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SECTION II: FINANCIAL SECTION

FY 2018 HHS Agency Financial Report

Topics In This Section:  Message from the Acting Chief Financial OfficerReport of the Independent Auditors | Department’s Response to the Report of the Independent Auditor | Principal Financial Statements | Notes to the Principal Financial Statements | Required Supplementary Stewardship Information | Required Supplementary Information

Message from the Acting Chief Financial Officer

CFO Community Logo I am proud to join the Secretary in issuing our Fiscal Year (FY) 2018 Agency Financial Report.  For the 20th consecutive year, we received an unmodified (clean) audit opinion on our financial statements from our independent auditors.  We provide stewardship and accountability of funds across HHS, by developing financial management policies and procedures, establishing and overseeing internal controls, and producing high-quality financial and managerial reports.

For the first time since 1996, the Department has no auditor-reported material weaknesses.  The Department spearheaded an integrated multi-year strategy to mature our financial systems security and controls environment, resulting in the resolution of the long-standing material weakness related to Information System Controls and Security.  While the auditors downgraded this material weakness to a significant deficiency, we will continue to strengthen our control environment by resolving deficiencies as quickly as possible through risk-based corrective action plans.     

For the fifth consecutive year, HHS’s financial report received the Association of Government Accountants’ Certificate of Excellence in Accountability Reporting.  Federal financial reports must pass a rigorous independent review against a comprehensive set of standards to earn this prestigious recognition, which is the highest award bestowed for federal financial reporting. 

Our Chief Financial Officer (CFO) community is dedicated to collaboratively improving Department-wide operations.  This year, our CFO Community developed the HHS CFO Community Strategic Plan for FY 2018-2022.  This Strategic Plan has five core values:  Accountability, Collaboration, Excellence, Integrity, and Transparency; and sets our HHS CFO priorities for the upcoming years.  Furthermore, the Strategic Plan aligns with and supports the HHS Strategic Plan FY 2018-2022.

HHS’s achievements illustrate the remarkable effort and dedication of our employees and partners.  We will continue to serve as accountable and committed stewards supporting the Department’s mission on behalf of the public.

/Jen Moughalian/

Jen Moughalian
Assistant Secretary for Financial Resources and
  Acting Chief Financial Officer
November 14, 2018

Report of the Independent Auditors

Report of the Independent Auditors

Department’s Response to the Report of the Independent Auditors

Title: HHS Letterhead - Description: Office of the Secretary Letterhead

To:          Daniel R. Levinson, Inspector General

From:      Jen Moughalian, Acting Assistant Secretary for Financial Resources and Acting Chief Financial Officer

Subject:  FY 2018 Financial Statement Audit

Thank you for the opportunity to comment on the results of the Independent Auditors’ Report.  We appreciate the professionalism exhibited by the Office of Inspector General (OIG) and our independent auditors, Ernst & Young LLP (EY), throughout this process.

FY 2018 was a significant year for federal financial management at HHS.  For the first time since 1996, the material weakness related to Information System Controls and Security is no longer reported by the auditors.  As noted by EY, HHS made considerable progress in resolving audit findings, reducing risk across the operating environment, and maturing the security and controls posture of HHS’s financial systems. 

We acknowledge the two existing material noncompliances with laws and regulations and generally concur with the auditor’s findings as presented in the Report on Internal Control.  HHS will continue to implement corrective actions to address those deficiencies.

We are proud of our success in achieving an unmodified audit opinion and resolving the information systems material weakness.  Overall, the Department made advances to enhance our internal control environment and is committed to a collaborative approach that will correct current deficiencies, further strengthen controls, and limit future deficiencies.

We would like to thank the OIG and EY for their efforts; and the OIG’s continued partnership as we improve our stewardship and transparency.

