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Home My WebLink About800493.tiff RESOLUTION RE: DECLARATION OF WELD COUNTY'S INTENT TO ISSUE INDUSTRIAL DEVELOPMENT REVENUE BONDS TO FINANCE A PROJECT FOR EUGENE J. HESSE, M.D. WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the County of Weld, and State of Colorado (the "County") , is authorized by the County and Municipality Develop- ment Revenue Bond Act, Title 29 , Article 3, Part 1, C. R.S. 1973 , as amended (the "Act") , for the benefit of the inhabitants of the State and for the promotion of their health, safety, welfare, convenience, and prosperity, to finance one or more projects , including any land, building, or other improvements and all necessary and appurtenant real or personal properties suitable for health care facilities, upon such conditions as the Board of Commissioners of the County may deem advisable, and WHEREAS, the County is further authorized by the Act to issue its revenue bonds or other obligations for the purpose of defraying the cost of financing any such project, and WHEREAS, Eugene J. Hesse, M.D. , (the "User) has met with officials of the County and has advised the County of the User' s interest in acquiring, improving and equipping an approximately 12, 000 square foot building located within the County to be used primarily as a medical building and the remaining space to be leased for other business and commercial purposes (the "Project") subject to the willingness of the County to finance the Project by the issuance of industrial development revenue bonds or other obligations pursuant to the Act, and WHEREAS , the User has represented to the County that the Project has been designed to qualify as a "project" within the meaning of the Act, and WHEREAS, the County has considered the User ' s proposal and has concluded that the economic benefit to the County will be 800493 N substantial due to an increase in employment and the promotion of industry and development of trade and other economic activity within the County, and WHEREAS, the County has hereby determined that issuing its industrial revenue bonds for the Project will benefit the health, welfare, safety, convenience, and prosperity of the inhabitants of the County, and WHEREAS, the County wishes to proceed with the financing of the Project, and WHEREAS, the proposed issuance of the industrial develop- ment revenue bonds and the execution of related financing docu- ments are not prohibited by any ordinances or rules of the County. NOW, THEREFORE, BE IT RESOLVED by the Board of County Com- missioners of Weld County, Colorado: Section 1. In order to induce the User to complete the Project within the County, the County shall take all steps necessary or advisable to effect the issuance of industrial development revenue bonds or other obligations (the "Bonds") in a maximum aggregate principal amount of $110, 000. This Resolution is, and constitutes the taking of, affirmative action by the County toward the issuance of the Bonds. The Bonds and the financing documents relating to said Bonds shall be subject to the terms and conditions of the Memorandum of Agreement between the County and the User attached hereto as Exhibit "A" and incorporated herein by specific reference. No costs are to be borne by the County in connection with the issuance of the Bonds. Section 2 . The terms and conditions of the Bonds and of the financing documents relating to said Bonds or other obliga- tions will be mutually agreed upon by the County and the User, and prior to their execution, such documents will be subject to authorization by Ordinance of the Board of County Commissioners pursuant to law and any ordinance or rules of the County. Section 3 . The User has agreed to provide for reimburse- ment of all expenses incurred or to be incurred by the County -2- related to the User' s Project pursuant to the Memorandum of Agreement attached hereto as Exhibit "A" . Section 4 . The Board of County Commissioners hereby finds and determines that the documentation furnished by the User satisfies that requirements set forth in Ordinance No. 25, regarding County Development Revenue Bonds, as amended by Ordi- nance No. 43 . The Board of County Commissioners also hereby finds and determines that the Project meets the criteria set forth in Ordinance No. 25, as amended. Section 5 . Neither the Bonds, including interest and any premiums thereon, nor anything contained in this Resolution shall constitute a debt or indebtedness of the County within the meaning of the Constitution or statutes of the State of Colo- rado, nor give rise to a pecuniary liability of the County or a charge against its general credit or taxing powers . The Bonds shall be derived from and payable pursuant to the financing docu- ments referred to in Section 2 hereof. Section 6 . All commitments by the County made herein are subject to the condition that on or before one year from the date hereof, the County and the User shall have agreed to mutually acceptable terms for the Bonds or other obligations provided for hereunder, in an amount not to exceed $110, 000, and for the sale and delivery thereof. Section 7 . The form of Memorandum of Agreement presented to the Board of County Commissioners is approved and the Chairman of the Board of County Commissioners and the County Clerk are authorized to execute the Memorandum of Agreement, with such changes as the County Attorney may approve, on behalf of the County. The Chairman of the Board of County Commissioners , County Clerk, County Attorney, and other officers and agents of the County are hereby authorized to initiate and assist in the preparation of such documents as may be appropriate to the Bonds. -3- The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 17th day of December, A.D. , 1980 . ? r) d BOARD OF COUNTY COMMISSIONERS ATTEST: "' a4? WELD COUNTY„ COLORADO Weld County Clerk and Recorder ( //ILL i L ig and Clerk to the Bpar - C. W. Kirby, Ciairman e Deputy County Clerk eonard L. Roe, Pro-Tem APRRO ED AS TO F RM: Norman Carlson C nn /J tan O 41)1C6yb(�yA County Attorney Ly ' Dun ar ?II, K. Steinmark DATE PRESENTED: DECEMBER 17 , 1980 EXHIBIT "A" MEMORANDUM OF AGREEMENT THIS MEMORANDUM OF AGREEMENT is between the COUNTY OF WELD, COLORADO (the "County") and Eugene J. Hesse, M. D. , (the "User") . 1. Preliminary Statement. Among the matters of mutual inducement which have resulted in the execution of this Agreement are the following: (a) The County is a county in the State of Colorado, a body politic and corporate, authorized and empowered by Title 29 , Article 3 , of the Colo- rado Revised Statutes 1973, as amended (the "Act") , to issue development revenue bonds to finance one or more projects, including any land, building or other improvement and all real or personal properties suitable or used for health care facilities upon such terms and conditions as the Board of County Commissioners of weld County (the "Board" ) deems advisable. (b) In order to increase employment and in order to promote industry and develop trade and other eco- nomic activity within the County of Weld, State of Colorado: (1) the User proposes to acquire, improve and equip an approximately 12, 000 square foot building and all necessary and appurtenant real and personal properties, whether or not now in existence, located within the County, to be used primarily as a medical facility and the remaining space to be leased for other business and commercial purposes (the "Project") , (2) pur- suant to a Loan Agreement between County and User (the "Loan Agreement") County will loan the pro- ceeds of its industrial development revenue bonds or other obligation not to exceed $110, 000 (the "Bonds") to the User for such acquisition, im- provement and equipment, and (3) the User will make loan repayments under said Loan Agreement sufficient to pay the principal of, premiums, if any, and interest on the Bonds or other obli- gation. (c) The County has indicated its willingness to pro- ceed with the issuance of its Bonds or other obli- gation as provided by the Act to finance the Pro- ject and has advised the User that, subject to due compliance with all requirements of law, the obtaining of all necessary consentes and approvals, and the happening of all acts, conditions and things required precedent to such financing, the County, pursuant to the Act, will issue the Bonds in a principal amount sufficient to pay the costs of such acquisition, improvement and equipment of the Project, the funds of any necessary revenues and the expenses of issuance and sale of the Bonds, not to exceed an aggregate principal amount of $110, 000. (d) The County considers that financing of the Project and entering into the Loan Agreement with the User with respect to the Project will promote economic activity within the County, which constitutes a public purpose as described in §29-3-102 (1) , C.R. S. 1973 . 2. Undertakings by the County. The County agrees as follows: (a) The County will issue the Bonds or other obliga- tion pursuant to the terms of the Act in a princi- pal amount not to exceed $110 , 000 to complete the Project, the funding of any necessary reserves -2- and the expenses incident to the authorization, sale and issuance of the Bonds . (b) The County will adopt such proceedings and authorize : ( i) the execution and delivery of such documents as may be reasonably necessary or advisable for the authorization , issuance and sale of the Bonds , ( ii) the financing, acquisition, improvement and equipment of the Project and ( iii) the execution of the Loan Agreement with the User and such other docu- ments relating to the Bonds as shall be authorized by the Act or other law and as shall be mutually satisfactory to the County and the User. (c) The aggregate sums to be paid by the User under the Loan Agreement shall be sufficient to pay the principal of , redemption premiums, if any, and interest on the Bonds as and when the same shall become due. (d) The County will take such other acts and adopt such further proceedings as may be reasonably required to implement the aforesaid undertakings and as it may deem appropriate in pursuance thereof . (e) The Bonds shall provide that they shall be payable solely from and secured by a pledge of the revenues derived from and payable pursuant to the provisions of the Loan Agreement , that they shall never constitute the general obliga- tions of the County within the meaning of any provision or limitation of the Constitution or statutes of the State , and that they shall not constitute nor give rise to a pecuniary liability or a charge against the general -3- credit or taxing powers of the County , the State of Colorado or any political subdivision thereof . (f) In authorizing the issuance of the Bonds pur- suant to this Agreement , the County will make no warranty , either expressed or implied, that the proceeds of the Bonds will be sufficient to pay all costs of the Project . 