HUD-92264-HCF Health Care Facility Summary Report

Health Care Facility
Summary Appraisal Report
Skilled Nursing Facility
Board and Care Facility

(SNF)
(B&CF)

Property Rights Appraised

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner

SAMA
Feasibility (Rehab)
Firm

Intermediate Care Facility
Assisted Living Facility

(ICF)
(ALF)

OMB Approval No. 2502-0029
(expires 05/31/2006)

Project Name

Project Number:

Fee Simple
Other _________________
Purpose: FHA Appraisers evaluate the subject property as security for a long-term insured mortgage. Included in the appraisal are the Appraiser's analyses of market
need, location, earning capacity, expenses, taxes, and warranted cost of the property. This form summarizes the FHA appraisal analyses and conclusions. Scope: The
Appraiser has developed, and hereunder reports, conclusions with respect to: feasibility; suitability of improvements; extent, quality, and duration of earning capacity; the value
of real estate proposed or existing as security for a long-term mortgage; and several other factors which have a bearing on the economic soundness of the subject property.

A. Location and Description of Property
1. Street Numbers

2. Municipality

5. Type of Project

11.

6. Gross Floor Area

7. No. Bldg./Floors

8. No. of Beds or Units

SNF
B&CF

Elevator
1 Story
Existing
Proposed

Rehab

Site Information

12. Year Built

3. County

4. State

9. Avg. Basic Monthly
10. Avg. Other Monthly
Charges per bed or per unit
Charges per bed or per unit
$
$

ICF
ALF

13. Accessory Buildings

14. Dimensions

15. Zoning (If recently changed, submit evidence)

ft. by

ft., or

sq. ft.

Building Information 16. Structural System

17. Exterior Finish

18. Heating-A/C System

B. Information Concerning Land or Property
19. Date Acquired 20. Purchase Price

21. Additional Cost
Paid or Accrued
$

$
25. Utilities

Public

Community

22. Annual Ground Rent

23. Total Cost

$

$

26. Unusual Site Features

Water
Sewers

Cuts
Poor Drainage
Other (specify)

Prepayable
Non-Prepayable

26a. Special
(1)
Assessments

24. Relationship between Seller & Sponsor
(Business, Personal, or Other)

Fills
High Water Table

(2) Principal Balance
$

Rock Formations
Retaining Walls

(3) Annual Payment
$

Erosion
None
(4) Remaining Term
years

C. Estimate of Income
Type of Room
or Unit

SNF

Number of Beds or Units
ICF
B&CF

ALF

SNF

Estimated Monthly Rate
ICF
B&CF

ALF

Est. Monthly Income
at 100% Occupancy

Private Pay *
(up to 30%)
Medicaid *
(at least 67%)
Medicare *
(up to 3%)
Other

* Jurisdictional Exception: FHA underwriting standards require recognition of the fact that defined percentages of public
reimbursement and private pay are sustainable in stabilized operations, and will generally be assumed in Income estimation.
27. Total Monthly Income from Beds and Units

$

Other Income (List)

$
$
$

28. Total Other Income

$

29. Total Monthly Income-All Sources

$

30. Total Estimated Annual Gross Project Income at 100% Occupancy

$

31. Number of Non-Revenue Producing Units for Employees (not shown above)

Replaces HUD-92264-NHICF which is obsolete

Page 1 of 6

ref Handbooks 4480.1 & 4600.1

form HUD-92264-HCF (6/95)

D. Payroll (Salaries)
Position

No.

Monthly Rate

Total Annual

Position

Administrative

No.

Monthly Rate

Total Annual

Housekeeping
$

$

32. Total Administrative

$

$

35. Total Housekeeping
Nursing Service

Bldg. & Grounds
$

$

$

33. Total Buildings and Grounds

$

$

$

$

34. Total Dietary

$

36. Total Nursing Service
Other Salaries

Dietary
$

$

$

$

$

37. Total Other Salaries

$
$

38. Estimated Annual Salaries (sum of lines 32 through 37)

E. Estimate of Operating Deficit
Periods
Gross Income
Occup. %
39.
$
% $

Effec. Gross
$

Expenses
$

Net Income

Debt Serv. Reqmt.
$

$

Deficit

$

$

$

$

1st
40.

