HomeMy WebLinkAbout20163923.tiffNCMC BOARD OF TRUSTEES
Regular Session Meeting
Monday, April 25, 2016
Attachment 1
Minutes of Regular Session of
March 28, 2016 *
* - Action Required
NCMC Board of Trustees
Regular Session Minutes
Monday, March 28, 2016
12:00 Noon
The Board of Trustees of North Colorado Medical Center met in Regular Session on Monday,
March 28, 2016, in the Richard Stenner Boardroom located at North Colorado Medical Center.
Dr. Carter declared a quorum and called the meeting to order at 12:20 p.m.
ATTENDANCE REPORT
NCMC Board of Trustees: Dr. Susan Carter, Larry Cozad, Catherine Davis, Mark Lawley,
Michael Simone, Brian Underwood, and Sean Conway (Commissioner, non -voting member)
were all present, with Jason Yeater being excused.
Banner Health: Rick Sutton (NCMC CEO) and Wendy Sparks (NCMC COO)
Staff: Ken Schultz (Board Executive)
Recording Clerk: Cheryl Hoffman, on behalf of Esther Gesick (Weld County Clerk to the Board)
PUBLIC COMMENT
There was no public comment.
APPROVAL OF MINUTES
It was MSC (Simone/Underwood) to approve the minutes from the February 29, 2016,
Regular Session meeting,
CEO REPORT or COO REPORT
NCMC COO, Wendy Sparks, gave the following report:
. Employees - All Banner employees received their performance reviews by the deadline
of March 15, 2016. NCMC Spirit of Women - Day of Dance took place on March 5, 2016,
at the Greeley Funplex, with approximately 2,500 in attendance, as well as 280
volunteers who helped operate the exhibits. The Northeast Colorado Nightingale
Awards Ceremony took place on March 5, 2016, and Tiffany Hettinger, NCMC Associate
CNO, was awarded the Nursing Advocate Award. Additionally, NCMC RN Senior
Manager, Amy Fusco, was awarded the Nursing Innovation Award and each of these
individuals will move on to the State Nightingale Award Ceremony.
• Patient Satisfaction - Eight of the ten dimensions were achieved, and they continue to
work very hard to improve.
. Quality - Health Grades named NCMC as one of America's Best 50 Hospitals for a second
year in a row. NCMC is the only Banner hospital to receive this recognition, and is only
one of three hospitals in the entire state of Colorado.
. Physicians- Dr. Michael Kim, Interventional Cardiology, starts this week. Dr. Robert Kinzer
will start in July and specializes in Infectious Diseases. There is also a lot of recruiting
Page 1 of 3
March 28, 2016 NCMC Board of Trustees
taking place in various areas. Rick Sutton gave a brief description of new technology
known as TAVR (Trans Aortic Valve Replacement), which is an endoscopic treatment.
. Financials - For February NCMC was ahead of budget by $507,000.00.
. Master Campus Plan - Ms. Sparks gave an overview of the various medical imaging
renovation projects which have gone live, as well as those which are currently underway,
and their associated costs. She also noted the $2.6 million Summitview CAT project has
begun, in addition to the various crane and large exterior projects around the main
campus.
Ms. Sparks also referenced the recent blizzard event and responded to Commissioner
Conway with a description of the emergency response measures in place to ensure
continued power, appropriate staffing, and how administration and leadership made the
decision to cancel various elective surgeries to ensure patient safety.
COMMISSIONER'S REPORT
Commissioner Conway expressed his appreciation to NCMC Inc. for the $40,000.00 donation
to the Bright Futures program. He reiterated the recent recognition by Health Grades as a
Top 50 Hospital in the Nation. He stated the Highway 34 Coalition unanimously
recommended funding the $2.3 million PEL (Planning Environmental Linkage) Study. Once
approved, CDOT will have the study under way this summer. There is a meeting with CDOT
concerning a $230 million TIGER Grant for improvements along 1-25, between Highway 402
to Highway 14. The Berthoud Hill construction project will be underway in 60 days, and the
reconstruction of Crossroads Boulevard at 1-25 will begin in early 2017.
VISITATION REPORTS
CARDIAC CATHETERIZATION LAB
Larry Cozad reviewed his report, dated March 8, 2016. A written copy of the visitation report
is attached as a part of these minutes.
BANNER NETWORK COLORADO (MANAGED CARE)
Brian Underwood reviewed his report, dated March 28, 2016. A written copy of the visitation
report is attached as a part of these minutes.