/Jen Moughalian/

Jen Moughalian
Assistant Secretary for Financial Resources and
  Acting Chief Financial Officer
November 14, 2017

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Principal Financial Statements

U.S. Department of Health and Human Services
Consolidated Balance Sheet

As of September 30, 2018 and 2017
(in Millions)

Line Item 2018 2017
Assets (Note 2)    
Intragovernmental Assets    
Fund Balance with Treasury (Note 3) $250,163 $209,753
Investments, Net (Note 4) 307,115 275,524
Accounts Receivable, Net (Note 5) 1,129 962
Other Assets (Note 8) 255 233
Total Intragovernmental Assets 558,662 486,472
     
Accounts Receivable, Net (Note 5) 26,802 33,087
Inventory and Related Property, Net (Note 6) 9,815 9,698
General Property, Plant and Equipment, Net (Note 7) 6,30 6,248
Advances (Note 8) 2,694 30,859
Other Assets 204 459
Total Assets 604,527 562,653
Stewardship Land (Notes 19)    
     
Liabilities (Note 9)    
Intragovernmental Liabilities    
Accounts Payable $1,029 $239
Other Liabilities (Note 13) 8,080 9,661
Total Intragovernmental Liabilities 9,109 9,990
     
Accounts Payable 957 1,099
Entitlement Benefits Due and Payable (Note 10) 99,148 108,347
Accrued Liabilities (Note 12) 14,521 11,872
Federal Employee and Veterans’ Benefits (Note 11) 14,386 13,532
Contingencies and Commitments (Note 14) 13,475 14.797
Other Liabilities (Note 13) 5,736 4,358
Total Liabilities 157,332 163,905
     
Net Position    
Unexpended Appropriations - Funds from Dedicated Collections (Note 18) 22,934 17,284
Unexpended Appropriations - All Other Funds 163,667 129,688
     
Cumulative Results of Operations - Funds from Dedicated Collections (Note 18) 262,972 257,676
Cumulative Results of Operations - All Other Funds (262,972) (1,730)
Total Funds from Dedicated Collections 285,906 274,960
Total All Other Funds 161,289 127,958
Total Net Position 447,195 402,918
     
Total Liabilities and Net Position $604,527 $566,823

The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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U.S. Department of Health and Human Services
Consolidated Statement of Net Cost

For the Years Ended September 30, 2018 and 2017
(in Millions)

  2018 2017
Responsibility Segments    
Centers for Medicare & Medicaid Services (CMS)    
Gross Cost $1,115,161 $1,060,793
Exchange Revenue (106,304) (97,294)
CMS Net Cost of Operations 1,008,857 963,499
Other Segments:    
Administration for Children and Families (ACF) 54,091 51,187
Administration for Community Living (ACL) 1,994 1,948
Agency for Healthcare Research and Quality (AHRQ) 344 340
Centers for Disease Control and Prevention (CDC) 12,382 11,945
Food and Drug Administration (FDA) 5,023 4,860
Health Resources and Services Administration (HRSA) 11,684 10,724
Indian Health Service (IHS) 10,766 6,456
National Institutes of Health (NIH) 33,587 31,376
Office of the Secretary (OS) 3,221 3,278
Program Support Center (PSC) 2,588 2,125
Substance Abuse and Mental Health Services Administration (SAMHSA) 4,124 3,625
Other Segments Gross Cost of Operations before Actuarial Gains and Losses $139,804 $127,864
Actuarial (Gains) and Losses Commissioned Corp Retirement and Medical Plan    
Medical Plan (Note 11) 416 449
Other Segments Gross Cost of Operations after Actuarial Gains and Losses $140,220 $127,864
Exchange Revenue (5,806) (4,963)
Other Segments Net Cost of Operations 134,414 123,350
Net Cost of Operations (Note 15) $1,143,271 $1,086,849

The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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U.S. Department of Health and Human Services
Consolidated Statement of Changes in Net Position

For the Year Ended September 30, 2018
(in Millions)

  2018
  Funds From Dedicated Collections All Other Funds Eliminations Consolidated Total
Unexpended Appropriations:        
Beginning Balances $17,284 $129,688 $- $146,972
         
Budgetary Financing Sources:        
Appropriations Received 376,964 653,567 - 1,030,531
Appropriations Transferred in/out (+/-) - 1 - 1
Other Adjustments (+/-) (34,637) (85,787) - (120,424)
Appropriations Used (336,677) (533,802) - (870,479)
Total Budgetary Financing Sources 5,650 33,979 - 39,629
Total Unexpended Appropriations 22,934 163,667 - 186,601
         
