
Core Curriculum Category: Success for the Oral Systemic Practice
Conflict of Interest:
N/A
Past AAOSH Lectures from Dr. Estep:
AGENDA
Day 1: Thursday, September 11
11:00 AM - 3:30 PM
Exhibitor Move In
1:30 PM - 9:15 PM
Shuttle Service
1:30 PM - 5:45 PM
registration opens
Please meet us at the registration desk to check in for Annual Session 2025, grab your swag bag, and badge!
2:00 PM - 3:00 PM
Presentation
Speaker TBD
3:15 PM - 4:15 PM
Presentation
Speaker TBD
4:00 PM - 8:45 PM
Vital Link Pavilion Opens
6:00 PM - 8:30 PM
Lone Star Link-Up Opening Reception
Location: Core Connection Main Ballroom and the Vital Link Pavillion
Connect and learn from our exhibiting partners. Come bid on the Silent Auction. Link up and network with friends, old and new.
8:45 PM
Vital Link Pavilion Closes
9:15 PM
Last Shuttle Leaves

Day 2: Friday, September 12
6:45 AM
Vital Link Pavilion Opens
6:45 AM - 8:15 AM
morning Shuttle Service
7:00 AM - 8:15 AM
Breakfast
7:00 AM - 8:15 AM
Registration
8:15 AM - 9:30 AM
Welcome/Keynote
Speaker TBD
9:35 AM - 10:50 AM
Presentation
Speaker TBD
9:35 AM - 10:50 AM
Presentation
Speaker TBD
10:50 AM - 11:30 AM
Break
11:30 AM - 12:30 PM
Presentation
Speaker TBD
11:30 AM - 12:30 PM
Presentation
Speaker TBD
12:30 PM - 1:30 PM
Lunch
1:30 PM - 2:45 PM
Presentation
Speaker TBD
1:30 PM - 2:45 PM
Presentation
Speaker TBD
2:50 PM - 4:00 PM
Presentation
Speaker TBD
2:50 PM - 4:00 PM
Presentation
Speaker TBD
2:50 PM - 5:45 PM
afternoon Shuttle Service
4:45 PM
Vital Link Pavilion Closes
6:00 PM
Transportation - From the Cooper Hotel to the Gala
Transportation from the Cooper Hotel to the Gala will leave at 6:00 PM. Only ONE Shuttle will be provided.
6:00 PM
Transportation - From the Hilton to the Gala
Transportation from the Hilton Lincoln Centre to the Gala will leave at 6:00 PM. Only ONE Shuttle will be provided.
10:00 PM
Transportation from gala to hotel
Please make sure you are taking the right shuttle back to your hotel. Only ONE shuttle will be available for each hotel.

Day 3: saturday, September 13
6:45:00 AM
Vital Link Pavilion Opens
6:45 AM - 8:15 AM
morning Shuttle Service
7:00 AM - 8:15 AM
Breakfast
8:15 AM - 9:30 AM
Welcome/Keynote
Speaker TBD
9:35 AM - 10:50 AM
Presentation
Speaker TBD
9:35 AM - 10:50 AM
Presentation
Speaker TBD
10:50 AM - 11:30 AM
Break
11:30 AM - 12:30 PM
Presentation
Speaker TBD
11:30 AM - 12:30 PM
Presentation
Speaker TBD
12:30 PM - 1:30 PM
Lunch
1:30 PM - 2:45 PM
Keynote
Speaker TBD
2:45 PM - 3:15 PM
Break
3:15 PM
Vital Link Pavilion Closes
3:15 PM - 4:15 PM
Presentation
Speaker TBD
3:15 PM - 4:15 PM
Presentation
Speaker TBD
4:30 PM - 5:00 PM
Presentation
Speaker TBD
THE COOPER HOTEL CONFERENCE CENTER & SPA

