Municipal Bonds. Mid-Atlantic Association for Financial Professionals. Municipal Capital Markets Group September 17, 2014

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Municipal Bonds Mid-Atlantic Association for Financial Professionals Municipal Capital Markets Group September 17, 2014

Speakers Greg Brunner Managing Director Bart Savidge Managing Director 25 South Charles Street Baltimore, MD 21201 Tel: 410-244-4707 Cell: 443-615-2885 gbrunner@mtb.com 25 South Charles Street Baltimore, MD 21201 Tel: 410-244-4046 Cell: 443-602-0597 bsavidge@mtb.com RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 2

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 3 The Basics What is a Bond? Loan made by a Bondholder to a borrower, paid back with interest, e.g., a U.S. Savings Bond. Person receiving interest income ALWAYS pays taxes on the interest earnings unless they buy a MUNICIPAL BOND.

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 4 What is a Municipal Bond? Municipal Bond A debt obligation of a state, city, county, redevelopment agency, housing authority or other political sub-division or public body or instrumentality of a state. Bonds issued by the federal government are not municipal bonds. Bonds issued by Section 501(c)(3) corporations are not municipal bonds. Section 501(c)(3)s can issue bonds to finance their activities, but those bonds are taxable. Section 501(c)(3)s can have a municipal issuer issue its bonds on a tax exempt basis and lend proceeds to the (c)(3) for certain charitable purposes.

Historical Interest Rates Comparison 14.0% Bond Buyer 25* (Tax-Exempt 30-yr) SIFMA (Tax-Exempt Weekly) 1-Mo LIBOR 12.0% 10.0% BB25* SIFMA LIBOR Average Since 1982: 6.46% 3.12% 4.17% 20 Year Average: 5.33% 2.10% 3.06% 10 Year Average: 4.99% 1.34% 1.81% Current (09/15/14): 4.86% 0.04% 0.15% % Higher Than Current: 87.4% 99.2% 98.8% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Past 12 Months 8.0% 6.0% 4.0% 2.0% 0.0% RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 5

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 6 Section 103 of Internal Revenue Code Provides that interest on municipal bonds is excluded from gross income for federal income tax purposes. Most states also exempt interest on muni bonds issued in that state from state income taxation. Often, the municipal issuer uses the proceeds itself for general public purposes, such as roads, water and sewer systems, police and fire departments, schools and other publicly owned facilities. These bonds are often backed by the general credit of the municipal issuer and are called general obligation bonds or sometimes are backed only by revenues from a certain public enterprise and are called revenue bonds. The availability of such tax or other benefits may be conditioned on meeting other requirements.

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 7 Section 103 of Internal Revenue Code (cont.) In other cases, a municipal bond issuer may loan the proceeds to a nongovernmental borrower a profit-motivated entity such as a developer or a Section 501(c)(3) nonprofit corporation which agrees to use the proceeds to finance an activity which has a specified beneficial public purpose. Such approved purposes include airports, certain educational facilities, docks and wharves, pollution control, certain privately owned water systems, industrial development, certain single-family housing and certain affordable and seniors rental housing facilities. In 1986, these quasi-public purpose bonds were labeled private activity bonds, and Congress limited the volume of such bonds which could be issued by each state to stem growing a revenue drain the federal treasury. These bonds are generally not backed by the general credit or revenues of the municipal issuer, which serves as a mere conduit to lend the tax exempt bond proceeds to the owner of the quasi-public purpose facility.

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 8 Basic Conduit Financing Structure Non Credit-Enhanced $ $ ISSUER (CONDUIT) TRUST INDENTURE $ LOAN AGREEMENT INVESTORS UNDERWRITER TRUSTEE BORROWER BONDS BONDS MORTGAGE NOTE

Types of Bonds Bank Qualified Bonds Traditional Fixed Rate Bonds Enhanced Rated Non-Rated Variable Rate Bonds RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 9

Tax-exempt Fixed Rate Bonds Interest rate is fixed to maturity (maximum maturity typically 30 years) Maximum maturity determined by the Borrower Bonds may be sold based on the strength of the Borrower without the need for credit enhancement Long-term commitment Rate premium to fix for the long term Bonds typically cannot be pre-paid for a 10-year period RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 10

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 11 Recent Market Conditions Interest rate updates on 30-year maturity: 34 basis point increase since January 2013 Through June 2014, supply is at approximately $179 billion, which is down approximately 17% from same time last year Weekly supply is low, averaging $5 billion Positive mutual fund inflows for 28 of the first 35 weeks in 2014 YTD net inflows are $5.9 billion Weaker growth for the first half of 2014 has dimmed hopes that the Fed will move rates 30-year indicative interest rates: BBB: 4.40% A: 4.05% AA: 3.80% Sources: Thomson Reuters; MMD