Cumulative Results of Operations:        
Beginning Balances 257,676 (1,730) $- 255,946
Budgetary Financing Sources:        
Other Adjustments (Rescissions, etc.) (+/-) (3) (5) - (8)
Appropriations Used 336,677 533,802 - 870,479
Non-exchange Revenue        
Non-exchange Revenue - Tax Revenue 264,566 - - 264,566
Non-exchange Revenue - Investment Revenue 9,746 27 - 9,773
Non-exchange Revenue - Other 4,946 - - 4,946
Donations and Forfeitures of Cash and Cash Equivalents 75 - - 75
Transfers-in/out without Reimbursement (5,203) 2,551 - (2,652)
Other (+/-) - 1 - 1
Other Financing Sources (Non-Exchange):        
Donations and Forfeitures of Property - 5 - 5
Transfers-in/out Without Reimbursement (+/-) (2) 3 - 1
Imputed Financing 64 1,001 (323) 742
Other (+/-) (8) (1) - (9)
Total Financing Sources 610,858 537,384 (323) 1,147,919
Net Cost of Operations (+/-) 605,562 538,032 (323) 1,143,271
Net Change 5,296 (648) - 4,648
Cumulative Results of Operations: 262,972 (2,378) - 260,594
         
Net Position $285,906 $161,289 $- $447,195

The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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U.S. Department of Health and Human Services
Consolidated Statement of Changes in Net Position

For the Year Ended September 30, 2018
(in Millions)

  2017
  Funds From Dedicated Collections All Other Funds Eliminations Consolidated Total
Unexpended Appropriations:        
Beginning Balances $35,912 $128,129 $- $164,041
         
Budgetary Financing Sources:        
   Appropriations Received 348,468 605,538 - 954,006
   Appropriations Transferred in/out (+/-) - (10) - (10)
   Other Adjustments (+/-) (41,644) (97,081) - (138,725)
   Appropriations Used (+/-) (325,452) (506,888) - (832,340)
   Total Budgetary Financing Sources (18,628) 1,559 - (17,069)
Total Unexpended Appropriations 17,284 129,688 - 146,972
         
Cumulative Results of Operations:        
Beginning Balances 233,470 3,860 - 237,330
Budgetary Financing Sources:        
   Other Adjustments (+/-) (3) (4) - (7)
   Appropriations Used 325,452 506,888 - 832,340
   Non-exchange Revenue        
      Non-exchange Revenue - Tax Revenue 259,740 - - 259,740
      Non-exchange Revenue - Investment Revenue 9,818 6 - 9,824
      Non-exchange Revenue - Other 4,904 - - 4,904
   Donations and Forfeitures of Cash and Cash Equivalents 70 - - 70
   Transfers-in/out without Reimbursement (4,950) 3,145 - (1,805)
Other Financing Sources (Non-Exchange):        
   Donations and Forfeitures of Property - (40) - (40)
   Transfers-in/out Without Reimbursement (+/-) (2) 2 - -
   Imputed Financing 37 682 (347) 372
   Other (+/-) 4 63 - 67
Total Financing Sources 595,070 510,742 (347) 1,105,465
Net Cost of Operations (+/-) 570,864 516,332 (347) 1,086,849
Net Change 24,206 (5,590) - 18,616
Cumulative Results of Operations: 257,676 (1,730) - 255,946
         
Net Position $274,960 $127,958 $- $402,918

The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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U.S. Department of Health and Human Services
Combined Statement of Budgetary Resources

For the Years Ended September 30, 2018 and 2017
(in Millions)

Budgetary Resources

 

2018 2017
Unobligated Balance from Prior Year Budget Authority, Net (Discretionary and Mandatory) $97,593 $78,846
Appropriations (Discretionary and Mandatory) 1,646,670 1,585,475
Borrowing Authority (Discretionary and Mandatory) (127) 3,871
Spending Authority from Offsetting Collections (Discretionary and Mandatory) 13,644 14,360
Total Budgetary Resources (Note 21) $1,757,780 $1,682,552
     
