Assuming the number of visits per year is normally distributed, mean 16.5, standard deviation 4.2.
x = number of visits
want to compute P(x > 20)
to find probability we convert to standard normal distribution, mean 0 standard deviation 1.
z = (x - mean)/standard deviation is normally distribution with mean 0 and standard deviation 1.
convert x from N(16.5,4.2) to z N(0,1):
P(z > (20-16.5)/4.2) = P( z > 0.833).
Since normal distribution is symmetric that is the same as P(z < -0.833) = 0.2033