3. Undertakings on the Part of the User. The User agrees as follows : (a) The User will enter into a contract or contracts for the acquisition, improvement and equipment of the Project . (b) Prior to the delivery of the Bonds , the User will enter into the Loan Agreement with the County under the terms of which the User will obligate itself to complete the acquisition , improvement and equipment of the Project and, to the extent not payable out of proceeds of the Bonds , to pay to the County sums suffi- cient in the aggregate to pay or reimburse the County for all reasonable expenses incurred by it in connection with the authorization , issuance and sale of the Bonds , including with- out limitation the reasonable expenses that the County deems necessary for attorneys' , accountants ' , and auditors ' fees and expenses , and to make loan repayments sufficient to pay the principal of , premiums , if any , and interest on the Bonds as and when the same shall become due and payable , all utility charges , taxes , assessments , casualty and liability insurance premiums , and any other expenses or charges relating to the ownership , use , operation , maintenance , occupancy and up- -4- keep of the Project , such Loan Agreement to contain such other provisions as may be re- quired to implement its aforesaid undertakings or as it may deem appropriate in pursuance thereof . 4 . General Provisions . (a) Prior to the issuance of the Bonds , there shall be a reasonable showing to the Board of County Commissioners that the User is capable and will remain capable of carrying out its financial obligations under the Loan Agreement . (b) All commitments with respect to the Bonds in a principal amount of $110 ,000 of the County under Section 2 hereof and of the User under Section 3 hereof are subject to the condition that , on or before one year from the date of this Agree- ment , the County and the User shall have agreed to mutually acceptable terms for the Bonds and for the issuance, sale and delivery thereof, and mutually acceptable terms and conditions for the Loan Agreement , and such other documents referred to in Section 2 and the proceedings referred to in Sections 2 and 3 hereof , and the County and the User shall have complied with all of the provisions of the Act applicable to the issuance , sale and delivery of the Bonds and the financing of the Project . (c) If the events set forth in Section 4(a) and (b) above do not take place within the time set forth or any extension thereof , and if the Bonds are not issued and sold within that time, the User agrees that it will reimburse the County for all reasonable and necessary direct out-of- pocket expenses which the County may incur arising -5- from the execution of this Agreement , including without limitation the reasonable expenses that the County deems necessary for attorneys ' , accountants ' , and auditors ' fees and expenses , and the performance of the County ' s obligations hereunder, whereupon this Agreement shall terminate. IN WITNESS WHEREOF, the parties have entered into this Agreement by their duly authorized officers on this 17th day of December , 1980 . BOARD OF COUNTY COMMISSIONERS ATTEST : �m `'t`--- 4 -1°'Lit ni WELD COUNTY, COLORADO J Weld County Clerk and Recorder and Clerk to the Bparc/m By: r, / L ( y C . W. Kirby ,/Chairman By : 4 3L ., ` ,. (7/ / yJaq Deputy County Clerk J U; v / Ic e �FIP 1A--h Eugera J. I sse , M. D. -6- A public hearing was conducted on December 17, 1980 at approximately 10 : 00 A.M. , with the following present: BILL KIRBY CHAIRMAN LEONARD ROE COMMISSIONER NORMAN CARLSON COMMISSIONER LYDIA DUNBAR COMMISSIONER JUNE STEINMARK COMMISSIONER Also present: ACTING CLERK TO THE BOARD, KEITHA WHITE COUNTY ATTORNEY, THOMAS O. DAVID DIRECTOR OF FINANCE AND ADMINISTRATIVE SERVICES, DONALD WARDEN The following business was transacted: I hereby certify that pursuant to a notice dated December 1, 1980 and duly published December 4, 1980 in the Johnstown Breeze a public hearing was held on the request of Dr. Eugene J. Hesse, M.D. for Weld County to issue $110, 000. 00 in Industrial Development Revenue Bonds . The proposed bond issue is so Dr. Hesse can acquire a medical facility in LaSalle, Colorado. Mr. David reviewed the notice. Mr. David E. Broyles, Vice President of the United Bank of LaSalle was present. The United Bank of LaSalle intends to purchase all the Industrial Revenue Bonds for the benefit of Dr. Hesse Dr. Hesse was present and elaborated on his request, the facility and the need in the LaSalle area for a resident physican. Mr. Dee P. Wisor, legal counsel for the Bond Counsel, was present. Following some discussion Commissioner Carlson made a motion to proceed with issuance of Industrial Revenue Bonds for Dr. Eugene Hesse for purchase of a medical facility in LaSalle and further approved the inducement resolut- ion and authorized the Chairman to sign the Memorandum of Agreement. Commissioner Dunbar seconded the motion and it carried unanimously. The County Attorney read the inducement resolution and attached memorandum of agreement into the record. Chairman Board of County Commissioners r.1 +y __ n ATTEST: (1 WELD COUNTY CLERK AND RECORDER ,CLERK TO THE ARD C BY -Deputy Coun y Clerk DOCKET #80-77 TAPE #80-109 LHR 2057 NOT I C E PUBLIC HEARING INDUSTRIAL DEVELOPMENT REVENUE BONDS FOR LASALLE MEDICAL CLINIC PROJECT Docket 80-77 NOTICE IS HEREBY GIVEN of a hearing before the Board of County Commissioners of Weld County, Colorado, on the 17th day of December. 1980 at the hour of 10:00 A.M. in the Weld County Commissioners hearing room, first floor. Weld County Centennial Center. 915 10th Street, Greeley, Colorado, for the purpose of considering the application from Dr. Eugene J. Hesse, M.D. for Weld County to issue $110,000 in Industrial Development Revenue Bonds. The pro- posed bond issue is so Dr. Hesse can acquire a medical facility in LaSalle. Colorado. This procedure is in accordance with the 1967 County and Munici- pality Development Revenue Bond Act, Section 29-3-101, et. seq. . CRS 1973 as amended. Copies of the application for Industrial Development Revenue Bonds are on file in the Office of the Clerk to the Board of County Commissioners located on the 3rd floor, Weld County Centennial Center, 915 10th Street, Greeley, Colorado and may be inspected during regular business hours. Following the close of the public hearing, the Board of County Commissioners will considere whether or not to proceed with the issuance of Industrial Development Revenue Bonds. All interested parties under the law will be afforded an opportunity to be heard at said hearing. This notice given and published by order of the Board of County Commissioners, Weld County, Colorado. DATED: December 1, 1980 THE BOARD OF COUNTY COMMISSIONERS BY: MARY ANN FEUERSTEIN COUNTY CLERK AND RECORDER AND CLERK TO THE BOARD OF COUNTY COMMISSIONERS BY: Keitha White, Deputy PUBLISHED: December 4, 1980 in the Johnstown Breeze AFFIDAVIT OF PUBLICATION THE JOHNSTOWN BREEZE STATE OF COLORADO ) ss COUNTY OF WELD ) I, Clyde Briggs, do solemnly swear that I IN ` DEVELOP- am publisher of The Johnstown Breeze; a Sir„ AL that the same is a weekly newspaper - Ilea printed, in whole or in part, and published +°� in the County of Weld, State of Colorado, and has a general circulation therein; that gi * said newspaper has been published at continuously and uninterruptedly in said or a:inty County of Weld for a period of more than enn ;, '$er fifty-two consecutive weeks prior to the et, first publication of the annexed legal notice Dr, •r—% .. or advertisement; that said newspaper has 1 is d ` been admitted to the United States mails as eXuart lb second-class matter under the provisions of • the Act of March 3, 1879, or any amendments thereof, and that said REAtlutblp re°�"" i newspaper is a weekly newspaper duly P g.; c " i n qualified for publishing legal notices and a�MAea: as advertisements within the meaning of the ot, o for laws of the State of Colorado. o� That the annexed legal notice or advertise- ment was published in the regular and entire issue of every number of,said weekly newspaper for the period of ../... consecu- ar its. tive insertions; and that the first nyWr � hoivs.. publication of said notice was in the issue of B atoonetM said newspaper dated D`c.z/., A.D. 198P, 1e or rtb e �� and that the last publication of said notice venue was in the issue of said newspaper dated , A.D. 19 Au Willb heardss under th as eisser a In witness whereof I have he[eunto set • my hand this .....1./ day of ,/./.cc:. , Ms notice and A.D. 19.. D arderldul'e}Wdld�t,,, (7 Ju,£ DATED ember 1, API /`I/ Publisher -1Co ISTHILOWD or:ia i.r '. BY:MARY ANN sE RBTEIV Subscribed and sworn to before me, a RE I' o Notary Public in and for the C,nty of CO RS Weld, Late of Colorado, this ..//.... day of SY*ltha White,Deputy /CUM/A.D. 19J'Q.... ,1080 In the,PUBLISHER):DILBrkYe�zeer . . . . . In I!'H=t-N.8R8-Elb�rko W Board \% Notary Public. My commission expires .