Status of Budgetary Resources    
New Obligations and Upward Adjustments (Notes 17 and 21) $1,680,053 $1,647,162
Unobligated Balance, End of Year:    
Apportioned, Unexpired Accounts 43,508 15,376
Exempt from Apportionment, Unexpired Accounts 188 (12,103)
Unapportioned, Unexpired Accounts 9,970 7,997
Unexpired Unobligated Balance, End of Year 53,666 11,270
Expired Unobligated Balance, End of Year 24,061 24,120
Unobligated Balance, End of Year 77,727 35,390
Total Budgetary Resources (Note 21) $1,757,780 $1,682,552
     
Outlays, Net:    
Outlays, Net (Discretionary and Mandatory) (Note 20) 1,589,140 1,562,696
Distributed Offsetting Receipts (Note 20) (468,877) (446,103)
Agency Outlays, Net (Discretionary and Mandatory) (Note 20) $1,120,263 $1,116,593

The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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U.S. Department of Health and Human Services
Statement of Social Insurance
(Unaudited)
75-Year Projection as of January 1, 2018 and Prior Base Years
(in Billions)

    Estimates from Prior Years
  2018 2017 2016 2015 2014
Actuarial present value for the 75-year projection period of estimated future income (excluding interest) received from or on behalf of: (Notes 22 and 23)          
Current participants who, in the starting year of the projection period:          
Have not yet attained eligibility age          
HI $11,323 $10,679 $10,294 $9,134 $8,398
SMI Part b 24,143 21,641 19,386 17,027 17,127
SMI Part d 7,176 6,929 7,659 6,424 5,928
Have attained eligibility age (age 65 or over)          
HI 525 492 455 382 332
SMI Part b 4,725 4,122 3,660 3,300 2,873
SMI Part d 1,015 958 952 887 775
Those expected to become participants          
HI 10,959 10,567 9,952 8,386 7,812
SMI Part b 5,586 5,019 4,437 3,668 4,311
SMI Part d 2,932 2,869 3,602 2,845 2,609
All current and future participants          
HI 22,807 21,738 20,701 17,902 16,542
SMI Part b 34,453 30,783 27,484 23,995 24,311
SMI Part d 11,124 10,756 12,213 10,156 9,312
Actuarial present value for the 75-year projection period of estimated future expenditures for or on behalf of: (Notes 22 and 23)          
Current participants who, in the starting year of the projection period:          
Have not yet attained eligibility age          
HI $18,604 $17,193 $16,800 $14,494 $14,117
SMI Part b 23,832 21,392 19,178 16,818 17,003
SMI Part d 7,176 6,929 7,659 6,424 5,928
Have attained eligibility age (age 65 and over)          
HI 5,027 4,539 4,285 3,803 3,484
SMI Part b 5,180 4,531 4,026 3,637 3,171
SMI Part d 1,015 958 952 887 775
Those expected to become participants          
HI 3,884 3,539 3,437 2,791 2,764
SMI Part b 5,442 4,860 4,281 3,540 4,137
SMI Part d 2,932 2,869 3,602 2,845 2,609
All current and future participants:          
HI 27,515 25,270 24,523 21,089 20,365
SMI Part b 34,453 30,783 27,484 23,995 24,311
SMI Part d 11,124 10,756 12,213 10,156 9,312
Actuarial present value for the 75-year projection period of estimated future excess of income (excluding interest) over expenditures (Notes 22  and 23)          
HI $(4,708) $(3,532) $(3,822) $(3,187) $(3,823)
SMI Part b - - - - -
SMI Part d - - - - -
           
Additional Information          
Actuarial present value for the 75-year projection period of estimated future excess of income (excluding interest) over expenditures (Notes 22 and 23)          
HI $(4,708) $(3,532) $(3,822) $(3,187) $(3,823)
SMI Part b - - - - -
SMI Part d - - - - -
Trust Fund assets at start of period          
HI 202 199 194 197 205
SMI Part b 80 88 68 68 74
SMI Part d 8 8 1 1 1
Actuarial present value for the 75-year projection period of estimated future excess of income (excluding interest) and Trust Fund assets at start of period over expenditures (Notes 22 and 23)          
HI $(4,506) $(3,333) $(3,628) $(2,990) $(3,618)
SMI Part b 80 88 68 68 74
SMI Part d 8 8 1 1 1

