EXHIBIT 10.29
 LEASE AGREEMENT
 Between
 MUSKOGEE MEDICAL CENTER AUTHORITY,
d/b/a MUSKOGEE REGIONAL MEDICAL CENTER,
an Oklahoma Public Trust,
 as
 Landlord,
 MUSKOGEE REGIONAL MEDICAL CENTER, LLC,
a Delaware limited liability company,
 as
 Tenant
 and
 CAPELLA HEALTHCARE, INC.,
a Delaware corporation,
 As
 Guarantor
 April 3, 2007




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LEASE AGREEMENT
 LEASE AGREEMENT Lease Execution Date MUSKOGEE MEDICAL CENTER AUTHORITY, d/b/a MUSKOGEE REGIONAL
MEDICAL CENTER Landlord MUSKOGEE REGIONAL MEDICAL CENTER, LLC Tenant CAPELLA HEALTHCARE, INC. Capella Party Parties
 RECITALS
 WHEREAS Hospital
 WHEREAS City Exhibit A Prime Lease Leased Real Property
 WHEREAS Exhibit
B Owned Real Property
 WHEREAS Premises
 WHEREAS Master Agreement inter alia
 WHEREAS Exhibit C West Side Expansion
Project
 WHEREAS




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NOW, THEREFORE
 ARTICLE I
 DEMISE OF LEASEHOLD
 1.1 Demise of Leasehold
 (a)
 (b)
 (c)
 ARTICLE II
 TERM
 2.1 Term Commencement Date Expiration Date 1 Term
 2.2 Delivery of Possession
 2.3 Condition of Premises
 
 1
    
    One day prior to the expiration of the Prime
Lease. -3-




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2.4 Provisions Regarding Prime Lease
 (a) Section 3.3
 (b)
 (c)
 (d)
 (e)
 (f) Section 2.4(e) Section 17.11
 -4-




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(g) Section
11.2(a)
 2.5 Citys Consent
 ARTICLE III
 RENT
 3.1 Base Rent Base Rent ($75,000,000)]
 3.2 Net Lease
 3.3 Additional Rent; Rent Additional Rent Rent
 -5-




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ARTICLE IV
 IMPOSITIONS
 4.1 Obligation to Pay Impositions ARTICLE III ARTICLE IV Impositions
 4.2 Payment by Tenant .
 4.3 Additional Taxes
 4.4 In-Kind Payments ARTICLE
IV
 4.5 Representations and Warranties
 -6-




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ARTICLE V
 PERMITTED USE AND COMPLIANCE WITH LAWS
 5.1 Permitted Use Section 5.2 Permitted Uses Section 5.4
 5.2 Operating Covenants
 (a) Continuation of Operations
 (b) Governance Board of Trustees
 (i)
 (ii)
 (iii)
 -7-




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(iv)
 (v)
 (vi)
 (vii)
 (viii)
 (c) Indigent Care Policies Exhibit D Charity Care Commitment Level Alternate Funding Program
 (d) General Capital Expenditures Section
5.2(e) Section 5.2(f)
 (e) Physician Recruitment
 (f) Nurse Recruitment
 -8-




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(g) Nursing School Support
 (h) Continuation of Continuing Medical Education Arrangements
 (l) Medical Staff
 (j) Commitment to Auxiliary
 (k) Quality of Care
 5.3 Landlord Improvements
 5.4 Compliance with Legal Requirements Legal Requirements Section 5.5
 -9-




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5.5 Americans With Disabilities Act ADA Title III ADAAG
 Section 5.5
 -10-




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ARTICLE VI
 UTILITIES AND SERVICES
 6.1 Utilities and Services
 ARTICLE VII
 MAINTENANCE
 7.1 Maintenance Obligations
 7.2 Landlords Maintenance Obligations
 7.3 Alterations, Additions, Demolitions, Expansions, Replacements and Improvements
 (a) Routine Improvements
 (b)
 -11-




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(c)
 (d) Section
7.3(b)
 (e) Section 10.14
 ARTICLE VIII
 WAIVER OF CERTAIN CLAIMS; INDEMNITY
 8.1 Waiver of Certain Claims Section 8.1
 8.2 Tenant Responsible for Personal Property
 -12-