$

% $

2nd
41.Total Operating Deficit
F. Estimated Annual Operating Expenses
Administrative—
1. Telephone
$ _____________
2. Advertising
_____________
3. Insurance and Liability
_____________
4. License or Permit
_____________
5. Legal and Audit
_____________
6. Miscellaneous
_____________
7. Office Expense
_____________
8. Total Administrative
Building and Grounds—
9. Decorating-Interior and Exterior $ _____________
10. Heating
_____________
11. Electricity
_____________
12. Water
_____________
13. Gas
_____________
14. Garbage Removal
_____________
15. Insurance
_____________
16. Supplies
_____________
17. Maintenance and Repairs
(Bldg. and Realty Items)
_____________
18. Ground Expenses
_____________
19. Miscellaneous
_____________
20. Exterminating
_____________
21. Total Building and Grounds
Dietary—
22. Supplies
$ _____________
23. Food Cost
_____________
24. Total Dietary

Replaces HUD-92264-NHICF which is obsolete

$

$ _____________

$ _____________

$ _____________

Page 2 of 6

Housekeeping—
25. Supplies
$ _____________
26. Laundry
_____________
27. Other
_____________
28. Total Housekeeping
Nursing Service—
29. Supplies
$ _____________
30. Drugs
_____________
31. Professional Fees
_____________
32. Total Nursing Service
Other Expenses—
33. Program and Activities
$ _____________
34. Library
_____________
35. Automobile Expense
_____________
36. Total Other Expenses
37. Total Salaries (Line D-38)
38. Repl. Reserve (Realty) (0.0060 x Line H-8)
39. Expenses (Less Taxes)
Taxes—
40. Real Estate Est. Assessed Val.
$ _____ at $ _____ per $1000 $ _____________
41. Personal Prop. Est. Assessed Val.
$ _____ at $ _____ per $1000 $ _____________
42. Employee Payroll Tax
_____________
43. Employee Social Security
_____________
44. Other
_____________
45. Total Taxes
46. Repl. Res. (Major Movable Equip.) 0.10 x Line H-36
47. Total Estimated Annual Operating Expenses
(Lines 39 plus 45 and 46)

ref Handbooks 4480.1 & 4600.1

$ _____________

$ _____________

$ _____________
_____________
_____________
$ _____________

$ _____________
$ _____________
$ _____________

form HUD-92264-HCF (6/95)

G. Estimate of Net Returns
1. Annual Gross Earnings Expectancy (From C-30) $ ______________
2. Predicted Occupancy Ratio __________ % *
3. Effective Annual Gross Income (Line G-1 x G-2) $ ______________

5. Net Return Available for Proprietary Earnings, Realty,
and Maj. Mov. Equip. (Line G-3 minus Line G-4)
$ _______________
6. Estimated Net Earnings Attributable to Realty
and Maj. Mov. Equip. (Line K-7)

$ _______________

4. Est. Total Annual Operating Expense (From F-47)$ ______________
* Jurisdictional Exception: May be limited by FHA Underwriting assumptions.

7. Residual Proprietary Earnings (Line G-5 minus Line G-6) ______________ $

H. Estimated Replacement Cost
1. Unusual Land Improvements
$ _____________
2. Other Land Improvements
$ _____________
3. Total Land Improvements
$ _____________
4. Structures-Gross Floor Area Sq. Ft. ____________
5. Main Building
$ _____________
6. Other ___________________ $ _____________
7. ________________________
$ _____________
8. Total Structures
$ _____________
9. General Requirements
$ _____________
Fees:
10. Builder's General Overhead
at __________ %
$ _____________
11. Builder's Profit
at __________ %
$ _____________
12. Architect Fee-Design
at __________ %
$ _____________
13. Architect Fee-Suprvr.
at __________ %
$ _____________
14. Bond Premium
$ _____________
15. Other Fees
$ _____________
16. Total Fees
$ _____________
17. Total for All Improvements (Lines 3 + 8 + 9 + 16) $ _____________
18. Cost Per Gross Sq. Ft.
$ _____________
19. Estimated Construction Time
_____________ Months

* FHA New Construction Underwriting requires that the site be valued
assuming that: 1) all off-site improvements are completed and 2) the site
will be used for its intended Care Facility use (not necessarily its highest
and best use).
I.