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 12 Holders of Municipal Debt 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013* TOTAL DEBT OUTSTANDING 2,821.20 3,019.30 3,189.30 3,424.80 3,517.20 3,672.50 3,772.10 3,719.40 3,714.40 3,721.10 HELD BY: Households 1,522.90 1,600.70 1,635.60 1,673.60 1,720.90 1,827.90 1,871.70 1,806.80 1,657.00 1,647.10 Mutual funds 293.8 311.2 343.9 371.6 389.4 478.8 525.5 541.2 627.4 641.2 Money market funds 322.3 349.1 392 496.6 509.5 440.1 386.7 357.3 336.7 309.6 Closed-end funds 89.1 89.3 89.3 91.2 77.9 81.2 81.6 82.5 85.8 85.5 Exchange-traded funds 0 0 0 0.6 2.3 5.9 7.6 8.6 12.3 12.5 Nonfinancial corporate businesses 31.8 32.1 28.1 29.2 26.2 27.1 23.9 22.5 34.8 28.5 Nonfarm noncorporate businesses 4.3 4.4 5.8 5.3 4.9 5.1 5.6 5.7 5.8 5.8 Government-sponsored enterprises 44.6 39.7 36.1 33.3 31.3 29.1 24.9 21 17 33.5 State & local government general funds 5.7 6.9 8.3 10 10.4 11.5 12.8 12.9 12.1 12.1 Rest of the world 26 29 34.4 45.1 51 58.7 71.7 70.3 65.4 59.2 U.S.-chartered depository institutions 147.8 166.1 190.1 202 221.9 224.3 254.6 297.3 363.1 390.3 Foreign banking offices in U.S. 0 0 0 0 0 0 0 0 0 0 Banks in U.S.-affiliated areas 0.3 0.5 1.3 2 2.5 3.5 2.5 3.4 2.6 2.7 Credit unions 0 0 0 0 0 0 0 3.2 4.2 5 Property & casualty insurance companies 267.8 313.2 335.2 371.3 381.9 369.4 348.4 331 327.6 330.4 Life insurance companies 30.1 32.5 36.6 41.4 47.1 73.1 112.3 121.6 131.2 132.8 State & local government retirement funds 2.5 1.6 1.6 1.5 1.3 1.4 2.2 3.1 5 5.8 Brokers & dealers 32 42.9 50.9 50.1 38.7 35.4 40 30.9 26.6 19 ISSUED BY: State & local governments 2,438.20 2,579.20 2,679.60 2,825.60 2,842.70 2,954.90 3,023.60 2,970.00 2,964.30 2,970.40 Short-term 44.2 42.5 34.3 51.2 55.8 63.6 63 52.3 56.1 39.4 Long-term 2,393.90 2,536.70 2,645.20 2,774.40 2,786.90 2,891.30 2,960.60 2,917.60 2,908.20 2,931.00 Nonprofit organizations 197.6 212.7 229.1 250.2 259.5 265.4 263.2 255.5 241 235.7 Nonfinancial corporate businesses 185.4 227.3 280.6 349 415 452.2 485.4 493.9 509.1 515 *Figures for 2013 are as of June 30, preliminary and seasonally unadjusted. Dollar amounts are in billions of dollars. Components may not add to totals because of rounding. Source: Federal Reserve Board, Flow of Funds Accounts, Flows and Outstandings, Second Quarter 2013 Source: Bond Buyer

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 13 Bond Issue Participants Issuer Issuer s Counsel Bond Counsel Financial Advisor / Municipal Advisor Underwriter Underwriter s Counsel Trustee and Trustee s Counsel Rating Agency Borrower s Counsel

Hospital Sector Discussion Topics Health Care Credit Themes Rating Agency Outlook Credit Trends Access to Capital RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 14

Rating Agency Key Hospital Credit Themes All three rating agencies assign the hospital sector a negative outlook: Declining inpatient volumes, increased use of high-deductible health plans and reimbursement pressures from payors has led to declining profitability Harder-to-find cost savings low hanging fruit gone Uncertainty about the Affordable Care Act Management critical to navigate the changing environment Strategic partnerships will continue scale matters RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 15

Negative Outlook Narrative negative sector outlook reflects the forces of pressure weighing on the sector (lower reimbursement, suppressed inpatient volumes, higher deductible plans and additional spending cuts) as it enters this potentially historic period of change Fitch, December 11, 2013 The negative outlook is due to a multitude of factors, including: top line revenue constraints, the impact of health care reform readiness activities, soft demand, and emerging changes to the payment environment" Standard & Poor s, December 10, 2013 Our sector outlook for not-for-profit hospitals remains negative reflecting the challenging operating landscape over the next 12-18 months as patient volumes shrink and revenue growth slows" Moody s Investors Service, November 25, 2013 Mid Atlantic Association for Financial Professionals 16