VISITATIONS FOR APRIL
Michael Simone
Jason Yeater
NCMC, INC. REPORT
There was no Inc. Report.
NEW BUSINESS
a) NCMC SERIES 2016 A & B BOND ISSUE: At the beginning of the meeting Ken Schultz
previously introduced Steve Clark, S.B. Clark Companies, who serves as the bond advisor for
NCMC Inc., as well as Bruce Barker, County Attorney. He also distributed a diagram of the
Page 2 of 3
March 28, 2016 NCMC Board of Trustees
NCMC Legal Structure and the parties involved, including: Weld County, the Colorado Health
Facilities Authority, NCMC Board of Trustees, NCMC, Inc. Board, NCMC and Banner Health
Colorado. He stated the County Commissioners have approved an Emergency Ordinance to
allow moving forward with the Series 2016 Bond issue. Next he reviewed the various talking
points, historical background, and the redline changes being made to the various lease
documents as recommended by legal counsel and detailed in the summary points. Copies of
the above described documents are attached as a part of these minutes.
Mr. Schultz and Mr. Clark reviewed the terms of the Bond document and answered questions
from the Trustees concerning the terminology and financial mechanisms of the bond. He
referenced the Resolution of the Board of Trustees for NCMC and gave a brief overview of
the terms.
Mr. Clark summarized the previous bond activity, the purpose of the current financing and
anticipated rates, as well as fiscal benefits of refinancing the funds. Mr. Barker added he did
review the various documents and the Board of County Commissioners had no objections and
approved Emergency Ordinance #252 and authorizes the Chair of the Trustee Board to sign
the proposed Resolution to move the process forward
It was MSC (Simone/Lawley) to approve the Resolution of the Board of Trustees for North
Colorado Medical Center for the 2O16 Series Bonds.
PLANNING SESSION
No discussion was held on scheduling a future planning session.
ADJOURN
There being no further business to come before the Board, it was MSC [Simone/Cozad] to
adjourn the meeting at 1:23 p.m.
Respectfully submitted,
Esther Gesick and Cheryl Hoffman
Page 3 of 3
March 28, 2016 NCMC Board of Trustees
Trustee Report
March 28, 2016
Brian Underwood, Trustee
Department: Banner Network Colorado (Managed Care)
Executive: Paul Kellogg, VP Banner Network Colorado & Business Development
I must begin by stating that interviewing Managed Care and grasping the myriad of issues and strategies
for which this department is accountable is like drinking from a fire hydrant! Managed Care is at the
center of a very dynamic health care environment that is undergoing rapid change and growth.
Conveying the information provided during this interview within a concise report was a challenge in
itself. This report is written with a very broad brush.
Banner Network Colorado is led by Paul Kellogg and includes a staff of 14 employees. It is a "Banner
Corporate" department and is responsible for all payer contracting within Banner's Western Region.
Department expenses are allocated to NCMC in accordance with a corporate allocation formula.
Paul provided me with insight into changes in Healthcare financing and how changes enacted through
CMS are radically impacting health care delivery both nationally and locally.
While NCMC still has many payers that are reimbursing healthcare services on a fee for service basis, the
trend is continuing toward population health management with incentives for improving the quality and
efficiency of health services using financial incentives (risk sharing) involving health care providers — at
all levels, large and small.
Underlying the need for transformation is the fact that growth in the cost of the US healthcare system is
unsustainable. The US spends almost two times more than other developed nations on healthcare and
yet statistically, the cost doesn't result in better outcomes (a complicated issue that is the subject of
many doctoral dissertations). And the comparatively large cost of health insurance traditionally borne
by private US corporations has become a competitive disadvantage in an international economy. We've
been hearing all of this for years. But what is happening is that actionable goals set forth within the
Affordable Care Act of 2010 are now taking hold and nationally, the financing of healthcare is
fundamentally changing to "Value -Based Payments." In short, CMS is moving away from fee for service
reimbursement and towards population -based payments to providers — and this is driving the entire
US healthcare industry. In 2016, Medicare has targeted 30% of reimbursement to be related to risk
sharing arrangements that provide a financial upside and downside to healthcare reimbursement. By
2018, that target moves to 50%. This is a big dealt — and an indicator of how fast these changes are
driving the healthcare market. Furthermore, outside of government reimbursed heath care, many
people are moving (or being moved) toward higher deductible medical insurance plans as corporations
are transitioning more of the upfront cost of care to employees. One of the results is that individual
patients who are bearing a greater share of the costs related to their healthcare decisions are more
price sensitive.
