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HomeMy WebLinkAboutA021 - Form 8038-G, Information Return for Tax-Exempt Governmental Obligation Ames/419370-52 Form 8038-G Information Return for Tax-Exempt Governmental Obligations (Rev.September 2011) ►Under Internal Revenue Code section 149(e) OMB No.1545-0720 Do-See separate instructions. Department of the Treasury Internal Revenue Service Caution:If the issue price is under$100,000,use Form 8038-GC. 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) PO Box 811 131 6 City,town,or post office,state,and ZIP code 7 Date of issue Ames,Iowa 50010-0811 December 29,2015 8 Name of issue 9 CUSIP number Electric Revenue Bonds,Series 2015B 030843 FR2 10a 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 13 Transportation . . . . . . . . . . . . 13 14 Public safety . . . . . . . . . . . . . . . 14 15 Environment(including sewage bonds) . . . . . . . . . . . . . 15 16 Housing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 17 Utilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 10,318,381 55 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 . . . . . . . . No. ❑ Description of Obligations.Complete for the entire issue for which this form is being filed. (a)Final maturity date (b)Issue price Ic)Stated redemption (d)Weighted (e)Yield price at maturity average maturity 21 06/01/2027 10,318,381.55 9,500,000 6.2294 years 1.9806 % 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 10,318,381 55 24 Proceeds used for bond issuance costs(including underwriters'discount). . 24 141,492 14 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 29 Total(add lines 24 through 28) . . . . . . . . . . . . . . . . . . . . . . . 29 141,492 14 30 Nonrefunding proceeds of the issue(subtract line 29 from line 23 and enter amount here) . . 30 1 10,176,8891 41 FUrM 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 . . . . ► years 33 Enter the last date on which the refunded bonds will be called(MM/DD/YYYY) . . . . . . ► 34 Enter the date(s)the refunded bonds were issued►(MM/DD/YYYY) 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 to other governmental units . . . . . . . . . . . . . . . . . . . . . . . . 37 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 Do- 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)(13)(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 Do- c Type of hedge Po- 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 . . . . . . . . . ► $5,136,981.75 b Enter the date the official intent was adopted► October 27,2015 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 process rocess th' r turn,to the Damp that have authorized above. Consent —�' C1 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 sign r Date Check ❑ if Preparer PTIN Robert E.Josten �+ Z-'� (�a f S self-employed P01075995 Use Only Firm's name ► Dorsey&Whitney LLP ; Firm's EIN ► 41-0223337 Firm's address ► 801 Grand Ave.,Suit 4 ,Des Moines,Iowa 50309-8002 Phone no. 515-283-1000 Form 8038-G(Rev.9-2011)