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8.3 Indemnification by Tenant
 8.4 Indemnification by Landlord . Tenant Indemnified Parties Section
8.4 Section 11.3
 ARTICLE IX
 SUBROGATION AND INSURANCE
 9.1 Waiver of Subrogation
 9.2 Tenants Insurance
 (a)
 -13-




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(i)
 (ii)
 (iii)
 (iv)
 (b)
 (c)
 9.3 Compliance with Requirements
 ARTICLE X
 RETURN OF PREMISES; SURRENDER
 10.1 Surrender of Possession
 10.2 Installations and Additions
 -14-




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10.3 Trade Fixtures and Personal Property
 (a) Section
10.3(b)
 (b) Operating Assets Proprietary
Assets Primary Option Notice Secondary Option Notice
 10.4 Holdover
 -15-




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ARTICLE XI
 ASSIGNMENT AND SUBLETTING
 11.1 Assignment and Subletting
 (a) Sections 11.1(b) 11.2 Section 11.1
 (b) Section 11.1 Capella
 (c) Section 11.1(a)
 11.2 Leasehold Mortgages
 (a) Leasehold Mortgage Tenants Leasehold Estate Leasehold Mortgagee
 -16-




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Non-Substantive Modifications
 (b)
 (i) Tenant Default Notice
 (ii)
 (iii)
 (iv)
 (v)
 -17-




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ARTICLE XII
 DAMAGE OR DESTRUCTION BY CASUALTY
 12.1 Tenants Obligation to Rebuild Section 12.2 Section 12.1
 12.2 Non-Operational Properties Casualty Loss Non-Operational Properties Net Proceeds Tenants Proportionate
Share
 ARTICLE XIII
 EMINENT DOMAIN
 13.1 Taking of Whole Condemning Authority Building
 -18-




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Section 13.1
 13.2 Termination Section
13.1 Section 17.13
 13.3 Partial Taking Section 13.3
 13.4 Effect of Termination Section 13.1 Section 13.3
 ARTICLE XIV
 HAZARDOUS MATERIALS PROVISIONS
 14.1 Defined Terms ARTICLE XIV
 (a) Claim
 (b) Environmental Laws
 -19-




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FIFRA RCRA CERCLA TSCA
 (c) Hazardous Materials
 (d) Manage Management
 (e) Release Released
 (f) Response Respond
 14.2 Tenants Obligations with Respect to Environmental Matters
 -20-




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ARTICLE V Permitted Hazardous Materials
 14.3 Copies of Notices
 14.4 Landlords Right to Inspect
 14.5 Tenants Obligation to Respond
 -21-




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14.6 Environmental Indemnification by Tenant
 (a) Section 14.7 Landlord Indemnified Parties Losses
 (i)
 (ii)
 (iii)
 (iv)
 (b)
 14.7 Exceptions to Landlord Indemnity Section 3.27
 -22-




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ARTICLE XV
 DEFAULT
 15.1 Events of Default Default
 (a)
 (b) ARTICLE XI
 (c) ARTICLE XIV
 (d)
 (e)
 (f)
 (g)
 (h)
 (i)
 (j)
 -23-




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15.2 Rights and Remedies of Landlord Sections 5.5 8.3 10.4 14.6
 15.3 Attorneys Fees
 15.4 Assumption or Rejection in Bankruptcy
 (a)
 (b)
 15.5 Default of Landlord, Tenants Remedies
 (a)
 (b) Sections 5.5 8.4
 -24-




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15.6 Irreparable Harm
 ARTICLE XVI
 QUIET ENJOYMENT
 16.1 Quiet Enjoyment
 ARTICLE XVII
 MISCELLANEOUS
 17.1 Successors and Assigns
 17.2 Brokers Schedule 17.2
 17.3 Modifications in Writing
 17.4 Headings
 17.5 Time of Essence
 -25-




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17.6 Default Rate of Interest
 17.7 Severability
 17.8 Entire Agreement
 17.9 Waiver of Trial by Jury; Nonwaiver
 17.10 Authorization by Parties
 17.11 Notices
 -26-




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If to Landlord:
    
    Muskogee Medical Center Authority101 Rockefeller DriveSuite 204Muskogee, Oklahoma 74401Attention: PresidentWith a simultaneous copy to:
    
    McDermott Will & Emery LLP227 West Monroe StreetSuite 4700Chicago, Illinois 60606-5096Attention: John M. Callahan, Esq.If to Tenant or Capella:
    