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About the venue
The Cooper Hotel Conference Center & Spa in Dallas, Texas, is the perfect setting for AAOSH Annual Session 2025, offering a unique blend of elegance, innovation, and wellness. With 30 acres of peaceful greenery, state-of-the-art facilities, and access to the renowned Cooper Fitness Center and Spa, attendees can recharge while engaging with groundbreaking oral-systemic health insights. This tranquil retreat provides an inspiring backdrop for collaboration, learning, and connection, making Annual Session 2025 an unforgettable experience.
Rooms at the Cooper Hotel are sold out for the event!
Now what? We've got you covered!
Stay at the Hilton! We’ve secured rooms for AAOSH attendees, and to make it even easier, a shuttle will be provided to transfer between the Hilton and the Cooper Hotel during the event. We will update you on the shuttle schedule as the event approaches. No stress, just seamless access to all the action!
📅 Book your room now: USE THIS LINK TO BOOK
ℹ️ Learn more about the Hilton: Hilton Dallas Lincoln Centre
*PLEASE NOTE* The hotels listed here are the only ones affiliated with AAOSH's Annual Session 2025. Any claims made by others suggesting otherwise are false and not connected to the event planning team of AAOSH. Please be cautious of anyone who claims to be working with AAOSH, and do not share any sensitive information with them.
CHECK OUT THE EXHIBITORS
Frequently Asked Questions
There will be an extremely limited number of rooms available at the Cooper Hotel Conference Center and Spa during the days of the event.
If you prefer to stay off-site, many hotels are available within a 5-mile radius of the Cooper Hotel Conference Center and Spa. Please note that AAOSH will not offer discounts or reserve rooms at these alternative hotel options.
The closest airports to the Cooper Hotel Conference Center and Spa in Dallas are:
- Dallas Love Field Airport (DAL) – Approximately 9 miles away (about a 20-minute drive)
- Dallas/Fort Worth International Airport (DFW) – Approximately 18 miles away (about a 25-minute drive)
Both airports offer a range of domestic and international flights, with Love Field being closer for quick access and DFW offering a broader range of flight options.
VIRTUAL EVENT TICKET PURCHASES: If you find that you are unable to attend an event, you may sell your ticket to a friend or colleague (this is a freely transferrable ticket).
You may request a refund of your ticket prior to 90 days before the start of the event, minus a $15 processing fee. Due to financial obligations incurred by AAOSH, we can offer a 50%, minus a $15 processing fee, refund 31-90 days before the start of the event. We cannot offer refund requests made 0-30 days before the start of the event.
If you wish to transfer your ticket, the initial registrant is responsible for finding and soliciting the ticket transferee and communicating the new attendee's contact information to AAOSH via email at support@aaosh.org.
Due to financial obligations incurred by AAOSH, no refunds or credits will be issued on cancellation requests less than 30 days before the start of the event.
LIVE EVENT TICKETS:
If you find that you are unable to attend an event, you may sell your ticket to a friend or colleague (this is a freely transferrable ticket).
You may request a refund of your ticket prior to 90 days before the start of the event, minus a $15 processing fee. Due to financial obligations incurred by AAOSH, we can offer a 50%, minus a $15 processing fee, refund 61-90 days before the start of the event. We cannot offer refund requests made 0-30 days before the start of the event.
If you wish to transfer your ticket, the initial registrant is responsible for finding and soliciting the ticket transferee and communicating the new attendee's contact information to AAOSH via email at support@aaosh.org.
Due to financial obligations incurred by AAOSH, no refunds or credits will be issued on cancellation requests less than 60 days before the start of the event.
All refunds incur a $15.00 processing fee.
All membership sales are final and not subject to refunds. All memberships renew on an annual basis. In order to cancel your membership, you must notify AAOSH 30 days in advance of your renewal date by contacting support@aaosh.org. If your membership tier changes (i.e. professional to retired), you must notify AAOSH 60 days prior to your renewal date so that we can change your status to the appropriate billing code.
All Exhibiting Partner Sales are final and non-refundable.