//—/—F'1-1 • LAMM STOWE BRAYMER & WISOR A PROFESSIONAL CORPORATION ATTORNEYS AT LAW ale AMERICAN NATIONAL BANK BUILDING 818 SEVENTEENTH STREET DENVER, COLORADO 80202 WILLIAM O. LAMM TELEPHONE (303) 825-1284 IN ASSOCIATION WITH ERICK D. STOWE LAMM 6 STOWE MARY ANNE BRAYMER ATTORNEYS AT LAW DEE P. WISOR CHEYENNE, WYOMING BARBARA E. BONDS• 1307' 635-0221 THOMAS FALACIENSKI November 13 , 1980 LICENSED ONLY IN WYOMING Board of County Commissioners Weld County Centennial Center 915 10th Street Greeley, Colorado 80631 Re: Industrial Development Revenue Bonds for Eugene J . Hesse , M.D. Gentlemen: I have been asked to write concerning a proposed indus- trial development revenue bond issue for Eugene J. Hesse , M.D. ( the "User" ) to be constructed within Weld County and the compli- ance of that proposed project with the County and Municipality Development Revenue Bond Act ( the "Act" ) of the State of Colorado. It is my understanding that the User intends to acquire , improve and equip an approximately 12 , 000 square foot building located in LaSalle , Colorado ( the "Project" ) , in which the User will locate his medical practice . It is further my understanding that the Town of LaSalle is currently without a medical doctor and desires a locally based physician to provide its citizens and those in the surrounding area with adequate medical services. It is further my understanding that the Project will require approximately $100 ,000 in bonds to be issued to finance the Project. The legislative intent of the Act is set forth in Section 29-3-102 C.R.S. as follows : "29-3-102 . Legislative declaration . ( 1 ) It is the intent of the general assembly by the passage of this article to authorize counties and municipalities to finance , . . . properties to the end that such counties and municipalities may be able to promote industry and develop trade or other economic activity by inducing . . .hospi- tals, and agricultural , manufacturing , industrial , commercial , or business enterprises to locate , expand , or remain in this state , to mitigate the • Page Two serious threat of extensive unemployment in parts of this state , to secure and maintain a balanced and stable economy in all parts of this state , or to further the use of its agricultural products or natural resources . " Based upon the foregoing information concerning this specific project and this firm' s interpretation of the legislative intent of the Act, it is the opinion of this firm that the Project as proposed does comply with the state law in question and ful- fills the intent of the legislature . This preliminary approval is not to be taken as final approval of the details of the financing pursuant to Federal regulations relating to industrial development bonds . That approval will require further review of the proposed project as the details develop. If I may answer any questions or be of any further assistance at this time , please do not hesitate to write or call . Very truly yours , DPW:rmm Approved: EUGENE J. HESSE, M.D. 207 1st Avenue La Salle, Colorado 8064E Telephone: (303)284-553. lkY) United Bank I4 of La Salle 4 7 ^° y N dllO fl8 Association n �' a.„•';',1 7 . deO* C September 19, 1980 ``' CP Weld County Commissioners Centennial Center 915 10th Street Greeley, Colorado 80631 Re: Industrial Revenue Bonds for the benefit of Eugene Hesse Gentlemen: The United Bank of LaSalle intends to purchase all Industrial Revenue. Bonds for the benefit of Eugene Hesse, to purchase a medical building in the Town of LaSalle, State of Colorado. The amount in which intends to purchase will not exceed $100,000. The interest rate is to be negotiated at the time of issue. The Industrial Revenue Bonds will be secured by a First Deed of Trust on the medical building. If there are any questions, please feel free to contact me. Sincerely, 9do;esr E. Br President cch EUGENE J. HESSE, M.D. Application for Revenue Bond September 22, 1980 Copy 2- of Six Copies iy• Table of Contents Ordinance Reference Page Application and Statement of Need --- 1 Letter of Support - Mayor of La Salle --- 2 Legal Opinion - Bond Counsel 3. 1 3 Letter of Intent to Purchase Bond 3. 2 4 History of Applicant 3. 3(a) 5 Letter from Applicant's Banker & Credit Report 3. 3(c) 6-7 Statement of Major Customers 3. 3(d) 8 List of Assets to be Purchased & Description of Property 3. 3(i) 9 Payment Schedule for Retirement of Bonds 3. 3(j) 10-14 • Prepared Financial Data Accountant's Letter 15 Financial Statements 3. 3(g) Balance Sheet 16 Statement of Income 17 Statement of Changes in Financial Position 18 Footnotes 19 Historical Financial Statistics 3. 3(b) 20 Financial Statements for Past 5 Years 3. 3(h) 21-30 Proforma Data - 5 Years 3. 3(f) Balance Sheets 31 Statements of Income 32 Cash Flow Projections 33 a APPLICATION Under the provisions of Weld County Ordinance #69, application is hereby made for the issuance of a single Weld County Development Revenue Bond in the amount of $90,000 for the purpose of purchasing and improving existing commercial real estate in the Town of La Salle, Colorado, in order that the. Town and environs secure the services of a doctor. bign re Date STATEMENT OF NEED The Town of La Salle and the surrounding areas have had a strong need for adequate medical services for approximately five years. The area was formerly served by Dr. Walter Ordelheide until he moved to California, leaving La Salle with a good medical facility but no doctor. Currently, residents must travel to Greeley to secure medical care. Emergency services are performed by Emergency Medical Technicians of the La Salle Fire. Protection District. The people of this area have consistently placed the acquisition of a doctor high on surveys of needs. A doctor located in La Salle would serve a large area of Weld County, including the towns of Gilcrest, Platteville, Hudson and Keenesburg. • -t- s , pulnoFCyTHE TOWN OF LA SALLE ' P. O. DOA 717 119 MAIN STREET '� 0/ LA SALLE, COLORADO 80645 �poaarE� PHONE : 284-6564 July 24, 1980 Weld County Dept. of Finance i 915 10th Street Greeley, CO 80631 Attention: Don Warden RE: Dr. E.J. Hesse Application Dear Mr. Warden: The Town of LaSalle is desirous of having a locally based physician to service the needs of its citizens. Since Dr. Hesse has expressed an interest in locating his practice in LaSalle, we would like to give our support of his application for De- velopment Revenue Bond funds. The location of facilities Dr. Hesse is interested in acquiring is in complete compliance with our Master Plan. The site is already serviced by the Town's water and sewer systems. We believe this medical practice would be a positive asset to enhance the welfare of our community. Respectfully, -- Bruce Kamada Mayor of .LaSalle Y jr -2- OPINION OF BOND COUNSEL To be furnished at a later date. -3- 207 1st Avenue La Salle. Colorado 80045 AA Telephone (303) 284-5537 0�� • United Bank of La Salle September 19, 1980 Weld County Commissioners Centennial Center 915 10th Street Greeley, Colorado 80631 Re: Industrial Revenue Bonds for the benefit of Eugene Hesse Gentlemen: The United Bank of LaSalle intends to purchase all Industrial Revenue Bonds for the benefit of Eugene Hesse, to purchase a medical building in the Town of Lasalle, State of Colorado. The amount in which intends to purchase will not exceed $100,000. The interest rate is to be negotiated at the time of issue. The Industrial Revenue Bonds will be secured by a First Deed of Trust on the medical building. If there are any questions, please feel free to contact me. Sincerely, (----- Da id E. Broyles ce President i DEB/cch c'y Original mailed directly to Weld County Commissioners -4- • HISTORY OF APPLICANT Dr. Eugene J. Hesse was born in Wynot, Nebraska, in 1928. He served in a US Army MASH unit from 1948-52. He was graduated from the University of Nebraska Medical School in 1958. His internship was served at St. Benedict's Hospital in Ogden, Utah, and he served his surgical residency at St. Luke's Hospital in Denver, Colorado. Upon completion of his training in 1960, he practiced in Keenesburg, Colorado, from that date until 1971. He has maintained his present practice at 1220 11th Avenue in Greeley, Colorado, from 1971 until the present. Dr. Hesse is a family practitioner employing four people in his office, one of whom is a La Salle resident. Dr. Hesse has been certified by the American Board of Family Practice since 1974. He is licensed to practice in the states of Colorado and Nebraska. He is on the medical staffs at Weld County General Hospital in Greeley and at St. Luke's Hospital in Denver. He is a member of the Weld County Medical Society, the Colorado Medical Society and the American Medical Society. There are several reasons for considering a move to La Salle. The immediate Greeley area appears to have an adequate medical community .at this time. However, the La Salle area has needed a doctor since Dr. Ordelheide moved in 1975, leaving an existing unoccupied medical facility in La Salle. Dr. Hesse could comfortably move his practice into this facility with a minimum of disruption of service to his patients. In this location, he would serve an area including Keenesburg, Hudson, Platteville and Giicrest, as well as La Salle and Greeley. A medical practice on the east side of La Salle would enlarge and enhance the present small nucleus of businesses in that part of La Salle. It is likely that the addition of a medical practice to the existing business area on Main Street would attract additional business to the east side of town and invigorate the economy of La Salle. Should the practice grow in this location and increase its professional staff, more local people would need to be hired. • -5- S ', l000 l enth street Greeley.Colorado 806?' Telephone:(303)356-1 bit United Bank of Greeley September 16, 1980 To Whom It May Concern: Gentlemen: Dr. Eugene Hesse has asked that our bank originate certain information relative to an application to the Weld County Commissioners expressing our opinion as to his ability to satisfactorily service debt to be incurred on an Industrial Revenue Bond. He has additionally requested that we obtain credit information from an outside bureau that evidences his good credit standing in the community. A report from the Weld County Credit Bureau is attached. It is our understanding that the Industrial Revenue Bond will be for approximately.