    Capella Healthcare, Inc.Two Corporate Centre, Suite 200501 Corporate Centre DriveFranklin, Tennessee 37067-2662Attention: General CounselWith a simultaneous copy to:
    
    Waller Lansden Dortch & Davis, LLP511 Union StreetSuite 2700Nashville, Tennessee 37219-8966Attention: George W. Bishop III, Esq.
  17.12 Title and Covenant Against Liens Section
11.2 Section 17.6
 17.13 Survival Section 3.3 , ARTICLE
IV ,
 -27-




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Section 7.3 , ARTICLE VIII , ARTICLE X , Section 11.2(b) , ARTICLES XII , XIII , XIV , Sections 15.2 , 15.3 , 15.4 , 15.5 , 15.6 ARTICLE XVII
 17.14 Memorandum of Lease
 17.15 Guaranty
 17.16 Choice of Law
 17.17 No Partnership
 17.18 No Third Party Beneficiaries
  -28-




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IN WITNESS WHEREOF
 LANDLORD:
    MUSKOGEE MEDICAL CENTER AUTHORITY,
d/b/a MUSKOGEE
REGIONAL MEDICAL CENTERBy:
    /s/ Chris CondleyChris CondleyIts:
    Chairman ATTEST:By:
    /s/ Wayne WilburnWayne Wilburn, Secretary 
  /s/ Michelle Lee KrofelNotary PublicCommission No.: 
 Official SealMICHELLE LEE KROFELNotary Public  State of IllinoisMy Commission Expires Nov 6, 2007
 -29-




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TENANT:
    MUSKOGEE REGIONAL MEDICAL CENTER, LLCBy:
    /s/ D. Andrew SlusserD. Andrew SlusserIts:
    Vice President ATTEST:By:
    /s/ Howard WallHoward Wall, Secretary 
  /s/ Michelle Lee KrofelNotary PublicCommission No.: 
 Official SealMICHELLE LEE KROFELNotary Public  State of IllinoisMy Commission Expires Nov 6, 2007
 -30-




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CAPELLA:
    CAPELLA HEALTHCARE, INC.By:
    /s/ D. Andrew SlusserD. Andrew SlusserIts:
    Senior Vice President ATTEST:By:
    /s/ Howard WallHoward Wall, Secretary 
  /s/ Michelle Lee KrofelNotary PublicCommission No.: 
 Official SealMICHELLE LEE KROFELNotary Public  State of IllinoisMy Commission Expires Nov 6, 2007
 -31-




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AMENDED AND RESTATED LEASE AGREEMENT
 AMENDED AND RESTATED LEASE AGREEMENT Agreement Execution Date CITY OF MUSKOGEE, OKLAHOMA City MUSKOGEE MEDICAL CENTER AUTHORITY MUSKOGEE REGIONAL MEDICAL
CENTER Trust Party Parties
 RECITALS:
 WHEREAS Original Lease Hospital
 WHEREAS
 WHEREAS Trust Affiliates CHI Capella Transaction
 WHEREAS
 WHEREAS Exhibit
A Sublease
 WHEREAS Bank Bonds Section 14.1 Exhibit E




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NOW, THEREFORE
 ARTICLE I
 STATUS OF ORIGINAL LEASE; PROPERTY LEASED
  Exhibit B Leased
Premises
    Hospital Revenues Revenues
 ARTICLE II
 TERM
 Term Expiration
Date
 2




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ARTICLE III
 LIENS AND ENCUMBRANCES
  ARTICLE IV
IMPROVEMENTS
 Permitted Assignee
 ARTICLE V
 INSURANCE
  ARTICLE VI
 AMENDMENTS
  ARTICLE VII
 REPRESENTATIONS BY CITY
  3




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ARTICLE VIII
 INDEMNIFICATION AND REIMBURSEMENT
 City Indemnified Parties
 Trust and Capella
Indemnified Parties
 ARTICLE IX
 RECORDATION OF LEASE
  ARTICLE X
 OKLAHOMA LAW CONTROLLING; MEANING OF TERMS
  4




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ARTICLE XI
 NOTICES; DEMANDS; REQUESTS
   
  
  
  ARTICLE XII
 RIGHTS AND REMEDIES UPON DEFAULT
  5




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ARTICLE XIII
 TRANSFER OF OPERATING ASSETS
 Exhibit C Bill of Sale and Assignment Operating Assets Option Date Option Notice
 ARTICLE XIV
 SUBLEASES
  Exhibit
D Nondisturbance Agreement
  6




