Figure: 30 TAC §37.9025(b)

ALTERNATIVE I

1. Sum of current cost estimates or the current amount required if a certification is used (total of all current cost estimates shown in the paragraphs above) $_____________

For colleges or universities that issue bonds, answer lines 2 through 5.

2. Current bond rating of most recent issuance of this firm and name of rating service _____________

_____________

3. Date of issuance of bond _____________

4. Date of maturity of bond _____________

5. Is line 2 at least an "A" or above rating? (Yes or No)

For colleges or universities that do not issue bonds, answer lines 6 through 9.

*6. Unrestricted endowment consisting of assets located in the United States $_____________

7. Is line 6 at least $50 million? (Yes or No)

8. Is line 6 at least 30 times line 1? (Yes or No)

9. If neither line 7 or line 8 is answered yes, indicate which line is greater _____________

________

*Denotes figures derived from audited financial statements.

ALTERNATIVE II

1. Sum of current cost estimates or the current amount required if a certification is used (total of all current cost estimates shown in the paragraphs above) $_____________

For hospitals that issue bonds, answer lines 2 through 5:

2. Current bond rating of most recent issuance of this firm and name of rating service _____________

_____________

3. Date of issuance of bond _____________

4. Date of maturity of bond _____________

5. Is line 2 at least an "A" or above rating? (Yes or No)

For hospitals that do not issue bonds, answer lines 6 through 17:

*6. Total revenues _____________

*7. Total expenditures _____________

*8. Long term debt _____________

*9. Net fixed assets _____________

*10. Current assets _____________

*11. Depreciation _____________

*12. Current liabilities _____________

*13. Operating revenues _____________

14. Is line 6 less line 7 divided by line 6 equal to or greater than 0.04? (Yes or No)

15. Is line 8 divided by line 9 less than or equal to 0.67? (Yes or No)

16. Is line 10 plus line 11 divided by line 12 greater than or equal to 2.55? (Yes or No)

17. Is line 13 at least 100 times line 1? (Yes or No)

________

*Denotes figures derived from audited financial statements.