$90,000 to be repaid in semi-annual in- stallments together with interest over a 15 year period. Based on today's rates, this would call for annual debt service of approximately $10,000. It is our understanding that Dr. Hesse presently pays rent of approximately $7,200 annually. The resulting increase of approximately $2,800 is well within the capabilities of Dr. Hesse to service, in our opinion. Our past experience on extensions of credit to Dr. Hesse has been totally satisfactory. Should you require additional information, you may feel free to call me at any time. Yours very truly, / /j -1" Ralph Kreitler Vice President RK:bjs Attachment -6- Sl /004 OPR 004 TERM 'l0 '4 REP MODE //GREELEY EY // I ' WWWWIXHMNW®GtlGtlGtltltltltlMM WMfl D}t ;39- .5;31 , AT x-00() UNITED BANK R 7 N 2 ]:/N _I-11:::8E3Ei:/I''--I:: .11:iIii:NI:::/M-..1l9--E:iO7 -:<.'.£ii _06'77/Z.- Ci1ii:3O; J): ** BU-GREECLESY v CO ID :@39--:1.270'.1.9 I: HESSE r EUGENE Ty THERESA SSN507---28- 06'77 B00/28 M/MAR/02 • CA 6180 24y 80631 S0'7/79 CE SELF 1.10:1./7:1. r MD • FA :1.220 :1.:1.71-1 v GREELEY v Co '1312/78 FE Klia:_:Nl:i: MEDICIAL (::1..:I:N:I:(:;, MD X E iN D NS/:1270:19/M/D/A }'11.1--f:-EiE::i:I...IEYv CO :1:I) 11;39—:1.270:19 HE:SSE' r EUGENE Ty THERESA • ' )NS07-28"`0677 B00/28 M/MAR/0 2 CA 6180 24y 80631 807/79 CE: SELF 1..10.1./ 7:1. s MI: FA l ?20 :L :LT'I-Iv liil^:E_E::L..I'r.:Yv CO 812/78 FE KEENE MEDICIAL CL:I:NICv MD • FILE 01/6:1 1i FIRM IDENTITY TYPE REPORTED OP END HIGH OWES PAST C LATE PAYMENT KB—BU—GP—CODE TERM MIiE'T'iiL)II I...'i,T/P DU1::. S H:E.'i3T:30/60/' 0} O UNITED BANK :1:27:1 0::,/00/782 04/77 9782 00 00 :I. 1-104 00/00/00 DD-39-----531#6218099 04/78 • 0 DENVER DRY 0 04/14/79Z 0:3/6:1. 145 00 00 1 D- 39 903#40070042 02/79 • O UNITED BANK 1154 03/00/7;5 07/72 :`1"'1:.3':.'1 00 00 1 ............ ................................ -5314B i MKS---PB 1-74 O UNITED Ii{FiNlc; I: Of:3/OG/'i'R!i`1 07/T.,;? 5535 00 00 :. .._....... .........._.......__......... ICI; x:-i.. '5311-0A 1 SCARS ROEBUCK R 5 05/05/79A 01/'78 42 00 00 1 H09 0:1./00/00 * DC 39 -915:@282224807068 INOUIRE It NAME KB—BU—GP—CODE LNU DATE Rll?.I::.L..Ei:Y FIN p E' 39 "" ;`S.LEi3 .07/24/29 I. AGRI CHEM 9[.'i---2218`151:1. 06/26/79 1 LAL..E5 CENT CR J........39 :1.365 :12/10/78 END ' el'12'70:19 Ri:EPT 029 09/22/80 :1. :1.1-1531 TERM :1.024 OPER 004 )1O/.004 OPERATOR 004 SIGNED 1:11.17 • -7- STATEMENT OF MAJOR CUSTOMERS Dr. Hesse is engaged in the general practice of medicine. Consequently, no single patient or institution constitutes a material portion of his practice. -8- LIST OF ASSETS TO BE PURCHASED AND INCIDENTAL EXPENSES Commercial Building, Blk 1 , L10 + Si L11, Ellis Subdivision, La Salle, Colorado Cost of building $ 75,000. Closing costs - estimated 500 Appraisal 500 Moving costs 500 Cleaning, remodeling, other 13,500 Total estimated cost . $ 90,000 DESCRIPTION AND CONDITION OF THE PROPERTY The building to be purchased is located at 125 Main Street in La Salle. It is in the central business district roughly adjacent to Town Hall and across the street from the La Salle. Fire Protection District Station. Even though,an older structure, the building was completely remodelled as a medical facility'+' by Dr. Ordelheide prior to his leaving the area. Consequently, no major improvements or repairs should be necessary. However, having been vacant or partially rented to non-medical businesses for the past six years, numerous small repairs and general cleaning and up-grading must be accomplished prior to the arrival of a new owner. These items include cleaning and painting, some plumbing work and probable relocation of interior walls to make the building more usable by a different doctor. It is estimated that these items should cost $10, 000 - $15,000. The building is currently in compliance with building codes for structural integrity, plumbing and, electrical work. It consists of three floors, of approximately 11,000 square feet per floor. Of this area, approximately 2, 000 square feet on the main floor are devoted to the clinic. The rest is unimproved, with the exception of a small 800 square foot apartment located in the rear of the upper floor. The basement area is also unimproved. ..:iy it 41E, — 1 Ir• ( L;,,� t i. l�tlMi.. y'Cy,r, -9- • v AMORTIZATION SCHEDULE PAGE : 1 RATE PRINCIPAL PAYMENT ODD DAYS LOAN DATE 1ST PYMT 8. 000000 • 90000. 00 860. 09 1 1/10/81 2/10/81 PMT 0 DATE PAYMENT INTEREST PRINCIPAL BALANCE 1 2/10/81 860. 09 620. 00 240. 09 89759. 91 2 3/10/81 860. 09 598 . 40 261 . 69 89498 . 22 3 4/10/81 860. 09 596. 65 263. 44 89234 . 78 4 5/10/81 860. 09 594 . 90 265. 19 88969. 59 5 6/10/81 850. 09 593. 13 266. 96 88702. 53 6 7/10/81 860. 09 591 . 35 268 . 74 88433. 89 7 _ 8/10/81 _860. 09 589. 56 270. 53 ' 88163. 36 8 9/10/81 860. 09 587 . 76 272 . 33 87891 . 03 9 10/10/81 860. 09 585. 94 274 . 15 87616. 88 10 11/10/81 860. 09 584 . 11 - - - 275. 98 87340 . 90 11 12/10/81 860. 09 • 582. 27 277 .82 87063. 08 TOTAL INTEREST FOR 1981 : 6524 . 07. . 12 1/10/82 860. 09 580. 42 279. 67 86783 . 41 13 2/10/82 860. 09 578. 56 281 . 53 86501 . 88 14 3/10/82 860. 09 576. 68 283. 41 85218 . 47 15 4/10/82 860. 09 574 . 79 285. 30 85933. 17 16 5/10/82 860. 09 572. 89 287 . 20 85645. 97 17 . 6/10/82 860. 09 570. 97 289. 12 85355. 85 18 7/10/82 860. 09 569. 05 291 . 04 85065. 81 19 8/10/82 860. 09 567. 11 292.98 84772. 83 -- 20 9/10/82 860. 09 565. 15 294 . 94 84477 . 89 21 10/10/82 860. 09 563. 19 296. 90 84180. 99 22 11/10/82 860. 09 561 . 21 298. 88. 83882. 11 23 12/10/82 860. 09 559. 21 300. 88 83581 . 23 ' -- TOTAL INTEREST FOR 1982: 6839. 23 24 1/10/83 860, 09 557 . 21 302. 83 83278 . 35 25 2/10/83 860. 09 555. 19 304 . 90 82973. 45 26 3/10/83 860. 09 553. 16 306 . 93 82665 . 52 27 4/10/83 860:09 551 . 11 308 . 98 82357 . 54 28 5/10/83 860. 09 549. 05 311 . 04 82046 . 50 29 6/10/83 860. 09 546. 98 313. 11 81733. 39 30 7/10/83 860. 09 544 . 89 , 315. 20 81418 . 19 31 8/10/83 860. 09 542. 79 317. 30 81100. 89 32 9/10/83 860. 09 540. 67 ' 319. 42 80781 . 47 i 33 10/10/83 860. 09 538. 54 321 . 55 80459 . 92 34 11/10/83 _ 860. 09 536. 40 323. 69 80135. 23 35 12/10/83 860. 09 534 . 24 325. 85 79818 . 38 -10- • TOTAL INTEREST FOR 1983 : 6550 . 23 36 1/10/84 860. 09 532. 07 328. 02 79482. 36 3- _2/10/84 -_ 860: 09 . 529. 88 - - 330.-21 7.9152..15 38 3/10/84 860. 09 527. 68 332. 41 78819. 74 39 4/10/84 860. 09 525. 46 334 . 63 78485. 11 40 5/10/84 - -----860.09 523. 23 --336. 86 78148. 25 41 6/10/84 860. 09 520. 99 339. 10 77809 . 15 42 7/10/84 860. 09 518 . 73 341 . 36 77457 . 79 4-3 -87-10/84 su-(T. OE1- 51-0: 45 '- 343. 54 77124. 15 44 9/10/84 860. 09 514. 16 345. 93 76778. 22 45 10/10/84 860. 09 511 . 85 348. 24 76429. 98 46 11/10/84 860. 09 509. 53 350. 56 76079. 42 47 12/10/84 860. 09 507 . 20 352. 89 75726. 53 TOTAL INTEREST FOR 1984 : '•237 . 23 48 1/10/85 860. 09 504. 84 355. 25 75371 . 28 49 2/10/85 86.0: 09 502.48 -3-5761 7501-3. 67 • 50 3/10/85 860. 09 500. 09 360. 00 74653. 67 51 4/10/85 860. 09 497 . 69 362. 40 74291 . 27 -- 52 5/10/85 860. 09 495. 28 364 . 81 73926. 45 53 6/10/85 860. 09 492. 84 367. 25 73559 . 21 54 7/10/85 860. 09 490 . 39 369 . 70 73189. 51 55 8/10/85 860. 09 487 . 93 . 372. 16 72817. 35 56 ;`/10/85 860. 09 485. 45 374 . 64 72442. 71 AMORTIZATION SCHEDULE PAGE : 2 •PMT fi DATE PAYMENT INTEREST PRINCIPAL BALANCE 57 10/10/85 860. 09 482. 95 377. 14 72065 . 57 58 11/10/85 860. 09 480. 44 379. 65 71585. 92 59 12/10/85 860. 09 477. 91 382 . 18 71303. 74 TOTAL INTEREST FOR 1985: 5898 . 29 60 1/10/86 860. 09 475. 35 384 . 73 70919. 01 61 2/10/86 860. 09 472. 79 387 . 30 70531 . 71 62 3/10/86 860. 09 470. 21 389. 88 70141 . 83 63 4/10/8.6 -860. 09 467 . 61 - 39248 59749 . 35 64 5/10/86 350. 09 465. 00 395.- 9 59154 . 26 65 6/10/86 860. 09 452. 36 397 . 71 7-58956 . 53 66 7/10/86 860. 09 459. 71 400. 38 *8556. 15 67 8/10/86 860. 09 457 . 04 403. 05 58153. 10 66 9/10/86 850. 09 454 . 35 405. 74 67747. 36 ----7-59 10/10/85 860. 09 451 . 65 408 . 44 57338. 92 70 11/10/86 860. 09 448. 93 411 . 16 66927 . 7> 71 12/10/86 850. 09 446 . 19 413. 90 66513. 86 TOTAL INTEREST FOR 1986: 5531 . 20 -11- 72 1/10/87 860. 09 443. 43 416. 65 66097 . 20 73 2/10/87 860. 09 440. 65 419. 44 65677 . 76 74 3/10/87 860. 09 437. 85 422. 24 65255. 52 ' 75 4/10/87 -860. 09 435. 04 425. 05 64830. 47 76 5/10/87 860. 09 432. 20 427. 89 64402. 58 77 6/10/87 860. 09 429. 35 430. 74 6.3971 . 84 - -- 78 7/10/87 -860. 09 426. 48 433: 61 63538. 23 79 8/10/87 860. 09 423. 59 436. 50 63101 . 73 80 9/10/87 860.. 09 420. 68 439. 41 6266232 - -- 81 10/10/87 860. 09 417. 75 442. 34 • 52219. 98 82 11/10/87 860. 09 414 . 80 445. 29 61774 . 69 83 12/10/87 860. 09 411. 83 448 . 26 61326. 43 TOTAL INTEREST FOR 1987 : 5133. 65 -:- 84 1/10/88 860.09 408 . 84 451 . 25 60875. 18 85 2/10/88 860. 09 405. 83 454 . 26 60420 . 92 86 ' 3/10/88 860. 09 402. 81 • 457. 28 59963. 64 ----- 87 - 4/10/88 --860. 09 -399. 76 _4-60. 33 -59503.31 - 88 5/10/88 860 . 09 396. 69 463. 40 59039 . 91 89 6/10/88 860. 09 393. 60 466 . 49 58571 . 42 -90 7/10/88 -_ 860. 09 390. 49 459. 60 58103. 82 91 8/10/88 860. 09 387. 36 472 . 73 57631 . 09 92 9/10/88 860. 09 384 . 21 475. 88. 57155. 21 -_ F -- 6676. 15 - 93-' 10/10/88 X60-01 381. (t3 - 479 94 11/10/88 860. 09 377 . 84 482 . 25 c6193 . 90 95 12/10/88 8.60. 09 374 . 63 485. 46 /5708 . 44 TOTAL INTEREST FOR 1988: 4703. 09 96 1/10/89 860. 09 - 171 . 39 488 . 70 55219. 74.= 97 2/10/89 860. 09 368. 13 491 . 95 54727. 78 98 3/10/89 850. 09 364. 85 495. 24 54232. 54 99 4/10/89 860. 09 361 . 55 498. 54 53734. 00 100 5/10/89 860. 09 358. 23 501 . 86 532.32 . 14 101 6/10/89 860. 09 354 . 88 505. 21 52726 . 93 --- 102 7/10/89 860.'09 351 . 51 508 . 58 52218 . 35 103 8/10/89 860. 09 348 . 12 511 . 97 51706 . 38 104 9/10/89 860. 09 344. 71 515. 38 51191 . 00 105 10/10/89 -860. 09 341. 27 518. 82 50572 . 18 106 11/10/89 860. 09 337 . 81 522. 28 50149. 90 107 12/10/89 860. 09 334. 33 525. 76 49624 . 14 TOTAL INTEREST FOR 1989: 4236 . 78 -12- 108 1/10/90 860. 09 330 . 83 529 . 26 49094 . 88 109 2/10/90 860. 09 327. 30 532. 79 48562. 09 110 3/10/90 860. 09 323. 75 536. 34 48025. 75 111 4/10/90 850.09 320. 17 539 . 92 47485. 83 112 5/10/90 J '0. 09 316. 57 54: . `52 44942 .31 AMORTIZATION SCHEDULE PAGE : 3 PMT # DATE PAYMENT INTEREST PRINCIPAL , BALANCE 113 4/10/90 860. 09 312. 95 547 . 14 ,45395. 17 114 7/10/90 860. 09 309. 30 550 . 79 45844 . 38 115 6/10/90 8.60. 09 305. 63 554 . 46 45289. 92 116 9/10/90 860. 09 301 . 93 558 . 16 44731. 76 117 10/10/90 860. 09 298. 21 561 . 88 44169. 88 118 11/10/90 860. 09 294. 47 565. 62 . 43604 . 