HomeMy WebLinkAboutA030 - Form 8038-G, Information Return for Tax-Exempt Governmental Obligations Ames/419370-58
Form 8038-G Information Return for Tax-Exempt Governmental Obligations
(Rev.September 2011) ►Under Internal Revenue Code section 149(e) OMB No.1545-0720
►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 Do-
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 f 13
6 City,town,or post office,state,and ZIP code 7 Date of issue
Ames,Iowa 50010-0811 September 12,2017
8 Name of issue 9 CUSIP number
General Obligation Corporate Purpose and Refunding Bonds,Series 2017A 030807 X71
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
18 Other.Describe ► street,sanitary and storm sewer,bridge and related improvements¤t refunding 18 1 11,903,9971 50
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 . . . . . . . . ON-
Description of Obligations.Complete for the entire issue for which this form is being filed.
(c)Stated redemption (d)Weighted
(a)Final maturity date (b)Issue price price at maturity average maturity (e)Yield
21 06/01/2029 11,903,997.50 $ 10,975,000 4.9894 yearsi 1.6677 %
FM 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 11,903,997 50
24 Proceeds used for bond issuance costs(including underwriters'discount) . . 24 96,771 66
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 4,285,000
28 Proceeds used to advance refund prior issues . . . . . . . . . 28
29 Total(add lines 24 through 28) . . . . . . . . . . . . . . . . . . . . . . . 29 4,381,771 66
30 Nonrefunding proceeds of the issue(subtract line 29 from line 23 and enter amount here) 30 1 7,522,2251 84
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 . . . . ► 2.2701 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) . . . . . . ► 09/22/2017
34 Enter the date(s)the refunded bonds were issued►(MM/DD/YYYY) 10129/2009
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►
c Enter the EIN of the issuer of the master pool obligation►
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 Do-
c Type of hedge►
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 . . . . . . . . . ► $35,868
b Enter the date the official intent was adopted► February 14,2017
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 process toirs,return,to the n that Ifhave authorized above.
Consent ! Diane R.Voss,City Clerk
�SignatutrehdfisAsu,ersuthorized representative 7 Date Type or print name and title
Print/Type preparer's name P rer's sign re Date PTIN
Paid Check ❑ if
Preparer Robert E.Josten \_1 self-employed I P01075995
Use Only Firm's name ► Dorsey&Whitney LLq Firm's EIN ► 41-0223337
Firm's address ► 801 Grand Ave.,Suite 4100 es Moines,Iowa 50309-8002 Phone no. 515-283-1000
Form 8038-G(Rev.9-2011)