Tab_122Form 80384; I Information Return for Tax-Exempt Governmental Obligations I
(Rev, September 2011) I
- Under Internal Revenue Code section 149(e) I OMB No, 1545-0720
See separate instructions. I Department of the Treasury
Internal Revenue Service Caution: If the issue price is under $100,000, use Form 8038-GC.
LTII Renortinci Authority If Amended Return, check here p" El -
1 Issuers name - 2 Issuers employer identification number (EIN)
Kenai Peninsula Borough, Alaska 92-0030894
3a Name of person (other than issuer) with whom the IRS may communicate about this return (see instructions) 3b Telephone number of other person shown on 3a
4 Number and street (or P.O. box if mail is not delivered to street address) Room/suite 5 Report number (For IRS Use Only)
144 North Binkley Street I
6 City, town, or post office, state, and ZIP code 7 Date of Issue
Soldotna, Alaska 99669 November 3, 2016
6 Name of issue 9 CUSIP number
South Kenai Peninsula Hospital Service Area General Obligation Refunding Bond, 2016 None
ba Name and title of officer or other employee of the issuer whom the IRS may call for more information (sea lob Telephone number of officer or other
instructions) employee shown on 1 Os
Craig C, Chapman, Finance Director (907) 714-2171
Type of Issue (enter the issue price). See the instructions and attach schedule.
11 Education .............................. 11
12 Health and hospital
13 Transportation ............................ 13
14 Public safety ............................. 14
15 Environment (including sewage'bonds) .................... 15
16 Housing
17 Utilities
18 Other. Describe llo- 18
19 If obligations are TANs or RANs, check only box 19a ............. U
If obligations are BANs, check only box 19b
20 If obligations are in the form of a lease or installment sale, check box ..........I
ii tesrrintinn cif CThIirltinn!. nnmnip.tp for thp entire issue for which this form is beino fled.
(a) Final maturity date (b) Issue price (c) Stated redemption 1
price at maturity
(d) Weighted I average maturity
(e) Yield
21 12/01/2023 $ 3,050,412( $ $2,660,0001 56339 years 2.5984 %
Uses of Proceeds of Bond Issue (including underwriters' discount)
22 Proceeds used for accrued interest ......................22 -
23 Issue price of entire issue (enter amount from line 21, column (b)) ------------23 3,050,412
24 Proceeds used for bond issuance costs (including underwriters' discount) . , 24 34,586
25 1,816
26 Proceeds allocated to reasonably required reserve or replacement fund - 26
27
Proceeds used for credit enhancement .............25
3,010,212
28
Proceeds used to currently refund prior issues ..........27
Proceeds used to advance refund prior issues ..........281 _______
29 _3,046,614
30
Total (add lines 24 through 28) ........................29
Nonrefundingproceedsoftheissue(subtractline29fromline23andenteramounthere)30 _3,798
-DescniTtion of Refunded Bonds. Complete this part only for refunding bonds.
31 Enter the remaining weighted average maturity of the bonds to be currently refunded . . . - 5.5460 years
32 Enter the remaining weighted average maturity of the bonds to be advance refunded , . . - years
33 Enter the last date on which the refunded bonds will be called (MM/DD/YYYY) 12/05/2016
34 Enter the date(s) the refunded bonds were issued Ill (MM/DD/YYYY) 04/05/2007
For Paperwork Reduction Act Notice, see separate instructions. Cat. No. 63773S Form 8038-G (Rev. 9-2011)
Form 8038-0 (Rev. 9-2011) Page 2
11LAI Miscellaneous
35 Enter the amount of the state volume cap allocated to the issue under section 141 (b)(5) ....I5
36a Enter the amount of gross proceeds invested or to be invested in a guaranteed investment contract
(GIC) (see instructions) ..........................L36a
b Enter the final maturity date of the GIC -
C Enter the name of the GIC provider
37 Pooled financings: Enter the amount of the proceeds of this issue that are to be used to make loans
to other governmental units ........................I 37 I
38a If this issue is a loan made from the proceeds of another tag-exempt issue, check box - Evl and enter the following information:
b Enter the date of the master pool obligation November 3, 2016
o Enter the EIN of the issuer of the master pool obligation - 92.6001185
d Enter the name of the issuer of the master pool obligation - Alaska Municipal Bond Bank
39 If the issuer has designated the issue under section 265(b)(3)(8)(i)(111) (small issuer exception), check box . , . E
40 If the issuer has elected to pay a penalty in lieu of arbitrage rebate, check box .............
41a If the issuer has identified a hedge, check here - E and enter the following information:
b Name of hedge provider -
o Type ofhedge
d Term of hedge
42 If the issuer has superintegrated the hedge, check box .....................
43 If the issuer has established written procedures to ensure that all nonqualified bonds of this issue are remediated
according to the requirements under the Code and Regulations (see instructions), check box ........
44 If the issuer has established written procedures to monitor the requirements of section 148, check box .....
45a If some'portion of the proceeds was used to reimburse expenditures, check here - E and enter the amount
of reimbursement ..........____________________________________________
b Enter the date the official intent was adopted lo-
under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge
Signature and belief, they are true, correct, and complete. I further declare that I consent to the IRS's disclosure of the issuer's return Information, as necessary to
and process this return, to the person that I have authorized above.
Consent . .'114-t.,--
November 3, 2010
, Craig C. Chapman, Finance Director
Paid
Preparer
Use -Only Firms name Jermain Dunnagan & Dv
Firms address - 3000 A Street, Suite 300,
Signature of
it/Type prep
ithia L. Ca
r Type or print name and title
3, 201 Check If PuN
self-employed P01467958
P.C. Firm's EIN 11, 920116216
iorage, Alaska 99503 Phone no, (907) 563"8844
Form 8038-G (Rev. 9-2011)
.'s authorized representtive
name I Pr90'aer's signature
i:cuwv
3000 A Street, Suite 300 Anchorage, Alaska 99503
JERMAIN DUNNAC-AN & OWENS, P.C. tel 907.563.8844 fcnc 907.563.7322 www.jdoIaw.com
November 7, 2016
H
7196 900& 9111 5D
Internal Revenue Service Center
Ogden, Utah 84201
Re: Kenai Peninsula Borough, South Kenai Peninsula Hospital Service Area
General Obligation Refunding Bond, 2016; Our File No. 009544.00001
Ladies and Gentlemen:
Enclosed please find Form 8038-G in the above-referenced matter for filing.
Sincerely,
JERMAIN, DUNNAGAN & OWENS, P.C.
Shirley Rich, Legal Assistant
Enclosure as stated
(00659703)
3. Service Type CERTIFIED MAILTM I
4. Restricted Delivery? (Extra Fee) Yes I
1. Article Addressed to: I
Internal Revenue Service Centel-
Ogden, UT 84201
A. Received by (Please Print Clearly) B. Date of Delivery
Agent
Addressee
Ire Is 4e jIm yes
enter de ftES livery address below] ct No
GDUT
Reference information
009544.00001
CLC: snr
2. Article Number
I I 9I III I 119 19
7196 9008 9111 0038 9660
PS Form 3811, January 2005 Domestic Return Receipt