26 ---11-9 12/1079t - ---8-6-0-,09 2-90 :70 559.39 43034 . 87 -% TOTAL INTEREST FOR 1990 : 3731 . 81 120 1/10/91 850. 09 286. 90 573 . 19 42461 . 68 121 2/10/91 860. 09 283. 08 577 . 01 41884 . 67 --"122 3/10/91 860. 09 279. 23 580. 86 41303. 81 123 4/10/91 860. 09 275. 36 584 . 73 40719. 08 124 5/10/91 860. 09 271 . 46 588 . 63 40130. 45 125 6/10/91 850. 09 267. 54 592 . 55 39537. 90 126 7/10/91 860. 09 263. 59 596. 50 38941. 40 127 8/10/91 860. 09 259. 61 600. 48 38340 . 92 128 9/10/91 860. 09 255. 61 604 . 48 37736. 44 129 10/10/91 860 . 09 2.51 . 58 608 . 51 37127. 93 130 11/10/91 860. 09 2.47. 52 612. 57 36515. 35. 131 12/10/91 860. 09 243. 44 616. 65 35398 . 71 TOTAL INTEREST FOR 1991 : 3184 . 92 132 1/10/92 860. 09 239. 32 620. 77 35277 . 94 133 2/10/92 860. 09 235. 19 624 . 90 34653. 04 134 3/10/92 860. 09 231 . 02 629. 07 34023. 97 135 4/10/92 860. 09 226. 83 633. 26 33390 . 71 136 5/10/92 860. 09 222. 60 637 . 49 32753. 22 -137 ' 6/10/92 860. 09 218. 35 641 . 74 32111 . 48 138 7/10/92 860 . 09 : 214 . 00 546. 01 .31465. 47 139 8/10/92 860. 09 209. 77 650 . 32 30815. 15 -140 9/10/92 860. 09 205. 43 654 . 66 30160. 49 141 10/10/92 860. 09 201 . 07 659 . 02 29501 . 47 142 11/10/92 860. 09 196. 68 663 . 41 28833. 06 14a _ _ T7/Y0791 —850.(-9 T-92. 25 r 77 .81 28170.72. TOTAL INTEREST FOR 1992 : 2592 . 59 -13- „y, 144 1/10/93 850. 09 187 . 80 672 . 29 27497 . 93 145 2/10/93 860. 09 183. 32 675. 77 26821 . 16 146 3/10/93 860. 09 178. 81 681 .28 26139. 88.-' 147 4/10/93 860. 09 174 . 27 685. 82 25454 . 06 148 5/10/93 860. 09 169. 69 690 . 40 24763. 55 149 6/10/93 860. 09 165. 09 695. 00 24068 . 65 150 7/10/93 860. 09 160. 46 699 . 63 23369. 03 . 151 8/10/93 860. 09 155. 79 704 . 30 22664 . 73 152 9/10/93 860. 09 151 . 10 • 708 . 99 21955 . 74 153 10/10/93 860. 09 146. 37 713. 72 21242. 02 154 11/10/93 860. 09 141. 61 718. 48 20523. 54 155 12/10/93 860. 09 136. 82 723. 27 19800 . 27 TOTAL INTEREST FOR 1993; 1951 . 13 156 1/10/94 860. 09 132. 00 728. 09 19072. 18 157 2/10/94 860. 09 127. 15 732. 94 18339 . 24 -- 158 3/10/94 860. 09 122. 26 737 . 83 17601. 41 159 4/10/94 860. 09 117. 34 742. 75 16858 . 65 160 5/10/94 960. 09 112. 39 747. 70 16110. 95 161 6/10/94 860. 09 107 . 41 752 . 58 15358 . 28 162 7/10/94 860. 09 102. 39 757 . 70 14600. 58 163 8/10/94 860. 09 97 . 34 762 . 75 13837. 83 164 9/10/94 860. 09 92. 25 767 . 04 13069 . 99 165 10/10/94 860. 09 37 . 13 772. 95 12297. 03 166 11/10/94 860. 09 81 . 98 778 . 11 11518 . 92 -16T 12/10/94 860 . 09 76. 79 783 . 30 10735 . 52 , TOTAL INTEREST FOR 1994 : 1256. 43 158 1/10/95 850. 09 71 . 57 789 . 52 9947 . 10 AMORTIZATION SCHEDULE PAGE : 4 v --------- PMT 4 DATE PAYMENT INTEREST PRINCIPAL BALANCE 169 2/10/95 860. 09 65 . 21 793 . 78 9153 . 22 170 3/10/95 850. 09 61 . 02 799 . 07 8354 . 25 171 4/10/95 860. 09 55. 70 804 . 39 7549. 86 172 5/10/95- 850 . 09 50. 33 809. 76 6740 . 10 173 6/10/95 860. 09 44 . 93 815. 1 5924 . 94 174 7/10/95 860. 09 39. 50 220. 59 5104 . 35 175 8/10/95 860. 09 34. 03 826. 06 4278 . 29 176 9/10/95 350. 09 2.8 . 52 831 . 57 3446 . 72 177 10/10/95 850. 09 22. 9B 837. 11 2509. 61 178 11/10/95 850. 09 17. 40 342. 59 1766. 92 179 12/10/95 860. 09 11 . 78 848 .' 1 918 . 51 TOTAL INTEREST FOR 1995: 504 . 07 180 1/10/96 860. 09 6 . 12 853. 97 64. 64 TOTAL INTEREST FOR 1996: 6.. 12 TOTAL INTEREST 64880 . 84 -14- • • DAVID L COLE CERTIFIED PUBLIC ACCOUNTANT P.O. BOX 718,228 MAIN STREET LA SALLE,COLORADO 80645 ' 13031 284-5169 August 7, 1980 Member: AICPA CSCPA To whom it may concern: The accompanying balance sheet of Eugene J. Hesse, MD, as of July 31, 1980, and the related statements of income and changes in financial position for the seven months then ended have been compiled by me. A compilation is limited to presenting in the form of financial statements information that is the representation of the owner. I have not audited or reviewed the accompanying financial statements and, accordingly, do not express an opinion or any other form of assurance on them. . In addition, certain schedules containing proforma (projected) data were prepared by me. Because presentation of data of this type involves prediction of events that may or may not happen, I do not express an opinion or any other form of assurance on it. li Financial data from past years is taken from income tax returns prepared by other accountants. No opinion or other form of assurance was expresses'. on those tax returns. Kao ICC , David L. Cole Certified Public Accountant • -15- EUGENE J. HESSE, M. D. Balance Sheet July 31, 1980 ASSETS • CURRENT ASSETS Petty cash $ 50 Cash in bank 4, 842 Accounts receivable 26, 224 Prepaid insurance 305 Total current assets 31;421 PROPERTY AND EQUIPMENT Medical equipment 2,847 Furniture and fixtures 10,604 Transportation equipment 4, 806 Leasehold improvements 630 18, 887 Less accumulated depreciation ( 12, 693) Total property and equipment 6, 194 • TOTAL ASSETS $ 37,615 LIABILITIES AND OWNER'S EQUITY CURRENT LIABILITIES Accounts payable $ 1. 328 Note payable - related party 200 Payroll taxes withheld and accrued 390 Accrued salaries 821 Total current liabilities 2. 739 OWNER'S EQUITY Balance, January 1, 1980 37, 868 Add net income 34,410 Less withdrawals ( 37, 402) Total owner's equity, July 31, 1980 34, 876 TOTAL LIABILITIES AND OWNER'S EQUITY $ 37,615 '9 PREPARED WITHOUT AUDIT . See accountant's compilation letter. The accompanying footnotes are an integral part of these statements. -16- 7 EUGENE J. HESSE, M. D. Statement of Income For the Seven Months Ended July 31, 1980 OPERATING INCOME Patient fees $ 77. 829 Medical director fees 1 ,680 Total operating income 79, 509 OPERATING EXPENSE Auto expense 820 Bank charges 52 Depreciation 1, 596 Drugs and medicine 628 Dues and subscriptions 1, 155 Employee benefits 1 , 033 Entertainment and promotion 350 Insurance 888 Lab fees 58 Laundry 207 Legal and accounting 1 , 870 Miscellaneous 429 Office supplies and expense 2,417 Medical supplies 659 Payroll taxes 927 Refunds 191 Rent 4, 200 Repairs and maintenance 40 Salaries - R. N. 6, 944 Salaries - clerical 7,659 Self-employed retirement plan 5, 065 Telephone 1 . 285 Security 84 Bad debts - Choice-Care 6, 688 Total operating expense 45, 245 NET INCOME FROM OPERATIONS 34, 264 NON OPERATING INCOME (EXPENSE) Interest income 153 Interest expense ( 7) Total non-operating income (expense) 146 NET INCOME $ 34, 410 PREPARED WITHOUT AUDIT. See accountant's compilation letter, The accompanying footnotes are an integral part of these statements. -17- EUGENE J . HESSE, M. D. Statement of Changes in Financial Position For the Seven Months Ended July 31, 1980 FINANCIAL RESOURCES WERE PROVIDED BY : Operations Net income $ 34,410 Add expense not requiring working capital in the current. period - depreciation 1, 596 Total financial resources provided 36, 006 FINANCIAL RESOURCES WERE APPLIED TO : Purchase of equipment 570 Owner's withdrawals 37, 402 Total financial resources applied 37, 972 DECREASE IN WORKING CAPITAL $( 1, 966) CHANGES IN WORKING CAPITAL • Increase (decrease) CURRENT ASSETS Cash $ 1, 261 Accounts receivable ( 1, 913) Prepaid expenses ( 1. 185) Change in current assets ( 1 , 817) • CURRENT LIABILITIES Accounts payable 20 Notes payable ( 200) Payroll taxes withheld and accrued 404 Accrued salaries ( 373) Change in current liabilities ( 149) DECREASE IN WORKING CAPITAL $( 1 , 966) • PREPARED WITHOUT AUDIT. See accountant's compilation letter. The accompanying footnotes are an integral part of these statements. 18- EUGENE J . HESSE, M.D. Footnotes to the Financial Statements July 31, 1980 NOTE 1 - SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES • These statements were prepared on the accrual basis of accounting. Fixed assets are recorded at cost. Depreciation is computed using the straight-line and double-declining balance methods with lives as follows: Medical equipment 5-10 years Furniture E fixtures 3-10 years Transportation equipment 6 years Lease of office space is recorded using the operating method, with payment expensed in the current period. NOTE 2 - LEASE / Lease of office space is payable at a rate of $600 per month. The lease expires in December, 1980, and can be renegotiated at that time. NOTE 3 - NON-BUSINESS ASSETS AND LIABILITIES Assets and liabilities of the owner, other than those specifically applicable to the medical practice, have been excluded from these statements. • -19- • EUGENE J. HESSE, M.D. Financial Highlights 1979 1978 1977 1976 1975 Gross income $ 109,830 $ 101 ,451 $ 96, 392 $ 90, 136 $ 82, 702 Expenses 57, 651 53, 653 50,642 48,093 50,660 Net income $ 52, 179 $ 47,798 $ 45,750 $ 42,043 $ 32,042 Assets employed $ 18, 317 $ 17,300 $ 17,546 $ 21 ,080 $ 23, 882 Employee salary expense $ 22, 784 $ 20, 703 $ 19,869 $ 19,762 $ 22,942 All data extracted from Schedule C, Form 1040. Note: Balance sheet ratios and analyses are not presented due to the difficulty in reconstructing this data. -20- EUGENE J . HESSE, M.D. Financial Highlights 1979 1978 1977 1976 1975 Gross income $ 109,830 $ 101 ,451 $ 96, 392 $ 90, 136 $ 82, 702 Expenses 57, 651 53, 653 50,642 48,093 50, 660 Net income $ 52, 179 $ 47,798 $ 45, 750 $ 42,043 $ 32,042 Assets employed $ 18, 317 $ 17,300 $ 17, 546 $ 21 ,080 $ 23. 