NCMC Trustee Report
Cardiac Catheterization Lab
Tour Date: March 8, 2016
Trustee: Larry Cozad
Department History: The Cardiac Catheterization Lab is a part of the CardioVascular Institute of
Northern Colorado. I toured the NCMC facility located on the 3rd floor of NCMC in Greeley.
Name of contact: Kari Holman, RN, Senior Manager NOCO Cardiac Cath Lab.
History of contact: Kari has lived in Greeley most of her life, graduated high school in Greeley and
received her nursing degree from UNC. She has worked at NCMC for 16 years, 10 years in the Cath Lab
and 2 years in the leadership position as Senior Manager.
Services Provided: The Cardiac Cath Lab provides non -surgical treatments that are minimally
invasive procedures commonly used to treat some forms of heart disease such as:
• Angiography
• Angioplasty (balloon)
• Atherectomy (rotational)
• Echo Procedures
• Electrophysiology Study ICD/Pacemaker Implantation
• Intracoronary Ultrasound
• Peripheral Vascular Intervention
• Stent Implantation
• Valvuoplasty
The CardioVascular Institute of North Colorado has three state-of-the-art catheterization labs including a
dual-purpose lab that can also be used for diagnostic or interventional electrophysiology studies. They
are currently upgrading one of the Angiography lab rooms with the latest technology. As soon as this
room is finished and operational they will upgrade the second room. The 3 rooms were described to me
as: one lab primarily for the electrical functions of the heart and 2 labs for the plumbing functions of the
heart.
Number of Staff: full-time and part-time and what fields: 10 -Full Time, 2 -Part Time and 3-PRN
Employees of the Cath Lab all split their time between the 3 Banner Cath Lab facilities. This cross
training improves all facilities as some are busier than others. The personnel sharing ensures that any
new cutting edge technology and techniques are equally implemented across all Banner facilities and
help to keep Banner a leader in a competitive market.
Revenues/Budc{ets If Relevant: Kari did not have the exact budget numbers at hand the day of my visit.
The Cath Lab is part of the overall Cardiac Treatment budget for Banner.
Successes: Combining with McKee and Fort Collins to share personnel and techniques was one thing
Kari pointed out. Also the upgrades taking place at NCMC with all new equipment and remodeled
procedure rooms.
A couple of new procedures include "The Watchman" which is a device that offers a new stroke risk
reduction option for patients with non -valvular atrial fibrillation who are seeking an alternative to long-term
warfarin (anti -clotting) therapy. This device is inserted through the femoral artery.
Another new procedure is called the MitraClip which is a device that helps with the disorder of the heart in
which the mitral valve does not close properly when the heart pumps out blood. This is also inserted
through the femoral artery.
A new procedure that will begin on April 1, 2016 that the team is very excited about is called
Transcatheter Aortic Valve Replacement (TAVR) The TAVR procedure offers hope for heart
patients with inoperable aortic stenosis (failing heart valves). TAVR valves are inserted via a catheter
through the femoral artery. This procedure is considered a "surgical" procedure and will be performed in
the surgical area at NCMC rather than the Cath Lab. Normal valve replacement involves open heart
surgery and this new minimally invasive procedure involves shorter hospital stays (typically 3-5 days) and
greatly reduced recovery time as compared to open heart surgery.
Challenges/Obstacles: The biggest challenges the Cath Lab has limited financial resources that limit the
ability to acquire the latest technology, equipment and procedures. Kari see's the market as being very
competitive with the new hospital in Loveland. She feels the need to keep up with or stay ahead of the
competition in order to provide the very best and latest technology locally.
Departmental Needs/Requests None specified.
Suggestions for improvement: Kari feels that advertising and promoting the services and procedure
offered at the Cath Lab would help to maintain and increase patient volumes in a very competitive market.
Higher patient volumes open up the ability for Banner to qualify for the latest technology and treatments.
This in turn will improve skills, attract the best doctors and nurses in the industry to the Banner system
and help with the financial side to make Banner Northern Colorado a premier cardiac service provider.
What Would The Department Manager/Director Like NCMC Trustees To Know Kari believes they have
a very dedicated and excellent staff of physicians, nurses and team members that are very proactive and
progressive in their field of cardiovascular health. She believes that this is the best way to compete in this
current market and not get left behind. She said with continued financial support of their programs they
will be the best that Northern Colorado has to offer.