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Article XIII
 ARTICLE XV
 MISCELLANEOUS
        7




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8




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IN WITNESS WHEREOF
 CITY OF MUSKOGEE, OKLAHOMABy:, Mayor ATTEST:By:, City Clerk STATE OF OKLAHOMA
    
    
    )) ss.COUNTY OF MUSKOGEE
    
    
    )
 
 Notary PublicCommission No.:  9




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MUSKOGEE MEDICAL CENTER AUTHORITYBy:Chris Condley, Chairman ATTEST:By:Wayne Wilburn, Secretary My Commission Expires:(SEAL) STATE OF OKLAHOMA
    
    
    )) ss.COUNTY OF MUSKOGEE
    
    
    )
 
 Notary PublicCommission No.: My Commission Expires:(SEAL) 10




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EXHIBIT A
 Capella Sublease
 (See Attached)




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EXHIBIT B
 Leased Premises




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BILL OF SALE AND ASSIGNMENT
 BILL OF SALE AND ASSIGNMENT Bill of Sale   CITY OF MUSKOGEE, OKLAHOMA City MUSKOGEE MEDICAL CENTER AUTHORITY, d/b/a MUSKOGEE REGIONAL MEDICAL CENTER Trust
 WITNESSETH Agreement
 TO HAVE AND TO HOLD
    IN WITNESS WHEREOF
 CITY OF MUSKOGEE, OKLAHOMA
    
    MUSKOGEE MEDICAL CENTERAUTHORITY, d/b/a MUSKOGEEREGIONAL MEDICAL CENTER,By:
    
    
    By:Its:
    
    
    Its:




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EXHIBIT D
 Nondisturbance Agreement
 (See attached)




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EXHIBIT B
 Owned Real Property




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EXHIBIT B
 Owned Real Property
 (Source:Schedule C of Pioneer Abstract Commitment No. 2007020047-3rd Revision)
 Tract 1 :
  Address: 301 South 36th Street, Muskogee, Oklahoma
 Tract 3 :
  Address: 3520 and 3524 Chandler Road, Muskogee, Oklahoma
 Tract 7 :
  Address: 211 South 36th Street, Muskogee, Oklahoma
 (Source:Schedule C of Pioneer Abstract Commitment No. 2007020047-3rd Revision)
 Tract 2 :
  Address: 201 South York, Muskogee, Oklahoma




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Tract 4 :
  Address Between 36th and 37th Street and Denver, Muskogee, Oklahoma
 Tract 5 :
  Address: 318 South 37th Street, Muskogee, Oklahoma
 Tract 6 :
  Address: Between 36th and 37th Street and Denver, Muskogee, Oklahoma
 Tract 9 :
  Address: 305 South 37th Street, Muskogee, Oklahoma
 and
  Address: 333 South 36th Street, Muskogee, Oklahoma
 Tract 9a :
  Address: 105 South 36th Street, Muskogee, Oklahoma 74401




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Tract 11 (from Schedule C of Title Commitment):
 AND
LESS AND LESS
 Address: Frontage on Highway 69, Wagoner, Oklahoma
 Or
 Tract 11: (Source from new Survey)
  AND LESS




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Tract 12 :
  Address: 251 South 37th Street, Muskogee, Oklahoma




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EXHIBIT C
West Side Expansion Project




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EXHIBIT D  Indigent Care Policies




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(MAP)
    
    NUMBER: 1000 A-70MUSKOGEE REGIONAL MEDICAL 
CENTER POLICY & PROCEDURE
    
    EFFECTIVE DATE:  9/1/04
IMPLEMENTATION DATE:
REVISION DATE:   12/29/05
REVIEW DATE:
RESPONSIBLE PARTY: Sr. VP/CIO
 TITLE:
    
    HEALTHCARE ASSISTANCE PROGRAMISSUING SOURCE:
    
    ADMINISTRATION
 ACCREDITING OR REGULATORY REFERENCE: N/A
 REVIEWED BY:
    
    
    
    
    
    DATE:REVIEWED BY:
    
    
    
    
    
    DATE:APPROVED BY:
    
    SIGNATURE ON FILE
    
    
    
    PAGE 1 of 8President/CEO
 PURPOSE:
  POLICY:
    PROCEDURE:




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Healthcare Assistance Program100 A-70
  I.
    