882 Employee salary expense $ 22, 784 $ 20, 703 $ 19,869 $ 19,762 $ 22,942 All data extracted from Schedule C, Form 1040. Note: Balance sheet ratios and analyses are not presented due to the difficulty in reconstructing this data. -20- HESSE 0135 07866 106137 310 Schedule C PROFIT OK ,(LOSS) FROM BUSINESS OR . ..OFESSION ir 1919 (Sete Proprietorship) (Form 1040) ►artnenhips, Joint Ventures, etc., Must File Forte 1065 r 09 Oopertment of the Treasury ► lttn[Il to Ferro 1040. ►See Instructions for Schedule C (Fenn 1040). k+' In e of p Revenue ServiceI s.cl woolly nolo d mo sier w. dww 507-28-0677 EUGENE J HESSE ; prided ► MEOICAL SERVICEl A Main business activity ► PHYSICIAN C Employer Identlllcolien number, t tininess Rome ► EUGENE J ES$E NO D Rosiness address P. 12 2 0 11TH AVE CO 8061118 a—C 5 06 3 l 3 City, State and 1U cede ► �+R rE L E Y 1 (2)1__I Accrual (3)U Other ► Ell E Accounting methddi 1 1 U Cash (TI f Methods) used to value closing Inventory: ES NO (1) O test (T) lower of cost or market (3)❑ Other(it other, attach expt.netiun) X 6 Was there any major clump in determining quantities,rests or valuations between opening end closing inventory? // //�� If"Yes," attach explanation. • X N ' Did you deduct expenses lot en office in your bem►7 1 Did you elect to claim amortization(under sortie's III)or depreciation(under section 167(o) tar o rehabilitated X certified historic structure(See instructions)? ) ,1-51 / 7X (Amortizable basis(see instructions) Pt lign Income I e Gross receipts or sales i th I 1 25 I--- / Returns and allowances lc c Balance(subtract line lb loom line la) 2 2, %90 2 Cost of goods sold and/or eperetiens(Schedule(.1, line I) J I U/ , 5 7 3 Gross profit(subtract line 1 InmiTFIN R E T 18 3 4 Other income(attach schedule) 4 163 Nu S 107o 540 S Total income(odd line 3 end 4) PART II Deductions — — 71 a Wages _ _27, 784 / 6 Advertising I lobs credit 7 led debts from sales or services — d Total credits 0 lank charges — — — 743 x 10 Car and truck expenses — — a Subtract line 31d from 31e — 11 Commissions _ 32 Other expenses(specify): 4 v IT Depletion _ e BANK CHG . — — — 1 1(',4 0 — 7,73U - h TF7UVITY • 13 Depreciation (ugloin in Schedule(-T) — _ N 1 S C i 14 — _ 7, 345 t 14 Dues and publications — T,773 d — IS Employee benefit programs — — o 16 Freight (not included in Schedule C I) — k'13 — ( • — 17 Insurance — . 11 Interest on business indebtedness • g — 164 — I H, foundry and cleaning — — 7�0 15 20 legal and professional services 4, '3y l __ _ - - — 21 Office supplies — 7,4741i k — 22 Pension and profit-sharing plans I — 23 Postage ?► 800 T — 24 Rent on business property — m - — it 25 Repairs — 26 Supplies (not included en Schedule (.1) — e — 27 Taxes — — Ls 154 — p — — q 21 Telephone 4 7 5 _ r — trialentertainment33 deductions(add amounts in columns for line I through 33x) 34 Net profit or(loss)(subtract line 33 from line 5). If a profit, enter on Form 1040, and on 5<'e ) 7 Schedule SE, Pert II. It a loss,go to line 35 I YES NO 35 II you hove o loss, do you have amounts for which you ore not"at risk" in this business (See instructions)? —21— � ^` Puy.: 1 HESSF 013b 078bo L',do'...4... 7 Schedule C (Farm 10401 •Schedule C-1 - Colt of Goods Sold and/or Oporat._ . (See Schedule C Instructions for Parl 1, line 3) } • 1 Inventory at beginning of year (if different from last year's dosing inventory, attach explanation)la , • 2 a Purchoses • 2b b Cost of items withdrawn for personal use 4c — — — _ _ — c Balance (subtract line 2b from line 3a) 3 — _ _ _. — 3 Cost of labor (do not include salary paid to yourself) 3 E�st6M. 4 Materials and supplies 2 _,//� . 5 Other costs: —g e} 4KiS 1.3 7 i/ • 139 MED SERV T7 PROF 'SERV Ti 2,a-q 2,6:90 6 Add lines 1, 3c, and 3 through 5 7 7 Inventory at end of year2 r ► 7 2 z •CO I Cost of goods sold and/or operations (subtract line 1 from line 6). Enter here and on Port 1, line Schedule C-2 - Depreciation Dapuuauaa I WWI it Ida or Dapuaarrw for dddaroaal t Oela cost or allowed ad or a0arroY4 ueyeu p rd. Oho yam lav Daugnan et prepay hnl your arOwrd orAu Yn't m prof peon 4Motiaoen (I ; depuualraa 1 tacit oddrtronal lustiest deportation(dvno I include/ // � SEE Z r Other de rauoGon: V�� 2; T 3`? _ P SCHEDULE 2b — 1 t — T — — — a T — _ _ r — — _ y- — — — — — — — Y — — — _ • y 18, 317 — — — — — — — — ,3 2,733 _ 3 Totals 4 4 Depreciation claimed in Schedule C-1 ► S 2,736 5 Salome (subtract lino 4 from line 31. Enter here and on Port II, tine 13 Schedule C-3. . Expense Account lefennetioa(See Schedule C Instructions for Schedule C:31 lei c,pem,Would Iii Salons pad wow fNana // /4 Owner . . 1 2 3 4 S YES NO Did you clam a deduction for expenses connected with: • x A Entertainment loulity (boot, resort, tench, etc.)? >t I living ouanodotwns(except employees(on business)? Y C Conventions ai meetings you a your employees intended outside the U S. or its possessruus? (See instructioosl X I It Employees' tamdies of conventions or meetings? 1r- It "Yes," Vella ony of these cOmrentrons or meetings outside the U S. of its poaessrons? I Vocations for employees or their iomflies not reported on form W?? ,ES.!c, 0005 079,56 C%1CC15 Schedule C. PROFIT OR (LOSS) FROM BUSINESS OR PROFESSION (Form Ike Tr Partnerships, • (Sole Proprietorship) . PJoint Ventures, etc., Must File Form 1065. lni nal headmen, .I the Treasury Attach to form 1040. ► See • IInstructions for Schedule C (Perm 1010). 1 O7 8 Imernal Revenue Service ► is,,iii moony motive prym,e, wme EUGENE 1ai I 5071Z@/0677 J HFyS. -; product► NE0Lc AL_ItRYJ_ t5 — p Main businessaclivity► PHYSIf,�AN ' B Business name► EUGENE_4_H_F$31 N9 c Employer identification number► .4'050 318 - D Business address► I _?C i 1_T H AYE �pyOh_�i City, Stale and ZIP coda►__GR E ush (2) Accrual• C(q�Other► F Accounting method: ( ) LJ F Method(s) used to value dosing inventory: Other (if other attach explanation) YES NO (1)n Cost (2)n Lower of cost or market (3)n O G Was there any major change in determining quantities, costs, or valuations between opening and closing inventory? If "Yes," attach explanation: H Does this business activity involve oil or gas, movies or video tapes, or leasing personal (section 1245) x properly to others? (See instructions) • I x I Did you deduct expenses for on office in your home? PART I income • la }I __Zfl�J_L�� { 1 a Gross receipts or soles I lb I 8291t__ b Returns and allowances • lc 1y0Er355 c Balance.(iubtracl line lb from line la) 2 14r355 2 Cost of goods sold and/or operations (Schedule C-I, line B) 03 2 - 87.352 0 3 Gross profit (subtract line 2 from line lc) 96 4 4 Other income (attach schedule) INTEREST , ► 5 9T►449 S. Total income (add lines 3 and 4) alli Deductions . ]i 974 6 Advertising . __, 2$ Telephone • 2.670 _ 7 Amortization . __, 29 Travel and entertainment r I 9 Ban debts from sales or services 30 Utilities - --- 31 a Wages f1r Qe 543}--- 9 Bank charges --' 10 Car and truck expenses 501 b New jobs Credit • C e 5 5 3 c Subtract line 316 from 310 11 Commissions 12 Depletion 32 Other expenses (specify): �0 —_ ' 13 Depreciation (explain In Schedule (-2) • - • 2.h24 a_ mg LS C ELLANE0US - 23 2 1 .731 6 RANK CHARGES 14 Dues and beneit ro 1.719 c LAUNDRY 435 15 Employee benefit programs d LAUNDRY 43 _ 773 _-- 16 Freight (not included in Schedule C-1) 1 � 4 4.;:t1.1 S IC C UN I TY - 44 5. --- 17 Insurance — e II Interest on business indebtedness 5 f _ 19 Laundry and cleaning - --' g- 20 Legal and professional services ] . 400 h _ '.061 i . 21 Office supplies 2 a 570 — 22 Pension and profit-sharing plans I - vs9�"--- k _ 23 Postage a.b00 . - 24 Rent on business property l 0 0 — - 25 Repairs ' m- _ 26 Supplies (not included in Schedule (-1) ,. n 27 Taxes 1 .775 0 33 Total deductions (add amounts in columns for lines'6 through 32o) ► 33 39.650 • 34 Net profit or (loss) (subtract line 33 (ram line 5). Enter here and on Form 1040. Also ► 34 4 7►796 ,, enter en Schedule SE (Form 1040). (for "at risk" provisions, see instructions) - .• • —23— ESSE 00"4 079bb 0100 PageA Schedule ( (Form 1040) Schedule C-1. — Cost of Goods Sold and/or Overall, (See Schedule C Instructions for line 2)I Inventory at beginning of year (if different from lost year's closing inventory, attach explanation),.�a ......1 S 2 a Purchases [ Yb} {--- b Cost of items withdrawn for personal use 2c t linc of lobo ((do nott ln lue eb alamr pai 2o) • 3 -_--- E 1 e 1 i0_ -_ 3 Cost of labor (do not include salary paid to yourself) _-__-_-- -_ 6 Materials and supplies La2A --_-� - S Other costs: ___OgUxTLN..21C1l t. La.l 14 nEOICAL_5_Q!! f ES 53SL-- �, PIE DJA'31_SE Y.lS,.ES 5 ?.95.1 6 15jA03_ -- 6 Add lines I, 2c, and 3 through 5 i � 7 Inventory at end of year $ Cost el goods sold end/or operations (subtract line 7 from line 6). Enter here and on Part I, line 2 ► 1 14.(1014 - _- Schedule C.2. — Depreciation(See Schedule C Instructions for line 13)-1 I o.yr«lal." 1 a«Iw d I Lilo « o.r«i•'n"tea I IssIas Colo [«I a allenl w ellwdle I rwN.'i9 mil IMn/wi Inr 1«niilion of wwerty wind albr bsis in Itlw/en Ne«itliw r lbeerMlen Ne 1 Total additional lirst.year depreciation (do not include in items below) ► 413 • 2 Other depreciation: ___j��lb____ _. __,5I�_SCie-QULF__24- — — _ • • • 7 Totals 17.100 J—' -2dA29_ -__ Depreciation claimed in Schedule CI A 4 5 Z►f��9 S Balance (subtract line 4 from line 3). Enter here and on Part II, line 13 Schedule C-J. — Expense Account Information (See Schedule C Instructions for Schedule (-3) SA MS said#40114 Went sums lo) III Irl Owner • .__ --- 2 -- 3 6 •, • S YES NO Did you claim a dditlStion for expenses connected with: K A Entertainment facility (boot, resort,_ranch, etc.)? • , X 1 living accommodations (except employees on business)? C Employees"families at conventions or meetings? X If "Yes," were any of these conventions or meetings oustide the U.S. or its possessions? (See Instructions) X D Vacations for employees or their families not reported on Form W-2? —24— -rase x r SCHEDULE C Profit or (Loss) From Business or Profession (Form 1040) (Sole Proprietorship) Partnerships, Joint Ventures, etc., Must File Form 1065. IS Attach to Form 1040.. ro See Instructions for Schedule C (Form 1040). 1977 Name of proprietor Social Security Number EUGEh'E J a T4:.. ESA 7, r+F5SE 5i)7/¢28/9T677 A Principal business activity Ist'_ 4Y SIC I AI . . ;product , -_-,._tE!��.L.CAL.__earl vJSaA:1 5_ B Business name Ems F' 'rc I,:. �FSS.:'.. --Q, . _ __..__. . • • . C Employer identification number IR .--'4!U5Q€3.183 iD Business address x___1220 12l ,q 4'JF City, State and ZIP code 6:11' -- CO r8..0631. t - ,— E Indicate method of accounting: (1)I del Cash (2) Accrual (3)1 'Others Yes No F Was an Employer's Quarterly Federal Tax Return, Form 941, filed for this business for any quarter in year? )i • G Did you own the business at the end of the yep,? �jJ • zv� It How many months in the year did you.own this business? �-- - ---- // % %/ I Valuation mothod(s) used for total closing inventory: I_.. .'cost, , l I lower of cost or market, Li other 1 a rt"other /�� Method of inventory valuation �)C _ 't� _.._ t Was (here any substantial change in determining quantities, costs, or valuations between opening and closing inventory? X If "Yin," attach explanation. ////�/Z,A • I Gross receipts or solos 5. c'6!,642,,less: returns and ullowonces $ .