Lastly, being somewhat of a "homer", strongly believing in supporting the local community, she would like
to see The Human Bean replace Pete's Coffee in the coffee shop. Support our local business!
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TALKING POINTS ON WHY VARIOUS DOCUMENTS WERE AMENDED AND
RESTATED
INTRODUCTION --HISTORICAL
• All of the basic financing documents were originally written back in 1985
• Because of the ownership structure in place then, a fairly complicated financing
mechanism was developed
• The owner of the facilities is the County, and the original operator of the facilities was a
county related entity, the Board of Trustees for North Colorado Medical Center
• But the issuer of the bonds was and is another entity, Colorado Health Facilities
Authority
• So the structure involved a Ground Lease from the County to the Colorado Health
Facilities Authority; the Authority issues the Bonds and uses the proceeds for the
Hospital and this was done through a financing Lease; NCMC, Inc. came along and they
took over functions for the Board of Trustees, so an Operating Sublease was entered into
whereby NCMC agreed to take over the responsibilities of the Board of Trustees
• Over the years, as more bonds were issued, all of these documents were amended time
and again, and it became almost impossible to follow the nuances of all the changes
• So in 2012, Bond Counsel took all the amendments and supplements, and melded them
into restated documents, in particular a Restated Trust Indenture, a Restated Lease and a
Restated Operating Sublease
• So the purpose back then was really to make the documents more readable and user
friendly.
WHEN ADDITIONAL BONDS ARE ISSUED, THESE DOCUMENTS NEED TO BE
AMENDED TO REFLECT THE NEW BONDS, BUT IF AN AMENDMENT IS NEEDED WE
DO THIS VIA RESTATING THE DOCUMENTS AGAIN SO ALL PROVISIONS WITH
RESPECT TO ANY DOCUMENT ARE IN ONE PLACE.
4820-0047-4159.1
SECOND RESTATED TRUST INDENTURE
• NCMC is not a party to the Trust Indenture which is between the Colorado Health
Facilities Authority and Wells Fargo Bank, National Association, as trustee
• The Second Restated Trust Indenture is restated primarily to provide the details with
respect to the new, Series 2016 Bonds, including principal amounts, interest rates,
redemptions, use of bond proceeds
• Since the 2003 Bonds are being refunded, we also deleted almost all of the provisions
dealing with the 2003 Bonds
• So the Restated Indenture now contains the details on the outstanding 2012 and 2013
Bonds, plus the new 2016 Bonds
• We created funds and accounts in the Indenture for the 2016 Bonds which parallel the
funds and accounts for the 2012 Bonds and the 2013 Bonds, including a 2016 Cost of
Issuance Fund, a 2016 Project Fund (which is where amounts reimbursing NCMC Inc.
will be deposited and then disbursed from), a 2016 Rebate Fund, etc.
• We also deleted details with respect to Assured Guaranty being the bond insurer, since
the 2003 Bonds they insured will have been refunded
• We left in the concept of a "Bond Insurer" which is given certain rights in case we
happen to have one in the future, though that is probably unlikely; and the provisions
have no applicability when there is no Bond Insurer, as will be the case immediately after
we issue the 2016 Bonds
SECOND RESTATED LEASE AGREEMENT
• This is a document between Colorado Health Facilities Authority and the Board of
Trustees for North Colorado Medical Center
• It was restated to acknowledge that the 2003 Bonds were going away, and that we have
new 2016 Bonds
• In Article III, we added provisions relative to the use of 2016 Bond proceeds
• It added a "tax covenant" for the new 2016 Bonds, which states the Board of Trustees
will not do anything to adversely affect the tax -exemption of the Bonds
• References to Assured Guaranty as a bond insurer were deleted or genericized to just
refer to possible future bond insurers
4820-0047-4159.1
FIRST RESTATED OPERATING SUBLEASE
• This is between the Board of Trustees and NCMC, Inc. and obligated NCMC, Inc. to pay
to the Bond Trustee amounts sufficient to pay the Bonds
• It has always contained various financial covenants, and these have not been changed
• This was NOT restated in 2013 when the 2013 Bonds were issued, because it used a
generic term throughout of "Bonds" to cover all past and future Bonds, so it was not
necessary to amend it or restate it
• However, this time, amendments were made to simplify some things for the benefit of
NCMC, Inc.