Please note for the entirety of the Statement of Social Insurance:
Totals do not necessarily equal the sum of the rounded components.
Current participants are assumed to be the “closed group” of individuals who are at least age 15 at the start of the projection period and are participating in the program as either taxpayers, beneficiaries or both.
The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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U.S. Department of Health and Human Services
Statement of Social Insurance (Continued) (Unaudited)

75-Year Projection as of January 1, 2018 and Prior Base Years
(in Billions)

    Estimates from Prior Years
  2018 2017 2016 2015 2014
Medicare Social Insurance Summary          
Current Participants:          
Actuarial present value for the 75-year projection period from or on behalf of:          
Those who, in the starting year of the projection period, have attained
eligibility age:
         
Income (excluding interest) $6,266 $5,572 $5,067 $4,569 $3,980
Expenditures 11,222 10,027 9,263 8,328 7,430
Income less expenditures (4,957) (4,455) (4,196) (3,759) (3,450)
Those who, in the starting year of the projection period, have not yet
attained eligibility age:
         
Income (excluding interest) 42,643 39,250 37,339 32,585 31,453
Expenditures 49,612 45,514 43,637 37,736 37,048
Income less expenditures (6,970) (6,264) (6,298) (5,151) (5,595)
Actuarial present value of estimated future income (excluding interest)
less expenditures (closed-group measure)
(11,926) (10,719) (10,493) (8,909) (9,045)
Combined Medicare Trust Fund assets at start of period 290 295 263 266 280
Actuarial present value of estimated future income (excluding interest) less expenditures plus trust fund assets at start of period (11,637) (10,425) (10,230) (8,643) (8,764)
Future Participants:          
Actuarial present value for the 75-year projection period:          
Income (excluding interest) 19,477 18,456 17,992 14,898 14,732
Expenditures 12,258 11,268 11,320 9,176 9,510
Income less expenditures 7,219 7,187 6,672 5,722 5,222
Open-Group (all current and future participants):          
Actuarial present value of estimated future income (excluding interest)
less expenditures
(4,708) (3,532) (3,822) (3,187) (3,823)
Combined Medicare Trust Fund assets at start of period 290 295 263 266 280
Actuarial present value of estimated future income (excluding interest)
less expenditures plus trust fund assets at start of period
$(4,418) $(3,237) $(3,559) $(2,921) $(3,542)

Please note for the entirety of the Statement of Social Insurance:
Totals do not necessarily equal the sum of the rounded components. 
Current participants are assumed to be the “closed group” of individuals who are at least age 15 at the start of the projection period and are participating in the program as either taxpayers, beneficiaries or both.
The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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U.S. Department of Health and Human Services
Statement of Changes in Social Insurance Amounts(Unaudited)

January 1, 2017 to January 1, 2018
Medicare Hospital and Supplementary Medical Insurance
(in Billions)