Carrying Charges and Financing
20. Int. _____ Mos. at _____ %
on $ __________________
$ _____________
21. Taxes
_____________
22. Insurance
_____________
23. FHA Mtg. Ins. Pre. (
%)
_____________
24. FHA Exam. Fee
(
%)
_____________
25. FHA Inspec. Fee (
%)
_____________
26. Financing Fee
(
%)
_____________
27. AMPO (N.P. only) (
%)
_____________
28. FNMA/GNMA Fee (
%)
_____________
29. Title and Recording
_____________
30. Total Carrying Charges and Financing
$ _____________
Legal and Organization:
31. Legal
$ _____________
32. Organization
_____________
33. Cost Certification Audit Fee
_____________
34. Total Legal and Organization
$ _____________
35. Consultant Fee (N.P. only)
$ _____________
36. Major Movable Equipment
$ _____________
37. Total Est. Development Cost (Excl. of Land or
Off-site Cost) (Lines 17 + 30 + 34 + 35 + 36)
$ _____________
37a.Depreciation (Line 37 times __________ %)
$ _____________
37b.Total Estimated Development Cost less Depreciation
(Line 37 minus line 37a)
$_____________
38. Warranted Price of Land (J-14(3))(*See note at left)
__________ sq. ft. at $ __________ per sq. ft.
$ _____________
38a.Off-site Costs (Rehab only)
$ _____________
39. Total Estimated Replacement Cost of Project as Depreciated
(Add lines 37b, 38, and 38a)
$ _____________

Remarks

Replaces HUD-92264-NHICF which is obsolete

Page 3 of 6

ref Handbooks 4480.1 & 4600.1

form HUD-92264-HCF (6/95)

J.

Project Site Analysis and Appraisal

1.
2.
3.
4.
5.

Is Location and Neighborhood acceptable?
Is Site adequate in Size for proposed Project?
Is Site Zoning permissive for intended use?
Are Utilities available now to serve the Site?
Is there a Market at this location for the Facility
at the proposed Rate Charges?

8. Value Fully Improved

Yes
Yes
Yes
Yes

No
No
No
No

Site acceptable for type of Project proposed under Section 232.
(If checked, acceptance subject to qualifications listed below.)
7.
Site not acceptable for reasons stated below.
Date of Inspection

Yes

No

By

6.

Location of Project

Size of Subject Site

Sq. Ft.
Comparable Sales Address

Date
of
Sale

Sales
Price

Size
Sq. Ft.

Price
per
Sq. Ft.

Adjustments (%)
Time

Location Zoning Plottage Demolition Pilings

0ther

Total
Adjustment
Factor

Adjusted
Sq. Ft.
Price

Indicated Value by
Comparison

1.
2.
3.
4.
5.
Remarks
9. Value of Site Fully Improved $ ______________________

10. Value "As Is"

Ft./Acres

11. Value of Site "As Is" by Comparison $ _____________________
12. Acquisition Cost (Last Arms-Length Transaction)
Buyer

Address

Seller

Address

Date

Price
$

Source

13. Other Costs
Legal Fees and Zoning Costs
Recording and Title Fees
Interest on Investment
Other
Acquisition Cost (From “12” above)
Total Cost to Sponsor

14. Value of Land and Cost Certification
(1) Fair Market Value of land fully improved (From “9” above)

$ ______________________

(2) Deduct unusual items based on line H-1

$ ______________________

(3) Warranted price of land fully improved (Replacement Cost items
excluded) (Enter on line H-38)
For Cost Certification Purposes—

$ ______________________

(3a) Deduct cost of demol. $ _______________ and required off-sites
$ ______________ to be paid by Mtgor. or by special assessments ______________________ $
(4) Estimate of “As Is” by subtraction from improved value
$ ______________________
__________________________
(5) Estimate of “As Is” by direct comparison with similar
__________________________
unimproved sites (From "11" above)
$ ______________________
__________________________
(6) “As Is” based on acquisition cost to sponsor (From "13"above)
$ ______________________
__________________________
(7) Commissioner's estimated value of land “As Is”
__________________________
(The lesser of [4] or [5] above)*
$ ______________________
$ __________________________ *Where land is purchased from LPA or other Governmental authority for specific reuse, use the lesser of 4, 5, or 6.
Page 4of 6

ref. Handbooks 4480.1 & 4600.1

form HUD-92264(HCF) (6/95)

K. Estimate of Value by Capitalization
1. Estimated Remaining Economic Life __________ Yrs.
2. Capitalization Rate Determined by:
Cash Flow

Overall Rate From Comparable Projects

Rate From Band of Investment (Add Recapture)

3. Rate Selected _________ %

4. Value of Leased Fee (if any).
Ground Rent $ ____________________ divided by CAP.
Rate __________ % = Value of Leased
Fee $ __________________________________________

5. Net Return to Realty and Major Movable Equipment based on Leased Care Facility data (Excluding Proprietary Income)
Address of Leased Care Facility

No. of
Beds

Rent Realty
Only PBPA

Adj. Net Return To Realty
and Equipment PBPA

$ Lump Sum Adjustment PBPA
Return on Equipment

6. Net Return to Realty and Major Movable Equipment for Subject PBPA

$ ________________________

7. Line K-6 x No. of Beds = Total Return Realty and Major Movable Equipment (Excluding Proprietary Income) (Enter on Line G-6) ___________________ $
8. Net Return (Line K-7) divided by Overall Cap. Rate (Line K-3) = Estimated Value of Property by Capitalization
(Excluding Proprietary Income)