    The patient, or a representative or responsible party will make
application to any possible sources for reimbursement such as DHS,
Victim of Crime, SSI or other available programs. Assistance in the
application process can be provided by medical center staff or
contract personnel.II.
    
    A Healthcare Assistant Program Application and valid documentation of
income will be required from each patient, his representative or
responsible party requesting charity care consideration.III.
    
    To be eligible for healthcare assistance, family income must be at or
below established medical center income guidelines.
 A.
    
    Family income is considered to be all income for all persons living in the same
household. Size of family is based on all persons living in the same household
including students or others claimed on income tax return. Proof of income must
accompany the application and additional information and documentation may be required
prior to determination.B.
    
    Income guidelines will be based upon the yearly rates as published in the
Federal Register.C.
    
    Approval and adjustment will be made only after all other sources of
reimbursement have been exhausted. Non-compliance in making application to other
sources will negate eligibility for charitable consideration.
 IV.
    
    For those patients falling outside the income guidelines, healthcare assistance consideration
can be determined by an evaluation and analysis of the patients income, other income sources,
disposable assets, and the patients ability to pay a portion of their medical bill. For an
expense to income analysis, expenses must be at least 90% of income. Expenses considered in
the analysis are as follows.
 1.
    
    Rent/Mortgage2.
    
    Utilities3.
    
    Food4.
    
    Transportation Fees5.
    
    Prescription medication, Durable Medical Equipment6.
    
    Other medical expenses7.
    
    Insurance premiums8.
    
    Taxes
 V.
    
    For those patients who are eligible for Medicaid benefits and receive medically necessary
services that are deemed non-covered for reimbursement by state Medicaid guidelines, a
charitable adjustment will be made at 100%.
 2




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Healthcare Assistance Program100 A-70
 VI.
    
    The final determination for a charitable adjustment will be made by
the designated representatives of the Administrative staff. All
charity documentation is retained in the Patient Financial Services.VII.
    
    When appropriate, long-term affordable payment arrangements will be
made. Non-compliance with the arrangements will result in the
account being classified Bad Debt with collection agency assignment.VIII.
    
    Income Guidelines
 A.
    
    100% Charity  Income to and including 1-1/2 times poverty guidelines.B.
    
    75% charity  Income over 1-1/2 times to and including 2 times poverty
guidelines.C.
    
    50% Charity  Income over 2 times and including 2-1/2 times poverty
guidelines.
 IX.
    
    The medical center reserves the right to reconsider its determination under any of, but not
limited by the following conditions.
 A.
    
    If the patient, his representative, or responsible party should refuse to
cooperate in furnishing current financial information to assist in a fair
determination.B.
    
    If the patient, his representative or responsible party should refuse to make
application or not fully cooperate in completing application requirements for any
amounts receivable from other available payer sources.C.
    
    If it is determined that any false or misleading information was provided by
the patient, his representative or responsible party.
 IX.
    
    The medical center reserves the right to revise these guidelines as deemed necessary and
without prior notice.
 
 3




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Healthcare Assistance Program100 A-70
 MUSKOGEE REGIONAL MEDICAL CENTER
300 ROCKEFELLER DRIVE, MUSKOGEE, OK 74401
918-684-2585
 ********** FILING THIS APPLICATION DOES NOT GUARANTEE APPROVAL **************
 For Hospital Use Only:
    
    Name:
    
    
    
    Acct#SS #:
    
    
    
    Acct#Acct#
 HEALTHCARE ASSISTANCE PROGRAM APPLICATION
   GUARANTOR:____________________________________
    
    SPOUSE:________________________________________SS#:____________________________________________
    
    SS#:___________________________________________EMPLOYER:_______________________________________
    
    EMPLOYER:_____________________________________ADDRESS:_______________________________________
    
    ADDRESS:______________________________________CITY,STATE:______________________________________
    
    CITY,STATE:____________________________________PHONE:__________________________________________
    
    PHONE:_________________________________________
  NAME:
    
    
    
    
    
    AGE:NAME:
    
    
    
    
    
    AGE:NAME:
    
    
    
    
    
    AGE:NAME:
    
    
    
    
    
    AGE:NAME:
    
    
    
    
    