• There was an old requirement to maintain with Wells Fargo, the Trustee, a Depreciation
Fund into which certain fairly small amounts had to be deposited and then could be used
by NCMC. This was required by investors in some of the early bonds and by Assured
Guaranty, the insurer of the 2003 Bonds. It has been eliminated in the Restated Sublease.
• Also eliminated in Section 5.25 were details required by Assured Guaranty, as both a
bond insurer and at one time it also insured a swap; both of these points are no longer
relevant
• Section 5.26 dealt with "Financial Products Agreement?' which were essentially interest
rate swaps that were and are specifically used to hedge a series of bonds. While NCMC
still has some swaps on its books really as investments, those "investments" don't hedge
bonds. The only one that hedges bonds is a swap done in 2013 with the parent of
Compass Bank. We have fixed Section 5.26 to make it clear that the only swap subject to
the "Financial Products Agreement" provisions is the 2013 swap relative to those bonds.
Future swaps are allowed under the same existing conditions.
FIRST RESTATED GROUND LEASE
• This is the Ground Lease from the County to Colorado Health Facilities Authority
• This is being amended because the TERM needed to be extended. The existing bonds go
out only through about 2030, and the new bonds may go out to as far as 2034
• So this will extend the Ground Lease to whatever the ultimate terms of the 2016 Bonds
turns out to be (but not beyond May 15, 2034)
• It also cleaned up some errant notice addresses from the prior version
• It is a "First" Restated Ground Lease because in 2013 it was not necessary to extend the
term
4820-0047-4159.1
SECOND RESTATED GUARANTY AGREEMENT
• NCMC, Inc. has always been required to "guarantee" payment of the Bonds under a
Guaranty Agreement
• NCMC is already committed under the Sublease to make payments equal to the debt
service on the Bonds
• However, in the remote chance of a bankruptcy, a "lease" such as the First Restated
Operating Sublease can potentially be rejected as not being indebtedness by a bankruptcy
court
• Since the Sublease is really intended as a debt instrument, the "guaranty" is a backstop
which again, in the unlikely event of a bankruptcy, would probably not be rejected by a
bankruptcy court and would be treated as debt
• The First Restated Guaranty Agreement already covered all Bonds outstanding, past or
future
• With that background, the only thing that changes in this Second Restated Guaranty
Agreement is changing a cross reference from the First Restated Lease to the Second
Restated Lease between the Board of Trustees and the Colorado Health Facilities
Authority
• It also deleted certain rights of and references to the Bond Insurer
4820-0047-4159.1
NEW ISSUE
BOOK -ENTRY ONLY
PRELIMINARY OFFICIAL STATEMENT DATED MAY [_I, 2016
Ratings: Standard & Poor's: "A+"
Fitch: " "
(See "RATINGS" herein)
In the opinion of Kutak Rock LLP, Bond Counsel, under existing laws, regulations, rulings and judicial decisions and assuming the
accuracy i, certain representations and continntng compliance with certain covenants, interest on the Series 2016 Bonds (as defined herein) is
excludable from gross income for federal income tax purposes and is not a specific preference item for purposes of the federal alternative
minimum tax. Bond Counsel is also of the opinion that the Series 2016 Bonds, the transfer thereof and the income therefrom, including any
profit made on the sale thereof, is exempt from all taxation and assessments in the Stole of Colorado under existing 1an,'s of the State or
Colorado. For a more complete description of such opinions of Bond Counsel, see "TAX MATTERS" herein.
IS 1'
[NCMC LOGO] COLORADO HEALTH FACILITIES AUTHORITY
HOSPITAL REVENUE BONDS
(NCMC, INC. PROJECT)
SERIES 2016
Dated: Date of initial delivery Due: May 15, as shown on inside cover
The Colorado Health Facilities Authority (the "Authority") will issue its Hospital Revenue Bonds (NCMC, Inc. Project) Series 2016
(the "Series 2016 Bonds") pursuant to the terms of a Second Restated Trust Indenture dated as of May 1, 2016 (the "Indenture"), between the
Authority and Wells Fargo Bank, National Association, as trustee (the "Trustee"). The Series 2016 Bonds will bear interest at the respective
rates set forth on the inside cover page of this Official Statement, payable on each May 15 and November 15, commencing on [May 15, 2016).