$ ________________________

Note: Comparable Leased Nursing Homes in Section K which are HUD insured must include Regulatory Agreement Form HUD-92466 (NHL) in the file. Comparable
Leased Nursing Homes in Section K which are not HUD insured must include in the file verification by the Appraiser from the lessor or the lessee that there is no
identity of interest between lessee and lessor, and that the lease payments for realty and major movable equipment to be paid to lessor do not include proprietary income.
Remarks:

L. Comparison Approach to Value*
Address of Comparable Sale

Date

Sale Price

Number
Beds

Sales Price
Per Bed

Gross Income
Per Bed

Gross Income
Multiplier

Adjustments

Indicated
Price/Bed

$
$
$
9. Subject Gross Income PA $
10a. Or: Number of Beds

x GIM
x Indicated Price

= Indicated Value of Subject by Comparison

$

= Indicated Value of Subject by Comparison, Including Proprietary Earnings $

10b. Value by Comparison, Excluding Proprietary Earnings ((Line K-7 divided by Line G-5) times Line L-10a)

$

Remarks: * The Appraiser must comment on any prior sale of the subject within three years of the date of this processing.

M. Appraisal Summary
11. Capitalization $ _________________________
Summation $ _________________________
12. The Fair Market Value of the Property as of Date of Valuation Is **
$ ____________________

Comparison $ _________________________

N. Reserved
O. Total Est. Cost of Off-Site Requirements
Off-Site
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Total Off-Site Costs

Est. Cost
$ ________________________
$ ________________________
$ ________________________
$ ________________________
$ ________________________

** Care Facility property is not necessarily valued for its "highest and best use," but instead for its intended insured use. New Construction is valued prospectively upon
completion and Substantial Rehabilitation proposals are valued "After Rehabilitation." Existing facilities being purchased or refinanced are valued hypothetically "Including
Repairs" as of the date of the appraisal.

Replaces HUD-92264-NHICF which is obsolete

Page 5 of 6

ref Handbooks 4480.1 & 4600.1

form HUD-92264-HCF (6/95)

P. Remarks, Conclusions, and Signatures
Cost Processor

Date

Architectural Processor

Date

Architectural Reviewer

Date

Appraiser's Certification
I certify that to the best of my knowledge and belief:
o the statements of fact contained in this summary report are true and correct.
o the reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my
personal, unbiased professional analyses, opinions, and conclusions.
o I have no present or prospective interest in the property that is the subject of this report, and I have no personal interest or bias with respect
to the parties involved.
o my compensation is not contingent upon the reporting of a predetermined value or direction in value that favors the cause of the client,
the amount of the value estimate, the attainment of a stipulated result, or the occurrence of a subsequent event (other than the effects
on value caused by FHA underwriting criteria already noted above).
o my analyses, opinions, and conclusions were developed, and this report has been prepared, in conformity with the Uniform Standards
of Professional Appraisal Practice and HUD Handbooks 4465.1, 4600.1, and 4480.1.
o I have made a personal inspection of the property that is the subject of this report. (This may not apply to the Valuation Reviewer signing
below.)
o no one provided significant professional assistance to the person signing this report, except for Architectural and Engineering, and Cost
Estimation professionals signing above. These professionals' estimations of the subject property's dimensions and "hard" replacement
costs have been relied upon by the Appraiser and Review Appraiser.
Appraiser

State Certified General Number

Date (See Note at bottom of page)

Review Appraiser

Date

Date

Director, Housing /Multifamily

Public reporting burden for this collection of information is estimated to average 114 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. This is part of the basic application package for insured mortgages for construction of rental housing projects. This is a
requirement under Section 207(b) of the National Housing Act (Public Law 479, 48 Stat. 1246, 12 U.S.C., 1701 et. seq.), authorizing the
Secretary of HUD to insure mortgages. The information requested enables HUD to determine the feasibility; suitability of improvements;
extent, quality, and duration of earning capacity; the value of real estate proposed or existing as security for a long-term mortgage; and
several other factors which have a bearing on the economic soundness of the subject property. The information is required to obtain
benefits. The agency may not collect this information, and you are not required to complete this form, unless it has a currently valid
OMB control number.

Note: The Appraiser may initial and date only those pages of this report for which his/her signature is authorized.
Replaces HUD-92264-NHICF which is obsolete

Page 6 of 6

ref Handbooks 4480.1 & 4600.1

form HUD-92264-HCF (6/95)