Why Does a Credit Rating Matter? Stronger organizations have improved capital market and borrowing opportunities A vs. BBB rated credits historical interest rate spread range typically 75+ bps Broader access to a variety of debt options Stronger organizations are market consolidators Stronger organizations can make strategic investments and tolerate a longer pay-back Mid Atlantic Association for Financial Professionals 17

Scale Matters S&P Stand-Alone vs. System Rating Categories 25% 20% 15% 10% Stand-Alone System 5% 0% AA AA- A+ A A- BBB+ BBB BBB- Spec Source: S&P RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 18

Standard & Poor s System Profitability Trends 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% 2011 2012 2013 Operating Margin Operating EBIDA Margin Excess Margin Source: S&P Mid Atlantic Association for Financial Professionals 19

AAA Municipal Yield Curves AAA Municipal Market Data yield curves are below historical averages. Healthcare long-term fixed rate issues are priced as a spread to the AAA index. 6.00 5.00 4.00 3.00 2.00 1.00 0.00 1 5 10 15 20 25 30 Data Since 1993 1 5 10 15 20 25 30 Record Low 0.18 0.62 1.47 1.80 2.10 2.42 2.47 Record High 4.95 5.60 6.15 6.65 6.85 6.90 6.95 Average 2.34 3.22 3.92 4.39 4.67 4.81 4.85 Current (9/5/2014) 0.12 1.12 2.16 2.60 2.88 3.07 3.12 Average Current Source: MMD * MMD is the Municipal Market Data index that tracks yields on AAA rated municipal securities. Municipal securities are priced as a spread off AAA MMD based upon underlying credit and market conditions. Mid Atlantic Association for Financial Professionals 20

Hospital Spreads & Yields Credit premiums have trended lower from the post Lehman Crisis. Estimated Healthcare Spreads to AAA GO Bonds by Rating Category* (bps) 600 500 500 Long-term municipal rates are attractive. Investors are looking for yield which is driving demand. 400 300 200 100 125 250 188 125 90 80 80 70 50 50 50 55 40 25 150 65 45 130 100 90 75 65 40 45 45 30 2530 135 200 185 325 115 250+ 195 100 150 200 85 135 185 75 165 168 125 118 91 Acute care providers have been lowering balance sheet risk by reducing short-term debt with long-term fixed rate bonds or extending the term for the remaining shortterm debt. 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Pre- 2008 Post- Lehman Lehman AA A BBB 2009 2010 2011 2012 2013 * MMD is the Municipal Market Data index that tracks yields on AAA rated municipal securities. Indicative 30-Year Acute Care Yields Rating 2007 2009 2014 AA 4.87% 5.81% 3.80% A 5.17% 6.61% 4.05% BBB 5.42% 7.16% 4.40% Source: MMD Mid Atlantic Association for Financial Professionals 21

RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 22 Investments: Are NOT FDIC-Insured Have NO Bank Guarantee May Lose Value Brokerage services are offered by M&T Securities, Inc. (member FINRA/SIPC), not by M&T Bank. This presentation is for informational purposes only and is not intended as an offer or solicitation for the sale of any financial product or service. This presentation is not designed or intended to provide financial, tax, legal, accounting, or other professional advice (including municipal issuance advice) since such advice always requires consideration of individual circumstances. Further, M&T Securities advises you to consult your own legal, financial and other advisors to the extent you deem appropriate. Third-party trademarks and brands are the property of their respective owners. Quality ratings are used to evaluate the likelihood of default by a bond issuer. Independent rating agencies, such as Standard & Poor's and Moody's Investors Service, analyze the financial strength of each bond's issuer. Moody's ratings range from Aaa (highest quality) to C (lowest quality). Bonds rated Baa3 and better are considered "Investment Grade". Bonds rated Ba1 and below are "Below Investment Grade" (also High Yield or Speculative ). Similarly, Standard & Poor's ratings range from AAA to D. Bonds rated BBB- and better are considered "Investment Grade" and bonds rated BB+ and below are "Below Investment Grade". Past performance is no guarantee of future results. All investments involve risk, including possible loss of principal. There is no assurance that any investment strategy will be successful. Diversification does not ensure a profit or guarantee against a loss.

Questions and Thank You RHOADS Mid Atlantic & SINON, Association LLP for Financial Professionals 23