Project Address: City / State / Zip: County: Lender Name: Section of the Act: 232/223(f) Refinance Purchase Operating License Operating Licensed Type of facility: Skilled Nursing beds units (SNF): Assisted Living beds units (AL): Memory Care beds units (AL): Board & Care beds units (B&C): Independent Living beds units (IL): Total: beds units Loan to Transaction Mortgage $ % % LTV: Cost: Amount: % Term: months Interest rate: $ Medicare.Gov DSCR Principal & % Star Rating # stars with MIP): Interest per month Underwritten Value per $ Value: % $ Cap rate: bed/unit*: UW Effective gross income: $ UW occupancy rate: % UW Expenses & repl. res.: $ Expense ratio: % UW Net operating income: $ Expense per bed/unit*: $ *Use per bed for SNF, or facilities with multiple care types (e.g., SNF/AL). Use per unit for ALF only. Reserve for Replacement: $ Critical Repairs: $ $ Non-Critical Repairs: Initial Deposit: Borrower Proposed $ $ Repairs: Annual Deposit: $ Total Repairs: $ Other escrows/reserves: <<description of other escrows/reserves>> Does the lender propose to administer the Yes No non-critical repair escrow? Borrower: <<Legal Name>> Operator: <<Legal Operating lease Name>>
Project Address: City / State / Zip: County: Lender Name: Section of the Act: 232/223(f) Refinance Purchase Licensed Operating Operating Type of facility: Skilled Nursing (SNF): beds units Assisted Living (AL): beds units Memory Care (AL): beds units Board & Care (B&C): beds units Independent Living (IL): beds units Total: beds units Mortgage Amount: $ LTV: % Loan to Transaction Cost: % Term: months Interest rate: % Medicare.Gov Star Rating # stars DSCR with MIP): % Principal & Interest $ per month Underwritten Value: $ Cap rate: % Value per bed/unit*: $ UW Effective gross income: $ UW occupancy rate: % UW Expenses & repl. res.: $ Expense ratio: % UW Net operating income: $ Expense per bed/unit*: $ *Use per bed for SNF, or facilities with multiple care types (e.g., SNF/AL). Use per unit for ALF only. Critical Repairs: $ Reserve for Replacement: Non-Critical Repairs: $ Initial Deposit: $ Borrower Proposed Repairs: $ Annual Deposit: $ Total Repairs: $ Other escrows/reserves: $ <<description of other escrows/reserves>> Does the lender propose to administer the non-critical repair escrow? Yes No Borrower: <<Legal Name>> Operator: <<Legal Name>> Operating lease License
9002_orcf-Redline.docx