The Series 2016 Bonds will be issued as fully registered bonds in denominations of $5,000 or any integral multiple thereof. The
Series 2016 Bonds will be issued in book -entry form (without definitive certificates). The Series 2016 Bonds will be registered in the name of
Cede & Co., as nominee of The Depository Trust Company ("DTC"), or such other name as may be requested by DTC. DTC will act as
securities depository for the Series 2016 Bonds. DTC will be responsible for distributing each payment to the participating members of DTC,
and such participating members of DTC will be responsible for distributing such payments to the beneficial owners of the Series 2016 Bonds, as
more fully described herein.
THE SERIES 2016 BONDS ARE SUBJECT TO OPTIONAL, EXTRAORDINARY OPTIONAL AND MANDATORY
REDEMPTION AND PURCHASE IN LIEU OF OPTIONAL REDEMPTION PRIOR TO MATURITY AS DESCRIBED HEREIN.
THE SERIES 2016 BONDS AND INTEREST THEREON ARE SPECIAL, LIMITED OBLIGATIONS OF THE
AUTHORITY.
The Series 2016 Bonds will be payable from the Basic Rent (as herein defined) received by the Authority pursuant to a Second
Restated Lease dated as of May 1, 2016 (the "Lease"). between the Authority and the Board of Trustees for North Colorado Medical Center (the
"Board of Trustees"). The Board of Trustees will derive the funds to make Basic Rent payments from amounts paid to the Board of Trustees by
NCMC, Inc., a Colorado nonprofit corporation ("NCMC") under the First Restated Operating Sublease dated as of May I, 2016 (the
"Sublease"), between the Board of Trustees and NCMC. It is expected that NCIHIC will derive the funds to make such payments to the Board of
Trustees from amounts paid to NCMC by Banner Health, an Arizona nonprofit corporation ("Banner") under the Second Amended and Restated
Operating Agreement effective January i, 20t2 (the "Operating Agreement"), between NCMC and Banner for so long as such Operating
Agreement is in effect_ NCMC has unconditionally guaranteed the payment of the Series 2016 Bonds pursuant to a Second Restated Guaranty
Agreement dated as of May 1, 2016 (the "NCMC Guaranty"), between NCMC and the Trustee.
The Series 2016 Bonds and the interest thereon are limited obligations of the Authority. Except for amounts received with respect to
the NCMC Guaranty and the 2016 Banner Limited Guaranty described in this Official Statement, the Series 2016 Bonds are payable solely from
and secured only by a pledge of certain rights of the Authority under and pursuant to the Lease with the Board of Trustees, including, without
limitation, payments of Basic Rent pursuant to such Lease, and from moneys and securities in certain funds described in the Indenture and
investment earnings thereon.
The Series 2016 Bonds do not constitute an indebtedness, a debt or liability or a charge against the faith, credit or taxing
power of the State of Colorado, its General Assembly or any of its political subdivisions or agencies other than the Authority to the
extent provided in the Indenture. The Series 2016 Bonds also do not constitute an indebtedness, a debt or liability or a charge against
the faith, credit or taxing power of Weld County, Colorado. The Authority is not authorized to levy or collect any taxes or assessments
to pay the Series 2016 Bonds or for any other purpose. The Authority makes no representation or warranty as to the adequacy or
sufficiency of the security for the Series 2016 Bonds.
The purchase of the Series 2016 Bonds involves certain risks and reference is hereby made to "BONDHOLDERS' RISKS"
and "REGULATION OF THE HEALTH CARE INDUSTRY" for a discussion of some of those risks.
This cover page contains certain information for quick reference only. It is not a complete summary of the terms of the Series 2016
Bonds. Investors must read the entire Official Statement to obtain information essential to the making of an informed investment decision.
The Series 2016 Bonds are offered when, as and if issued and delivered to the Underwriter subject to prior sale, withdrawal or
modification of the offer without notice and subject to approval of the legality of the Series 2016 Bonds by Kutak Rock LLP, Denver, Colorado,
Bond Counsel, and other conditions, Kutak Rock LLP has also been retained to advise NCMC concerning, and has assisted in, the preparation
of this Official Statement, Certain legal matters will be passed upon for the Authority by its general counsel, Ballard Spahr LLP, Denver,
Colorado; for the Board of "trustees by the County Attorney; for Banner by its Senior Vice President and General Counsel; for NCMC by its
general counsel, Berenhaunt Wcinshienk, PC, Denver, Colorado: and for the Underwriter by its counsel, Dorsey & Whitney LLP, Missoula,
Montana. the Series 20 Hi Bonds are expected to be available tar delivery through DTC on or about May , 2016_
Preliminary; subject to change.
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