-_ - 25() Balanw0__1 __9bt.V2 2 less: Cost of goods sold and/or operations (Schedule C--1, line 8) 2 13,9'48 • ° E 3 Gross profit 3 811844 ' o , 461 4 Other income (attach schedule) q 5 Total income (odd lines 3 and 4) 5 i 82,811 • 6 Depreciation (explain in Schedule C-2) _ 6- 2 t�Ke -- 7 Taxes on business and business property 7 ----. 11753 ---- 8 Rent on business property _ e . ..___ pis?.8 9 156 9 Repairs . -10. Salaries and wages not included on line 3, Schedule C-1 (exclude any paid to yourseU) 1_0 8,64 i1 Insurance 11 1,1(l[t�, . . 12 Legal and p12 ' 2,315rofessional fees 13 --I. 13.Commissions -- • 14 Amortization (attach stotement) 14 _--- 15 a Pension and profit-sharing plans (see Schedule C Instructions) 15_0 1, 122 b Employee benefit programs (see Schedule C Instructions) b 1, 377 16 Interest on business indebtedness • 16 __ 1 e 302 17 Bad debts arising from soles or services , 17 _.- - -18 Depletion • 18 ' is19. Other business expenses(specify): ° • s/TD EXr+cLDFi 843 3 b SCts f°;_ SJE1SCatt'TI_i'_5 . _ . 1195 ° E 'TrtiTI1 LE 'I• CA ai lin, 91 G c -; ISCFI ( r .Er, lS - -- --- .. 568 __ • rFFI(`.F. SUPPLIES 4,557 f TELEPH:1 •1: 1 , 881 rt' I< r gl' Hi R1 1.1-C.17 USES 42 ( Str.;J1TY 155 ns p Total other business expenses(add lines 19a through 190) 19P 11,167 20 Total deductions (odd lines 6 through 19p) 20 37,1)94 21 Net profit or (loss) (subtract line 20 from line 5). Enter here and on Form 1040. ALSO enter on Schedule SE _ 21 ).).rlD � Dad you claim a deduction for expenses of on office in your ionic 1l Yes I No -25- IF.SSE . ''10.2 .•7066 • 7). ` t ( c., • . . fsapa 2 Schedule C(Form 1040) SCHEDULE C-1. -- Cost of Goods Sold and/or Operations • _(See Schedule C Instructions for Line 2) ----'---'--" -- 1 Inventory at beginning of year(if different from last year's closing inventory,attach p explanation) _ Balance _2--- 2 Purchases$•____,------------ . Less:cost of items withdrawn for personal use __ 3 �.t. R _.__ 3 Cost of labor (do not include salary paid to yourself) 3 __-_ -_ 4 Materials and supplies 1 3 Other costs:.. t l i`r S/_'1 F ,r.1.X ,I ---- 1905:1 -"i.r:r-t! CAL S' P Pt.IR:S ___. • 93 'F')1r,ti. St=kVICIF4 — • __ _ 5 6 Add lines 1 through 3 7 _ 7 Inventory at end-of year M' 8 Cost of goods sold and/or operations(subtract line 7 from line 6). Enter here and on page 1,line 2. ,,_8 , 13.54, SCHEDULE C-2. —.Depreciation If ed more space. use Form Schedule C t 4562ns for Line 6) �_.__.. .-..,..1-74.------ --- ---------'- b ..r.__._.___- --•-- .—•.__._.._., __._ • ,. .a o.yrrr[�uuun C M. , I Ua. Y.n.�,«,m,«r for r Dew ' r c.o. db.+xd or unixin allowable •canpuUne i raio �'r o Pogrom'',of property. o[gwre4 WM.her. tow w p,p,VOWS depr«.rrwn . 1 Total additional first-year depreciation(do'not include in items below) r •• 2 Other depreciation: r __- ---- --,--r- -•--- •-1 ---r-••- ---... .._ .- -1 ._.-_--.-- --_•r- ._...____. • • _ -• -- -- J_ • 1._- -- .nN�l•3 Totals 17054 , 4 Depreciation claimed in Schedule C-1, above s 2.6E.58S Balance(subtract line 4 from line 3). Enter here and on page I,line 6. • • SCHEDULE C-3. -- Expense Account Information (See Schedule C Instructions for Schedule C-3) — ��_ . .. . -_..-- Nome Eapunse Account $aloriat and Wages _Enter information with regard• to yourself and your five highest _.- - ---- ...- -"--- _ ' �f l o,eG�� paid employees- In determining the live highest paid employees. Owner expense account allowances must be added to their salaries and 1 wages. However, the information need not be submitted for any 2 ____-- - -- - employee for whom the combined amount is less than $25,000, ni ._..._._ for yourself if•your expense account allowance plus line 1, { g' 4 I.is less than 525,000. - `" ' '" • Did you claim a deduction for expenses connected with. 5 -• -----" -- X Me Yes iNo (3) Employees I lies of coavenlions or ntevtings? Yes (1) living reru t r:loti facility(boat, p ranch,etc.}4,,r%� xitlo ( } I y --• - • o--' - f �l Fn„L. r n.,, I,.,.,.ly vntntiom tint rrpn.lod on Fan►r W 2? Yes X NO (�) Irvrn-g nrrmm�dnhuns(except empbyaPs on business)? Yes ----------.- ._. --26- • - ... • _ _ . . . - --- -_. .._ ?_06 5831-00 ..HFSSE / I SCHEDULE C Profit or (Loss) From Business or Profession I (Sole Proprietorship) (Form 1040) Partnerships,Joint Ventures,etc., Must File Form 1065. . 1 976 Internal Rer nueeSeTIM rvice tl ► Attach to Form 1040. ► See Instructions for Schedule C(Form 1040). Social security number • Name of proprietor 507 1 ?fl iO677 A 1 r ci a F I s T tap..F CA I) HI-IA F C product layar Mantlllcetioa Cumber ► .8 ICAL Ft,Pric SERVICA Busciplbusiness.EU. LE .('tiYSHESSE —`' - ' _2JrQ0.3tQ____ Business name►_EUf.EJ1E__J___HESS___!!A D Business address (number and street) ►._1220--11IH_.A_YC GDLARAt)!1 13.0.6.31 Yes No City, State and ZIP code ►__GRFt1,.EY �•••'( -•-- • E Indicate method of accounting:(1)1)( 1 I Cash (2)LJ Accrual (3)_ Other I X F Were you required to file Form W-3 or form 1096 for 1976 (see Schedule C Instructions)? %////� If "Yes," where filed I. QCDE.B.e.l_IAlt X G Was an Employer's Quarterly Federal Tax Return,Form 941,tiled for this business for any quarter in 1976 1 Was there any N Method of inventory valuation ► substantial change in the manner of determining quantities, costs, or valuations between the opening and closing inventories?.(II • s "yes," attach explanation) X 1 Gross receipts or sale$ cl(ls2'13 Less:returns and allowances$ S.Z_.-Blanca D. 1 40x136 I 2 Less: Cost of goods sold and/or operations (Schedule C-1, tins 8) 3 yOx ) 36 ...... 3 Gross profit 4 S. 4 Other income(attach schedule) 5 ra0 e 1 36 5 Total Income (add lines 3 and 4) • 6 • 4x 2 83 6 Depreciation (explain in Schedule C-3) 6 1y. ?83 7 Taxes on business and business property (explain in Schedule G-2) 7 6y 112 8 Rent on business property 'g 9 Repairs(explain in Schedule C-2) 19y T62„ 10 Salaries and wages not included on line 3, Schedule C-1 (exclude any paid to yourself) 1101 0 l) 7 t 2 11 Insurance 12 1y 315 12 Legal and professional fees 13 13 Commissions 14 y 14 Amortization(attach statement) 15(a)' J y 078 15 (a) Pension and profit-sharing plans (see Schedule C Instructions) (b) Employee benefit programs (see Schedule C Instructions) 16(b) ' 9 900 16 Interest on business Indebtedness 17 , e 17 Bad debts arising from sales or services 17 18 Depletion 18 T 19 Other business expenses(specify): 1x a l 4 W:ASITA..EXY.E.NSF 1x696 (b)_Dt)F_S.__ANtI__StI&_SCAtP._I1QNi 2x 9 _.._. (c)_DFF_ICF__SUPEI•.l.ES..AN.R_.E1P ENSF 2.1114..... DO.IFJ.EP HDN.E 59 3 (p.9AAl1C__SFB SltCJw_.C HA R flES (I).ttHliCtS_.At�LQ._HF.P ICIJI • (g).LAJJItDRY 29 2 305 •4 (h).P.FD_I:ESS.LQKA),_..SF,ItY_1CF.5. 170 ;/ 0) _H_lS_CELL S 101101 . 5 5 7 0)_Elti_._di1S__.PF.0!1....G__L9tlYENT_LCINS 1 .099 1. (k)_!!_E_ ICAL___S.W.H..1E.S2 (I) Total other business expenses (add lines 19(a) through 19(k)) 19u) 10. 7329 4 Hy 73 2 20 Total deductions(add lines 6 through 19(i)) • 21 Net profit or (loss) (subtract line 20 from line 5). Enter here and on Farm 1040,line 29• ALSO 21 42, 043 enter on Schedule SE, line 5(a) SCHEDULE C-1,--Cost of Goods Sold and/or Operations (See Schedule C Instructions for Line 2) 1 1 Inventory at beginning of year (if different from last year's closing inventory,attach explanation) 2 2 Purchases$ Less: cost of items withdrawn for personal use$ Balance ► 3 3 Cost of labor(do not include salary paid to yourself) _ 4 4 Materials and supplies 5 5 Other costs(attach schedule) 6 6 Total of lines 1 through 5 7 7 Less: Inventory at end of year 8 8 Cost of goods sold and/or operations. Enter here and on line 2 above Yes R No Did you claim a.deduction for expenses of an office In your home? —27— 206 Sb7k-UJ - HESSF • 5O-1-287-O6-77Page 2 Schedule C(Form 1040) 1 97 h SCHEDULE C-2.—Explanation of Lines 7 and 9 Amount LinNo. Explanation $ j•.___L.... _-Yx.^P_f_&T-Y__-L.�KES L,_571'. Py1Y_3I)Ll z [S • � �; 3. -- ---i-4X F S_-L--L 1L E ]f5 • ----__•-_-'---- - Jr • • ._-_-_-_--_- -4 ----. x. • SCHEDULE C-3.—Depreciation (See Schedule C Instructions for Line 6) II you need more space,use Form 4562. . a • d Cost or d. Depreciation e. Method of L Life g. Depreciation for b. Dab • allowed or allowable computing mate this year a. Deuriptioe el pmparpr aceairW etNr hasis in prior years depreciation 1 Total additional first-year depreciation (do not Include in items below) • 2 Other depreciation: _N.fOjf AL EQQ1pM€MT MAO1:5U7 8O9__ k _ VP. 18 T R AP.212_R.].A[-LQM..bati P M F NJ ----- T 5 q ...__ _ Q_L LQZ/_I5t_ 34.541 ._a_3l14__Sk 3 Y IIS. -Li44E__?!,._P__.1MPR_QYEMr;tilc 1?/01/14 640 3k5 SL 3 YRS Pt - ---- Zkerf Vial_AI.1QN_.FS1Lk1P05 L * 51 54 ?oaoe 6 YRS 77 ..11F F LCC F V EtN_!0.Q_.f_QLr IP Stij 4 ? t yZ�y,wk V R 6;7 AAIA .--L1f1-1.L1 F 11 @N_.At(Q._1:QL,1.P A - 3�4 1 R9¢ 2 Q f)8 • YR So . KJRI. / T ' • T T T T TM _-- 41 28- 3 Totals. . . . . . . . . : • . . . .• 4 less amount of depreciation claimed in Schedule C-1, page 1 4e 28 5 Balance—Enter here and on page 1, line 6 SCHEDULE C-4.—Expense Account Information (See Schedule C Instructions for Schedule C-4) Name Expense account Salaries and Wages Uttar In tidn with regard to yourself and yopaid emple highest, x paid /fJ//� ///�� employees.ccount determining the five highest salaries es and wa expense • account allowances must be added to their coteries and wages. Now Owner ever, the Information need not be submitted for any employee for 1 • whom the combined amount is less than $25,000, or for yourself if 2 --' your expense account allowance plus line 21, page 1,. is less than 3 =25,000. 4 • _._. 5 Did you claim a deduction for expenses connected with: �-I ��'''111 Yes I it l (1) Entertainment facility(boat,resort,ranch,etc.)?. , • Yes l x.l No (3) Employees' families at conventions or meetings?. n tic(2) Living accommodations(except employees on business)? • Yes X No(4) Employee or family vacations not reported on Form W-2?. I I Yes X Ni • -28- • HESSE 442 4589-91 SCHEDULE C • Profit or. (Loss) From Business or Profession (Form 1040) (Sole Proprietorship) Partnerships,Joint Ventures, etc., Must File Form 1065. 1975 iiDe,enmenl•1 the Tnuury • ir r eamue s.mu ► Attach to Form 1040. ► See Instructions for Schedule C(Form 1040). Social security number NameU)as shown on Form 1040 5 0 7 12 B 106 7 / EUGENE J E THERESA D HESSE A Principal business activity.. PHY$IC L AN .; product ►_4.