    AGE:
    4




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Healthcare Assistance Program100 A-70
  CHECKING ACCOUNT:________________________
    
    SAVINGS ACCOUNT:______________CDs:_______________________________________
    
    OTHER:_________________________
 
   MARKET VALUE
    
    -
    
    LOAN BALANCE
    
    =
    
    EQUITYHOME
    
    
    
    -
    
    
    
    =OTHER
    
    
    
    -
    
    
    
    =VEHICLE
    
    
    
    -
    
    
    
    =VEHICLE
    
    
    
    -
    
    
    
    =
 
 
   WEEKLY/BIWEEKLY
    
    
    ANNUALSOURCE OF INCOME
    
    AMOUNT
    
    
    AMOUNTWAGES OR SALARY
    
    $
    
    
    
    $NET INCOME SELF-EMPLOYMENT
    
    $
    
    
    
    $NET INCOME FARM
    
    $
    
    
    
    $SOCIAL SECURITY
    
    $
    
    
    
    $AFDC  WELFARE
    
    $
    
    
    
    $UNEMPLOYMENT COMPENSATION $
    
    $
    
    
    
    $WORKERS COMPENSATION
    
    $
    
    
    
    $ALIMONY
    
    $
    
    
    
    $CHILD SUPPORT
    
    $
    
    
    
    $
 5




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Healthcare Assistance Program100 A-70
 OTHER (SPECIFY)
    
    $
    
    
    
    $INTEREST INCOME
    
    $
    
    
    
    $TOTAL INCOME
    
    $
    
    
    
    $
   
 BANK LOANS:
    
    $
    
    
    
    $BANK NAME:
    
    $
    
    
    
    $BANK NAME:
    
    $
    
    
    
    $CREDIT CARDS:COMPANY:
    
    $
    
    
    
    $COMPANY:
    
    $
    
    
    
    $COMPANY:
    
    $
    
    
    
    $OTHER:HOUSE PAYMENT/RENT:CAR/TRUCK PAYMENTS:
    
    $
    
    
    
    $HOME INSURANCE PAYMENT:
    
    $
    
    
    
    $CAR/TRUCK INSURANCE PAYMENT:
    
    $
    
    
    
    $UTILITIES:
    
    $
    
    
    
    $TELEPHONE:MEDICAL BILLS:NAME:
    
    $
    
    
    
    $NAME:
    
    $
    
    
    
    $NAME:
    
    $
    
    
    
    $NAME:
    
    $
    
    
    
    $NAME:
    
    $
    
    
    
    $OTHER (PLEASE SPECIFY):NAME:
    
    $
    
    
    
    $NAME:
    
    $
    
    
    
    $TOTAL PAYMENTS
 6




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Healthcare Assistance Program100 A-70
  PATIENT OR RESPONSIBLE PARTY SIGNATURE DATE  COMMENTS:
 
 
 
 
 7




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Healthcare Assistance Determination Worksheet
     Poverty
    
    150% of
    
    200% of
    
    250% ofFamily Size
    
    Guideline
    
    Guideline
    
    Guideline
    
    Guideline123456




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List of Guarantor accounts and all application documentation should remain attached to this form




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Healthcare Assistance Program Application Analysis
 Weekly Income (or)
    
    $
    0GUARANTOR INCOME
    
    Monthly Income
    
    $
    0Total annual income
    
    $
    0Weekly Income (or)
    
    $
    0HOUSE/OTHER FAMILY INCOME
    
    Monthly Income
    
    $
    0Total annual income
    
    $
    0FAMILY (HOUSEHOLD) SIZE
    
    
    
    
    
    
    
    
    
    $
    0
 EXPENSE TO INCOME ANALYSIS
    
    Note
    
    
    Monthly Cost
    
    
    Annual CostMortgage or rent
    
    
    
    
    
    $
    0
    
    
    $
    0Phone
    
    
    
    
    
    $
    50
    
    
    $
    600Electricity
    
    
    
    
    
    $
    100
    
    
    $
    1,200[___]s
    
    
    
    
    
    $
    50
    
    
    $
    600Water and sewer
    
    
    
    
    
    $
    50
    
    
    $
    600Waste removal
    
    
    
    
    
    $
    30
    
    
    $
    360[__od]
    
    
    
    
    
    $
    300
    
    
    $
    3,600Auto/Transportation Payment
    
    
    
    
    
