In order to meet the unique needs of different types of borrowers, and/or unique financing programs, the authority will develop and modify from time to time, as necessary, the application forms for financial assistance. Any such application shall contain at least the following information:

(1) Identification of applicant:

(a) Legal name and address of applicant;

(b) Name, title and telephone number of person assigned responsibility for liaison with the authority;

(c) Description of applicant's legal structure (e.g., private nonprofit corporation, public district hospital);

(d) If applicant is a private entity, attach copies of articles of incorporation or other similar documentation, and a copy of IRS determination of 501 (c)(3) status;

(e) Religious or other group affiliation, if any.

(2) Project for which financial assistance is sought (if applicable):

(a) The maximum principal amount requested and, if the requested financial assistance will finance multiple projects at separate sites, a breakdown of the maximum principal amount to finance each separate project;

(b) General description of project to be financed or refinanced;

(c) Current status of planning for project and dates proposed for (i) completion of drawings for project, if applicable (attach copies if completed); (ii) filing of environmental impact statement, if applicable; (iii) entry into construction contract; and (iv) completion or occupancy;

(d) Current status of certificate of need for project, if required. If certificate has been issued, attach copy;

(e) Cost of project (including simple breakdown of costs of general construction, site work, utilities, equipment, land acquisition, architects' and other fees, contingency, interim interest, other);

(f) Feasibility studies on project, if any (attach copy if one has been completed);

(g) Proposed security for authority-issued bonds.

(3) Finances of applicant:

(a) Audited (if audited) financial statements for past three years;

(b) Latest current financial statement;

(c) Current year's budget of revenues, expenses and capital expenditures.

(4) General:

(a) Pending or threatened litigation or administrative actions with potential of material adverse effect on applicant;

(b) Brief description of existing health care facilities, including number of beds, number of health care and other staff, categories of health care services offered, and laboratory and research facilities, if any;

(c) Describe means applicant proposes to use to ensure that savings from tax-exempt financing the estimated financial benefits resulting from financing its project through the authority, as opposed to obtaining financing other than through the authority, will be used for building, providing and utilization of modern, well-equipped and reasonably priced health care facilities in a manner that will minimize the capital costs of construction, financing and use thereof and thereby the costs to the public for the use of such facilities, and to contribute to improving the quality of health care;

(d) The application shall contain an appropriate legal commitment to indemnify the authority against any expenses or costs incurred by it in connection with the processing of the applicant's application and the completion of any project or plan and system subsequently approved and undertaken by the authority. (See WAC 247-16-040 regarding authority charges);

(e) The authority or the executive director may require the submission of additional information depending on factors such as the scope, size, and complexity of project;

(f) Application forms are available from the authority and are available on the authority website.