HomeMy WebLinkAboutA063 - Letter from Dorsey & Whitney dated December 28, 2012 L70RSEY
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10 E N AN ;
TEWURY )UkSEY .x. WHiINEY 11.P
OF SERVICE
1912 1 2012
December 28, 2012
Diane R. Voss
City Clerk/City Hall
515 Clark Ave.
Ames, Iowa 50010
Re: $26,000,000 Hospital Revenue Bonds (Mary Greeley Medical Center) Series
2012
Dear Diane:
We have prepared and enclose the IRS 8038-G filing form for the above-captioned issue.
Please sign one copy of the form under the heading "Signature and Consent,"
date it as of
the date it is signed, and return it to us by no later than January 14, 2013, so that we can file it
with the Internal Revenue Service in order to preserve the tax-exempt status of the interest
earnings on the Bonds. The extra copy enclosed is for the City's records.
If you have any questions, please contact me.
Sincerely,
Waw
Jessica Wells
Enclosures
Csl:RSEY & 'l HIT`NE`r LLF WWW.DORSEY,COM T 115,283.1000 F 5 i 5.283.10f60
80 i �aRAND , SUITE 4100 DES M INES, IOWA 50309-2790
USA CANADA EUROPE ASIA-PACIFIC
418663-44
Form 8038-G Information Return for Tax-Exempt Governmental Obligations
(Rev.September 2011) ►Under Internal Revenue Code section 149(e) OMB No.1545-0720
0-See separate instructions.
Department of the Treasury P Caution:If the issue rice is under$100,000,use Form 8038-GC.
Internal Revenue Service -
Reporting Authority If Amended Return,check here ► ❑
1 Issuer's name 2 Issuer's employer identification number(EIN)
City of Ames,Iowa 42-6004218
3a Name of person(other than issuer)with whom the IRS may communicate about this return(see instructions) 3b Telephone number of other person shown on 3a
4 Number and street(or P.O.box if mail is not delivered to street address) Room/suite 5 Report number(For IRS Use Only)
515 Clark Avenue 13
6 City,town,or post office,state,and ZIP code 7 Date of issue
Ames,Iowa 50010 November 20,2012
8 Name of issue 9 CUSIP number
Hospital Revenue Bonds(Mary Greeley Medical Center),Series 2012 030850 ES6
108 Name and title of officer or other employee of the issuer whom the IRS may call for more information(see 10b Telephone number of officer or other
instructions) employee shown on 10a
Diane R.Voss,City Clerk 515-239-5105
Type of Issue(enter the issue price).See the instructions and attach schedule.
11 Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
12 Health and hospital . . . . . . . . . . . . . . . . . . . . . . . . . . 12 26,000,000
13 Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
14 Public safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
15 Environment(including sewage bonds) . . . . . . . . . . . . . . . . . . . . 15
16 Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
17 Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
18 Other.Describe ► 18
19 If obligations are TANS or RANs,check only box 19a . . . . . . . . . . . . . ► ❑
If obligations are BANs,check only box 19b . . . . . . . . . . . . . . . . ► ❑
20 If obligations are in the form of a lease or installment sale,check box . . . . . . . . ► ❑
Description of Obligations.Complete for the entire issue for which this form is being filed.
a Final maturity date (c)Stated redemption (d)Weighted ( )
( ) ty (b)Issue price price at maturity average maturity a Yield
21 6/15/2027 26,000,000 $ 26,000,000 6.0394 years 2.0701 %
Uses of Proceeds of Bond Issue(including underwriters' discount)
22 Proceeds used for accrued interest . . . . . . . . . . . . . . . . . . . . . 22
23 Issue price of entire issue(enter amount from line 21,column(b)) . . . . . 23 26,000,000
24 Proceeds used for bond issuance costs(including underwriters'discount). 24 282,834
25 Proceeds used for credit enhancement . . . . . . . . . . . . 25
26 Proceeds allocated to reasonably required reserve or replacement fund 26
27 Proceeds used to currently refund prior issues . . . . . . . . 27
28 Proceeds used to advance refund prior issues . . . . . . . . 28 14,342,077
29 Total(add lines 24 through 28) . . . . . . . . . . . . . . . . . . . . . . . 29 14,342,077
30 Nonrefunding proceeds of the issue(subtract line 29 from line 23 and enter amount here) . . . 30 11,375,089
LEEU Description of Refunded Bonds.Complete this part only for refunding bonds.
31 Enter the remaining weighted average maturity of the bonds to be currently refunded . . . . ► years
32 Enter the remaining weighted average maturity of the bonds to be advance refunded . . . . ► 5.4020 years
33 Enter the last date on which the refunded bonds will be called(MM/DD/YYYY) . . . . . . ► 06/15/2013
34 Enter the date(s)the refunded bonds were issued►(MM/DD/YYYY) 06/11/2003
For Paperwork Reduction Act Notice,see separate instructions. Cat.No.63773S Form 8038-G(Rev.9-2011)
Form 8038-G(Rev.9-2011) Page 2
Miscellaneous
35 Enter the amount of the state volume cap allocated to the issue under section 141(b)(5) 35
36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
(GIC)(see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . 36a
b Enter the final maturity date of the GIC►
c Enter the name of the GIC provider►
37 Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans u�,h
to other governmental units . . . . . . . . . . . . . . . . . . . . . . . . 37.1
38a If this issue is a loan made from the proceeds of another tax-exempt issue,check box► ❑and enter the following information:
b Enter the date of the master pool obligation►
c Enter the EIN of the issuer of the master pool obligation Ol-
d Enter the name of the issuer of the master pool obligation►
39 If the issuer has designated the issue under section 265(b)(3)(B)(i)(III)(small issuer exception),check box . . . . ► ❑
40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate,check box . . . . . . . . . . . . . ► ❑
41a If the issuer has identified a hedge,check here► ❑ and enter the following information:
b Name of hedge provider►
c Type of hedge Ol-
d Term of hedge►
42 If the issuer has superintegrated the hedge,check box . . . . . . . . . . . . . . . . . . . . . ► ❑
43 If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated
according to the requirements under the Code and Regulations(see instructions),check box . . . . . . . . ► ❑✓
44 If the issuer has established written procedures to monitor the requirements of section 148,check box . . . . . ► ❑✓
45a If some portion of the proceeds was used to reimburse expenditures,check here► ❑ and enter the amount
of reimbursement . . . . . . . . . lo-
b Enter the date the official intent was adopted Op-
Under penalties of perjury,I declare that I have examined this return and accompanying schedules and statements,and to the best of my knowledge
Signature and belief,they are true,correct,and complete.I further declare that I consent to the IRS's disclosure of the issuer's return information,as necessary to
and cess .7 return,to th that have authonz d above.
Consent t T I I, "3
' Diane R.Voss,City Clerk
Signature of issuer's authorized representative Date Type or print name and title
Paid Print/Type preparer's name Preparer's signature Date Check ❑ if PTIN
Preparer Cristina Kuhn self-employed P01067129
Use Only Firm's name ► Dorsey&Whitney LLP Firm's EIN ► 41-0223337
Firm's address ► 801 Grand Avenue,Suite 3900,Des Moines,Iowa 50309 Phone no. 515-283-1000
Form 8038-G(Rev.9-2011)