    $
    0
    
    
    $
    0Auto Insurance
    
    
    
    
    
    $
    0
    
    
    $
    0Other
    
    
    
    
    
    $
    0
    
    
    $
    0Subtotals
    
    
    
    
    
    $
    580
    
    
    $
    6,960
 VEHICLES/BOATS/TRAILERS
    
    Market Cost
    
    
    Loan Balance
    
    
    Difference1 Make/Model
    
    $
    0
    
    
    $
    0
    
    
    $
    02 Make/Model
    
    $
    0
    
    
    $
    0
    
    
    $
    03 Make/Model
    
    
    
    
    
    
    
    
    
    $
    0Motorcycle/ATV
    
    
    
    
    
    
    
    
    
    $
    0$
    0$
    0$
    0Subtotals
    
    $
    0
    
    
    $
    0
    
    
    $
    0
 BANK CHECKING ACCOUNT
    
    
    
    
    
    
    
    
    
    BalanceStarting Balance
    
    
    
    
    
    
    
    
    
    $
    0Deposits
    
    
    
    
    
    
    
    
    
    $
    0Withdrawals
    
    
    
    
    
    
    
    
    
    $
    0Fees
    
    
    
    
    
    
    
    
    
    $
    0Balance Subtotal
    
    
    
    
    
    
    
    
    
    $
    0
 FARM EQUIPMENT
    
    Market Value
    
    
    Loan Balance
    
    
    DifferenceTractors
    
    
    
    
    
    
    
    
    
    $
    0Buildings
    
    
    
    
    
    
    
    
    
    $
    0__mplements
    
    
    
    
    
    
    
    
    
    $
    0Subtotals
    
    $
    0
    
    
    $
    0
    
    
    $
    0
 LIVESTOCK
    
    
    
    
    
    
    
    
    
    Cash ValueCattle
    
    
    
    
    
    
    
    
    
    $
    0Horses
    
    
    
    
    
    
    
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0OtherSubtotals
 INCOME (INCLUDE IN TOP BOXES)
    
    Weekly Income
    
    
    Monthly Income
    
    
    Annual Income[__________
ployment]
    
    
    
    
    
    
    
    
    
    $
    0$
    0Social Security
    
    $
    0
    
    
    $
    
    
    
    $
    0[__FDC] -Welfare
    
    
    
    
    
    
    
    
    
    $
    0Unemployment Compensation
    
    $
    0
    
    
    
    
    
    
    $
    0Alimony/Child Support
    
    
    
    
    
    
    
    
    
    $
    0Workers Compensation
    
    
    
    
    
    
    
    
    
    $
    0Subtotals
    
    
    
    
    
    $
    0
    
    
    $
    0
 Up to 150% of POVERTY GUIDELINE  Discount 100%
    
    
    #N/AUp to 200% of POVERTY GUIDELINE  Discount 75%
    
    
    #N/AUp to 250% of POVERTY GUIDELINE  Discount 50%
    
    
    #N/AANNUAL FAMILY INCOME
    
    $
    0DISCOUNT QUALIFICATION % (for income level basis)
 MEDICAL EXPENSES
    
    Monthly Cost
    
    
    Balance
    
    
    Annual TotalPrescription Medication
    
    $
    0
    
    
    $
    0
    
    
    $
    0Hospital (not including MRMC)
    
    
    
    
    
    $
    0
    
    
    $
    0Physician
    
    
    
    
    
    $
    0
    
    
    $
    0Durable Medical Equipment
    
    
    
    
    
    
    
    
    
    $
    0Other Medical Equipment
    
    
    
    
    
    
    
    
    
    $
    0Medical Insurance Premiums
    
    
    
    
    
    
    
    
    
    $
    0MRMC
    
    
    
    
    
    
    
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0Subtotals
    
    $
    0
    
    
    $
    0
    
    
    $
    0
 LOANS
    
    Balance
    
    
    Monthly Pay
    
    
    Annual TotalPersonal
    
    $
    0
    
    
    $
    0
    
    
    $
    0Student Loan
    
    $
    0
    
    
    $
    0
    
    
    $
    0Credit Card
    
    $
    0
    
    
    $
    0
    
    
    $
    0Credit card
    
    $
    0
    
    
    $
    0
    
    
    $
    0Credit card
    
    $
    0
    
    
    $
    0
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0Subtotals
    
    $
    0
    
    
    $
    0
    
    
    $
    0
 TAXES
    
    Refund
    
    
    Amound Owed
    
    
    NetFederal
    
    $
    0
    
    
    $
    0
    
    
    $
    0State
    
    $
    0
    
    
    $
    0
    
    
    $
    0Local (Home, Personal Property)
    