€011E5—ME 414A1a B Business name P. EUGENE J HESSEI,MD C Employer IdenG(latIon number ► 84-0500318 • D Business address (number and strut) ►.,12..Q.1.111!..9YS REEL QQ.LQK,A.AQ._. AQ--31-- .' ......... Yes No 6 City, Stile and ZIP coda ►,,,f1.. 1 Y """'""' E Indicate method of accounting:(L .'l Cash WC Accrual (3)C Other P F Were you required to file Form W-3 or Form 1096 for '19 75 7(see Schedule C Instructions) X /A I II "Yes," where filed P. N... Oci AJT Mi. • •• r X G Was an Employer's Quarterly Federal Tax Return, Form 841, filed for this business for any quarter in 197 5? . Was there any H ubsta of ge I valuation ► -- substantial change In the maneer of determining quantities,costs,or valuations between the opening and closing inventories? "Yes,"attach explanation) X 1 Gross receipts or sales $.. . —82.1115 Less: returns and allowances$ 2.1,s.Balance ► 1 B 2 t:70. 2 • E 2 Less: Cost of goods sold and/or operations (Schedule C-1, line 8) 3 82, 70 3 Gross profit 4 5 4.Other income (attach schedule) . . , ,., 5 Total income (add lines 3 and 4) • 5 412.10 • 6 3,22 I 6 Depreciation (explain in Schedule C-3) L. ,,63 7 Taxes on business and business property (explain in Schedule C-2) , . ,. .. . .. . ,, , , . . . . . .• . • • • 8 7 L. 1 1 e 12 g 8 Rent on business property 9 Repairs(explain in Schedule C',2) 10 2 Z 31 10 Salaries and wages not included on line 3, Schedule C-1 (exclude any paid to yourself) i 11 1,27 11 Insurance. .. , 12 80 • _._ • 12 Legal and professional fees 13 13 Commissions — 14 14 Amortization (attach statement) ' 15(a) t 86 15 (a) Pension and profit-sharing plans (see Schedule C Instructions) (a) vie 1 r 38 (b) Employee benefit programs (see Schedule C Instructions) • , 16 16 Interest on business Indebtedness 17 e 17 Bad debts arising from sales or services , 1�8/ / — .I 18 Depletion 3 19 Other business expenses (specify): 11 12 ' AUTO EXPENSE 1e10 8 (') DUES AND SUBSCRIPTIONS (b)c� DPFICE SUPPLIES AND EXPENSE ,199 TELEPHONE r (d) BANK SERVICE CHARGES 99 (f) DRUGS AND MEDICINE 6U • LAUNDRY 39 (¢) PROFESSIONAL SERVICES 73 ) MISCELLANEOUS li U) ENT BUS PROM E CONVENTIONS • 39 ,% (k) MEDICAL SUPPLIES 1 , 59 Off ICE IN HOME EXPENSE • 52 /, (I) 9(m', 119030 (m) Total other business expenses (add lines 19(a) through 19(I)) y0 50,030 20 Total deductions (add lines 6 through 19(m)) 21 Net profit or (loss)(subtract lipe 20 from line 5). Enter here and on Form 1040, line 28•ALSO 21 32,042. enter on Schedule SE, line 5(a) SCHEDULE C-1.—Cost of Goods Sold and/or Operations (See Schedule C Instructions for Line 2) 1 1 Inventory at beginning of year (if different from last year's closing inventory, attach explanation) Balance ► 2 --- 2 Purchases $ Less: costL of items withdrawn for personal use$ — 2 3 Cost of labor (do not include salary paid to yourself) 4 - 4 Materials and supplies . 5 k • 5 Other costs(attach schedule) , 6 6 Total of lines 1 through 5 7 7 Less: Inventory at end of year a • 8 Cost of goods sold and/or operations. Enter here and on line 2 above -29-- hESSE 442 4589-91 507'1.0—U477 Page 2 Schedule C(Form 1040) SCHEDULE C-2.-Explanation of Lines 7 and 9 Amount Line No. Explanation 7 • PMDPOATY TAxE_s 1=.. $ y2 7 PAYROLL TAXES ltl0 7....._...r_. TA 4t$ AND Lick t( Lk 4.-- SCHEDULE C-3.—Depreciation (See Schedule C Instructions for Line 6) If you need more space, you may use Form 4562. Note: If depreciation is computed by using the Class Life (ADR) System for assets placed In service after December 31, 1970, or the Guideline Class Life System for assets placed in service before January 1, 1971, you must file Form 4832 (Class Life(ADR) System) or Form 5006 (Guideline Class Life System). Except as otherwise expressly provided in income tax regulations sections 1.167(a)-11(b)(5)(vi)and 1.167 (a)-12, the provisions of Revenue Procedures 62-21 end 65-13 are not applicable for taxable years ending alter December 31, 1970. (See Publication 534.) Check boi if you mode on election this taxable year to use I ''l I Clefs Life(ADR)System and/or n Guideline Close life System. • e. Cost or A Depuaafion e. Method of 1. Lila or I. Depreciation Ipr a. Group and n pine ity I. Date other basis allowed or allowable epracicompu na rate this Year or description el property ' acquired. In prior years depreciation 1 Total additional first-year Form832. I depreciation N to not include in items below) -.. �/~ 380 2 Depreciation from Form 4832. so Note 3 Depreciation from Form 5006.1/4 above / . , • 4 Other depreciation: ' I SCE STATEMENT 4 kr` Ly ≥≤44__,_.-_ 5 Totals : . ix122— 6 Less amount of depreciation claimed in Schedule C-1, page 1 j,X22 7 Balance—Enter here and on page 1, line 6 e • SCHEDULE Cry.—Expense Account Information (See Schedule C Instructions for Schedule C-4) Enter Information with regard to yourself and your five highest paid Name Expense account Salaries and Wages employees. In determining the live highest paid employees, expense �� account allowances must be added to their salaries and wages. Now- Owner ever, the information need not be submitted for any employee for 1 whom the combined amount is less than 125,000, or for yourself if • your expense account allowance plus line 21, page 1, Is less than 2 $25,000. 3. . . • 4 • Did you claim a deduction for expenses connected with: 5 (1) Entertainment facility(boat,resort,ranch,etc.)?. . . _ Yes X No (3) Employees'families at conventions or meetings? . . . Yes X No (2) Living accommodations(except employees on business)?. . Yes X No (4) Employee or family vacations not reported on Form W-21. • Yes X No -30- EUGENE J . IiESSE, M.D. Proforma Balance Sheets ASSETS 12/31 /81 12/31 /82 •12/31 /83 12/3,1/84 13/31 /85 CURRENT ASSETS Cash in bank $ 4, 000 $ 4, 000 $ 4,000 $ 4,000 $ 4,000 Accounts receivable 31,000 36, 000 41,000 46, 000 51, 000 Prepaid expenses 500 500 500 500 500 Total current assets • 35, 500 40, 500 45, 500 50, 500 55, 500 PROPERTY & EQUIPMENT Land 5,000 5,000 5,000 5, 000 5,000 Building 85, 000 85,000 85,000 85, 000 85,000 Equipment & fixtures 19,000 20, 000 21, 500 23, 500 26, 000 Vehicles 4, 800 4, 800 4,800 4,800 4, 800 Less accumulated depreciation (21 ,702) (28, 202) (34, 702) (41, 202) (47, 702) 92,098 86, 598 81, 598 77, 098 73, 098 TOTAL ASSETS $ 127, 598 $ 127, 098 $ 127,098 $ 127, 598 $ 128, 598 LIABILITIES AND OWNER'S EQUITY CURRENT LIABILITIES Accounts payable $ 1,400 $ 1,400 $ 1,400 $ 1, 400 $ 1,400 Bond payable - current 3, 507 3, 798 4, 113 4,454 5,497 Other current liabilities 1, 000 1 ,000 1,000 1, 000 1 ,000 Total current liabilities 5,907 6, 198 6,513 6, 854 •7,897 LONG-TERM BOND PAYABLE 83, 255 79, 457 75, 344 70, 890 65, 393 OWNER'S EQUITY Beginning of year 35, 948 38, 436 41, 443 45, 241 49,854 Add net income 58, 192 63,286 69, 119 75, 507 82, 370 Less withdrawals (55, 704) (60, 279) (65, 321) ' (70,894) (76,916) End of year • 38, 436 41,443 45, 241 49,854 55, 308 TOTAL LIABILITIES & ''.r OWNER'S EQUITY $ 127, 598 $ 127,098 $ 127, 098 $ 127, 598 $ 128, 598 -31- EUGENE J. HESSE, M.D. Proforma Statements of Income For the Years Ended 12/31 /81 12/31/82 12/31/83 12/31 /84 12/31/85 MEDICAL FEES (1 ) $ 125, 000 $ 133, 750 $ 143,000 S 153,000 $ 163,710 COST OF SERVICES Labor 13,000 13, 900 14,900 15, 900 17,000 Drugs, etc. 2,450 2,620 2,800 3,000 3,210 Total cost of services 15,450 16, 520 17, 700 18, 900 20,210 GROSS PROFIT 109, 550 117, 230 125, 300 134, 100 143, 500 EXPENSES Auto 1 ,000 1 ,070 1 ,145 1 , 225 1 , 310 Depreciation 6, 500 6, 500 6, 500 6, 500 6, 500 u Dues & publications 2, 400 2,425 2,450 2, 475 • 2, 500 Employee benefit program 2,000 2, 140 2, 290 2,450 2, 620 Insurance - liability & misc. 1,850 1 , 900 2,000 2, 100 2, 200 Insurance - building 500 535 570 615 655 Interest (2) 7,083 6,814 6, 523 6, 208 5, 867 Laundry & cleaning 1 ,600 1 ,710 1,830 1, 960 2, 100 Legal & professional 2, 500 2, 675 2,860 3,060 3, 280 Office supplies 4, 300 4,600 4,920 5,270 5,640 Pension/profit sharing 2,800 2,900 3,000 3, 100 3, 200 Taxes - payroll 2, 375 2, 540 2,720 2, 910 3, 110 Taxes -property 50 590 600 625 650 Travel & entertainment 500 535 570 615 655 Telephone S utilities 2, 200 2, 350 2, 518 2,695 2,833 Office salaries 12, 000 12, 840 13,740 14,700 15, 730 Other expenses 500 535 570 615 655 Repairs & maintenance 1 ,200 1, 285 1, 375 1,470 1, 575 Total expenses 51,358 53,944 56, 181 58, 593 61, 130 NET INCOME $ 58, 192 $ 63, 286 $ 69, 119 $ 75, 507 $ 82, 370 Assumptions: (1) Fees - 7% annual increase (2) Interest expense - 15 year, 8%, $90,000, beginning 1 /10/81 . Most other items - 7% annual increase • -32- EUGENE J. HESSE, M.D. Proforma Cash Flow Projection For the Years Ended 12/31/81 12/31 /82 12/31 /83 12/31 /84 12/31 /85 CASH RECEIPTS Medical fees $ 120,000 $ 128;750 $ 138,000 $ 148,000 $ 158, 710 Withholdings & other 1 , 540 1, 650 1,765 1, 880 2, 015 Total cash receipts 121, 540 130,400 139, 765 1119,880 160, 725 CASH DISBURSEMENTS Auto 1 ,000 1 ,070 , 1, 145 1, 225 1, 310 Dues & publications 2,400 2,425 2, 450 2,475 2, 500 Employee benefits 2,000 2,440 2, 290 2, 450 2, 620 Insurance - liability 1, 850 1 , 900 2,000 2, 100 2, 200 Insurance - building 500 535 570 615 655 Debt service 10,321 10,321 10, 321 10, 321 10, 321 Laundry and cleaning . 1, 600 1, 710 1,830 1 ,960 2, 100 Legal & professional 2, 500 2, 675 2,860 3,060 3,280 Salaries 25,000 26,740 28,640 30,600 32, 730 Drugs, etc. 2, 450 2,620 2,800 3,000 3, 210 Office supplies 4, 300 4,600 4,920 5,270 5,640 Pension/profit sharing 2,800 2,900 3,000 3, 100 3,200 Taxes - payroll 3,915 4, 190 4,485 4, 790 5, 125 Taxes - property 50 590 600 625 650 • Travel & entertainment 500 535 570 615 655 Telephone & utilities 2,200 2, 350 2, 518 2, 695 2,883 Other • 500 535 570 615 655 Repairs & maintenance 1, 200 1 ,285 1 , 375 1 ,470 1, 575 Equipment 750 1 ,000 1, 500 2,000 2, 500 65,836 70,121 74, 444 78,986 83,809 TOTAL CASH AVAILABLE BEFORE OWNER WITHDRAWALS 55, 704 60, 279 65,321 70, 894 76,916 Less withdrawals (55, 704) (60,279) (65,321) (70,894) (76, 916) Cash balance, beginning 4, 000 4,000 4,000 4,000 4,000 CASH BALANCE, END $ 4, 000 $ 4,000 $ 4,000 $ 4,000 $ 4,000 vi.... -33- Hello