Sale of beds Sale of land or other security Reconstructing Demolishing portions Instructions *See section on page 1 for “remodeling” definition. Complete this table if there is a proposed change in the number or type of beds/units. Operating Operating Licensed Licensed Type of facility: Skilled Nursing beds units (SNF): Assisted Living beds units (AL): Board & Care beds units As Is (B&C): Dementia Care: beds units Independent Living beds units (IL): Total: beds units Operating Operating Licensed Licensed Type of Skilled Nursing facility: beds units (SNF): Assisted Living beds units (AL): Board & Care beds units As (B&C): Dementia Care: beds units Proposed Independent Living beds units (IL): Total: beds units Lenders Pre-Construction Conference Coordinator Information: Name: Email: Phone: Mailing address: Continued Program Eligibility Key Questions Yes No Upon completion of the proposed collateral change, will the facility require more than four residents to share a full bathroom (see 24 CFR 232.3)? (Not N/A applicable for SNFs.) Upon completion of the proposed collateral change, will any residents be required to access a qualifying bathroom by moving through a public corridor or area (see 24 CFR 232.3)? N/A (Not applicable for SNFs.) Upon the completion of the collateral change, are there any “minimum requirements necessary to quality under the Section 232 assistance” mortgage insurance program that the facility does not plan to offer? Are there floodways or coastal high hazard areas located on the site of any portion of the proposed collateral change?*
Sale of beds Sale of land or other security Reconstructing Demolishing portions *See Instructions section on page 1 for “remodeling” definition. Complete this table if there is a proposed change in the number or type of beds/units. Licensed Operating Licensed Operating Type of facility: Skilled Nursing (SNF): beds units Assisted Living (AL): beds units As Is Board & Care (B&C): beds units Dementia Care: beds units Independent Living (IL): beds units Total: beds units Licensed Operating Licensed Operating Type of facility: Skilled Nursing (SNF): beds units Assisted Living (AL): beds units As Board & Care (B&C): beds units Proposed Dementia Care: beds units Independent Living (IL): beds units Total: beds units Lenders Pre-Construction Conference Coordinator Information: Name: Email: Phone: Mailing address: Continued Program Eligibility Key Questions Yes No Upon completion of the proposed collateral change, will the facility require more than four residents to share a full bathroom (see 24 CFR 232.3)? (Not applicable for SNFs.) N/A Upon completion of the proposed collateral change, will any residents be required to access a qualifying bathroom by moving through a public corridor or area (see 24 CFR 232.3)? (Not applicable for SNFs.) N/A Upon the completion of the collateral change, are there any “minimum assistance” requirements necessary to quality under the Section 232 mortgage insurance program that the facility does not plan to offer? Are there floodways or coastal high hazard areas located on the site of any portion of the proposed collateral change?*
90030_orcf-Redline.docx