SAMPLE HEALTHCARE FORM OF LETTER OF APPLICATION TO

Prior to any application to the Commission, Alex Burlingame of Squire Patton Boggs (US) LLP,

Bond Counsel to the Commission, may be contacted for assistance in the preparation of the application. The

following is only a sample form of application letter and should be completed only after discussion with Mr.

Burlingame concerning the application process. Mr. Burlingame may be called at 216/479-8500. A copy of the

application letter along with the related accompanying materials should be sent to Mr. Burlingame for distribution to

Commission members. A copy of the letter and a check for the Application Fee should be sent at the same time

directly to Kevin Holtsberry, OHEFC Administrator, at the Commission’s address shown below.

SAMPLE HEALTHCARE FORM OF LETTER

OF APPLICATION TO THE OHIO

HIGHER EDUCATIONAL FACILITY COMMISSION

Thomas F. Needles, Chair

Ohio Higher Educational Facility Commission

25 South Front Street, 2

Floor

Columbus, Ohio 43215

Re: Proposed OHEFC Project for ___________________

Dear Mr. Needles:

On behalf of the Board of Trustees of ______________________, I wish to provide the Ohio

Higher Educational Facility Commission with information and assurances pertaining to this request

for financing by the Commission of [the Project, e.g., the construction emergency room facilities,

etc…..].

[Describe the Project in reasonable detail, the need for the Project and the Project costs, including

estimated construction costs and costs relating to the financing of the Project to the extent

available.]

[Discuss the projected operating costs of the Project including debt service on the bonds.]

[Discuss what Project costs are to be financed through the Commission and other sources, if any,

particularly any grants or proceeds of fund-raising activities.]

[Discuss the proposed financing arrangements for the sale of the bonds, i.e., underwriter or

financial advisor, if known at this time.]

[The [Health System’s] Board of Trustees has approved the proposed financing through the

Commission. A copy of the [Health System’s] approving Board resolution is enclosed.] or [The

[Health System’s] Board of Trustees has not yet approved the proposed financing. Please include a

discussion of the status of Board level discussions regarding the proposed financing, including the

anticipated time at which Board approval will be obtained.]

The Project will be constructed on real estate presently owned by the [Health System] as part of its

main [hospital campus]. Appropriate rights in the real estate would be conveyed by the [Health

System] to the Commission if the Commission finances a portion of the Project. [Revise as

necessary. Discuss any existing mortgages or liens on property relating to the Project.]

[Discuss outstanding debt of the Health System.][Discuss Obligated Group structure, if applicable]

[Discuss past, present and projected utilization; separate tables or charts may be attached.]

____________ is a corporation not for profit, formed and operated for purposes of providing

health care.

The [Health System] is accredited by _______________________________.

____________ represents to and assures the Commission that the Health System intends to use and

operate the Project at all times as the type of facility originally planned and constructed.

_____________represents to and assures the Commission Project and the services rendered

thereby will be available to or for the service of the general public without discrimination by

reason of race, creed, color or national origin

Enclosed herewith is a copy of the Health System’s most recent audited financial reports for the

fiscal years ending ___________, 20__ and 20__.

[Discuss, in general terms, the financial condition of the Health System.]

[Also enclosed, if available, any resolution of the Board of Trustees or Executive/Finance

Committee relating to the financing of the Project.]

The following is the proposed time schedule for the Project/Financing:

The Board of Trustees of the [Health System] or the [Health System’s] administrative officers

would be pleased to provide you with any further information if required.

Enclosed with a copy of this letter to Thomas F. Needles, Chair, is a check from the [Health

System] in the amount of $500.00 made out to Ohio Higher Educational Facility Commission,

representing payment of the Application Fee.

The undersigned certifies that he/she is familiar with the facts stated in this letter and enclosures,

and that the same are true.

Very truly yours,

cc: Kevin Holtsberry, OHEFC Administrator (with Application Fee check)

[More detailed descriptions of the Project and Project costs may be attached as appendices.]

[General information about the Health System, e.g. brochures, catalogs, etc., may also be enclosed.]