    
    
    
    
    
    
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0Subtotals
    
    $
    0
    
    
    $
    0
    
    
    $
    0
 SAVINGS OR INVESTMENTS
    
    Starting Bal
    
    
    Activity
    
    
    End BalanceRetirement account
    
    $
    0
    
    
    $
    0
    
    
    $
    0Investment account
    
    $
    0
    
    
    $
    0
    
    
    $
    0Savings account #1
    
    $
    0
    
    
    $
    0
    
    
    $
    0Savings account #2
    
    
    
    
    
    
    
    
    
    $
    0Certificate of Deposit
    
    
    
    
    
    
    
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0Other
    
    
    
    
    
    
    
    
    
    $
    0Subtotals
    
    
    
    
    
    
    
    
    
    $
    0
 LEGAL
    
    Projected Cost
    
    
    Actual Cost
    
    
    DifferenceAttorney
    
    
    
    
    
    
    
    
    
    $
    0Alimony
    
    
    
    
    
    
    
    
    
    $
    0Payments on lien or judgment
    
    
    
    
    
    
    
    
    
    $
    0Subtotals
    
    $
    0
    
    
    $
    0
    
    
    $
    0TOTAL ANNUAL INCOME
    
    
    
    
    
    
    
    
    
    $
    0TOTAL ANNUAL EXPENSES
    
    
    
    
    


    90% Threshold
 $0.0
    
    
    $
    6,960TOTAL ASSETS
    
    
    
    
    
    
    
    
    
    $
    0TOTAL INCOME LESS EXPENSES
    
    
    
    
    
    
    
    
    
    $
    (6,960
    )




---



##### 



Family Size
    
    Poverty Guideline
    
    
    150% of Guideline
    
    
    200% of Guideline
    
    
    250% of Guideline1
    
    $
    9,800.00
    
    
    $
    14,700.00
    
    
    $
    19,600.00
    
    
    $
    24,500.002
    
    $
    13,200.00
    
    
    $
    19,800.00
    
    
    $
    26,400.00
    
    
    $
    33,000.003
    
    $
    16,600.00
    
    
    $
    24,900.00
    
    
    $
    33,200.00
    
    
    $
    41,500.004
    
    $
    20,000.00
    
    
    $
    30,000.00
    
    
    $
    40,000.00
    
    
    $
    50,000.005
    
    $
    23,400.00
    
    
    $
    35,100.00
    
    
    $
    46,800.00
    
    
    $
    58,500.006
    
    $
    26,800.00
    
    
    $
    40,200.00
    
    
    $
    53,600.00
    
    
    $
    67,000.007
    
    $
    30,200.00
    
    
    $
    45,300.00
    
    
    $
    60,400.00
    
    
    $
    75,500.008
    
    $
    33,600.00
    
    
    $
    50,400.00
    
    
    $
    67,200.00
    
    
    $
    84,000.009
    
    $
    37,000.00
    
    
    $
    55,500.00
    
    
    $
    74,000.00
    
    
    $
    92,500.0010
    
    $
    40,400.00
    
    
    $
    60,600.00
    
    
    $
    80,800.00
    
    
    $
    101,000.0011
    
    $
    43,800.00
    
    
    $
    65,700.00
    
    
    $
    87,600.00
    
    
    $
    109,500.0012
    
    $
    47,200.00
    
    
    $
    70,800.00
    
    
    $
    94,400.00
    
    
    $
    118,000.0013
    
    $
    50,600.00
    
    
    $
    75,900.00
    
    
    $
    101,200.00
    
    
    $
    126,500.0014
    
    $
    54,000.00
    
    
    $
    81,000.00
    
    
    $
    108,000.00
    
    
    $
    135,000.0015
    
    $
    57,400.00
    
    
    $
    86,100.00
    
    
    $
    114,800.00
    
    
    $
    143,500.00Discount
    
    
    100
    %
    
    
    100
    %
    
    
    75
    %
    
    
    50
    %




---



##### 



Schedule 17.2  Brokers