  Actuarial present value over the next 75 years
(open group measure)
Combined HI and SMI trust fund account assets Actuarial present value of estimated future income (excluding interest) less expenditures plus combined trust fund assets
Estimated future income (excluding interest) Estimated future expenditures Estimated future income less expenditures
Total Medicare (Note 24)          
As of January 1, 2017 $63,277 $66,809 $(3,532) $295 $(3,237)
Reasons for change          
Change in the valuation period 2,355 2,523 (168) - (168)
Change in projection base (502) 419 (921) (5) (926)
Changes in the demographic assumptions (551) (985) 434 - 434
Changes in economic and health care assumptions 3,176 3,162 14 - 14
Changes in law 629 1,165 (535) - (535)
Net changes 5,107 6,283 (1,176) (5) (1,181)
As of January 1, 2018 $68,385 $73,092 $(4,708) $290 $(4,418)
HI - Part A (Note 24)          
As of January 1, 2017 $21,738 $25,270 $(3,532) $199 $(3,333)
Reasons for change          
Change in the valuation period 747 915 (168) 11 (157)
Change in projection base (612) 309 (921) (8) (929)
Changes in the demographic assumptions (214) (648) 434 - 434
Changes in economic and health care assumptions 1,223 1,208 14 - 14
Changes in law (74) 461 (535) - (535)
Net changes 1,069 2,245 (1,176) 3 (1,173)
As of January 1, 2018 $22,807 $27,515 $(4,708) $202 $(4,506)
SMI - Part B (Note 24)          
As of January 1, 2017 $30,783 $30,783 $- $88 $88
Reasons for change          
Change in the valuation period 1,154 1,154 - (10) (10)
Change in projection base 197 197 - 2 2
Changes in the demographic assumptions (358) (358) - - -
Changes in economic and health care assumptions 2,087 2,087 - - -
Changes in law 591 591 - - -
Net changes 3,670 3,670 - (8) (8)
As of January 1, 2018 $34,453 $34,453 $- $80 $80
SMI - Part D (Note 24)          
As of January 1, 2017 $10,756 $10,756 $- $8 $8
Reasons for change          
Change in the valuation period 455 455 - (1) (1)
Change in projection base (87) (87) - 1 1
Changes in the demographic assumptions 21 21 - - -
Changes in economic and health care assumptions (133) (133) - - -
Changes in law 113 113 - - -
Net changes 368 368 - - -
As of January 1, 2018 $11,124 $11,124 $- $8 $8

Totals do not necessarily equal the sum of the rounded components.
The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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 U.S. Department of Health and Human Services
Statement of Changes in Social Insurance Amounts (Continued) (Unaudited)

January 1, 2016 to January 1, 2017
Medicare Hospital and Supplementary Medical Insurance
(in Billions)

  Actuarial present value over the next 75 years
(open group measure)
Combined HI and SMI trust fund account assets  Actuarial present value of estimated future income (excluding interest) less expenditures plus combined trust fund assets
Estimated future income
(excluding interest)
Estimated future expenditures Estimated future income less expenditures
Total Medicare (Note 24)          
As of January 1, 2016 $60,398 $64,220 $(3,822) $263 $(3,559)
Reasons for change          
Change in the valuation period 2,481 2,669 (187) 24 (163)
Change in projection base (136) (479) 342 8 350
Changes in the demographic assumptions (122) (20) (102) - (102)
Changes in economic and health care assumptions 617 384 233 - 233
Changes in law 40 36 4 - 4
Net changes 2,880 2,590 290 31 321
As of January 1, 2017 $63,277 $66,809 $(3,532) $295 $(3,237)
HI - Part A (Note 24)          
As of January 1, 2016 $20,701 $24,523 $(3,822) $194 $(3,628)
Reasons for change          
Change in the valuation period 792 979 (187) 1 (186)
Change in projection base 133 (209) 342 4 346
Changes in the demographic assumptions (152) (50) (102) - (102)
Changes in economic and health care assumptions 265 32 233 - 233
Changes in law - (4) 4 - 4
Net changes 1,037 748 290 5 295
As of January 1, 2017 $21,738 $25,270 $(3,532) $199 $(3,333)
SMI - Part B (Note 24)          
As of January 1, 2016 $27,484 $27,484 $- $68 $68
Reasons for change          
Change in the valuation period 1,115 1,115 - 17 17
Change in projection base 281 281 - 3 3
Changes in the demographic assumptions 7 7 - - -
Changes in economic and health care assumptions 1,856 1,856 - - -
Changes in law 40 40 - - -
Net changes 3,299 3,299 - 20 20
As of January 1, 2017 $30,783 $30,783 $- $88 $88
SMI - Part D (Note 24)          
As of January 1, 2016 $12,213 $12,213 $- $1 $1
Reasons for change          
Change in the valuation period 575 575 - 5 5
Change in projection base (550) (550) - 1 1
Changes in the demographic assumptions 22 22 - - -
Changes in economic and health care assumptions (1,504) (1,504) - - -
Changes in law - - - - -
Net changes (1,457) (1,457) - 6 6
As of January 1, 2017 $10,756 $10,756 $- $8 $8

Totals do not necessarily equal the sum of the rounded components.
The accompanying “Notes to the Principal Financial Statements” are an integral part of these statements.

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Content created by Office of Finance (OF)
Content last reviewed on November 29, 2018