SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire

SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessment Questionnaire

3245-0062 F3-Template.xls

SBIC Management Assessment Questionnaire & License Application; Exhibits to SBIC License App./Mgmt. Assessement Questionnaire

OMB: 3245-0062

Document [xlsx]
Download: xlsx | pdf

Overview

Instructions
Table 3.1
Table 3.2
Table 3.3
Table 3.4
File Name Help


Sheet 1: Instructions

Exhibit F3: Partial Fund Workbook Instructions
V1.1.b - May 24, 2006
General Instructions:




You will have one Excel workbook (file) for each partial fund you are presenting.


Save the name of this file as "F3-" + 10 character (or less) acronym that identifies your applicant name + "; Partial" + year of first investment + "; " + the first and last name initials for each principal for which this workbook pertains separated by commas + "; " + date when this report was prepared in YYYYMMDD format.
For assistance in creating the correct file name, click on the link to the right.
File Name Help
Example:


Applicant Name: Southern Ventures Fund


Principal Name: John Browning, Mary Jones


Year of First Investment: 1995


Date Report Prepared: September 30, 2003


File Name for Workbook:
F3-SouthernVF; Partial1995; JB,MJ; 20030930







Follow the step by step instructions below, referring to Exhibit F for detailed instructions on each table.






Click on tables to go to associated worksheets.






Instruction Worksheet





1. Enter General Fund Information Table F3.1





2. Applicable Portfolio Investments Table F3.2





3. Enter Fund Cashflow Information Table F3.3





4. Review Fund Statistics Table F3.4


Sheet 2: Table 3.1

i

Next Step













Table F3.1 General Fund Information for Partial Fund






































1. SBIC Applicant:
Enter your SBIC applicant name.


































2. Principal:
Enter the SBIC applicant principal (s) for which this fund applies.


































3. Fund Name
Enter the name of the fund.


































4. Fund Location


















(a) Street Address

Enter street address for the fund.














(b) City, State

Enter the city and state of the fund.














(c) Phone Number (include area code)

If the fund is still in existence, enter the phone number, including area code.


































5. Your Status With Fund


















(a) Job Title(s) at this fund

Enter your job title at this fund. If this exhibit applies to more than one person, identify the associated job title and to whom it applies.

Start Date End date










(b) Were you here at the start of the fund?

Select Yes or No.



Dec-99 31-Dec-99














If No, what month/year did you arrive at the fund? Enter in MM/YYYY format, when you left the fund.














(c) Are you Still with Fund? (Yes or No)

Select Yes or No.



















If No, what month/year did you leave fund? Enter in MM/YYYY format, when you left the fund.














6. General Fund Information


















(a) Fund Status

Choose:













(b) Date of First Portfolio Investment Closing



Enter the earlier of the date the first investment was closed or the date the first takedown of investor capital occurred.

12 1899










(c) Is this fund closed? (Y/N)



Select Yes if this fund is fully terminated. If the fund is ongoing (i.e., unrealized and undistributed values remain in the fund's portfolio), then select "No".














(d) Enter the date the fund was closed OR the "as of" date for which the fund



If the fund is terminated, enter its termination date in MM/YYYY format. If the fund is ongoing, enter the "as of date" for which this fund information you are reporting applies in MM/YYYY format.

2021











information will be reported, if the fund is ongoing.


















(e) Except for contingent or follow-on investments, final year expected for making new investments.



Enter the year (in YYYY format) you expect to make the final new initial investment. (Exclude contingent and follow-on investments.)














(f) Number of Companies Financed to Date



Enter the current number of companies in this fund has financed to date.














(g) Total committed capital (incl. Participating Securities Leverage commitments if an SBIC)



Enter the total committed capital in dollars.














(h) Total capital commitments released



Enter in dollars the total amount of commitments released, that is commitments identified under (g) that will not be called.














(i) If you were not part of the fund management at the start of the fund, enter the following:


















Total paid-in capital taken down prior to the year of your arrival to the fund


















Total distributions made to investors prior to the year of your arrival to the fund


















Total financings of investments prior to your arrival to the fund






































8. Very short narrative on investment strategy of prior fund, including lifecycle stages of investments


















and industry sectors


















Provide a short narrative on your investment strategy.
































































































































































9. Footnotes






































Any footnotes related to the track record specified above must be detailed in this text box. See instructions for the notation convention required to identify the tab and cell referenced.


















































































































































Next Step

















Sheet 3: Table 3.2

i


Next Step








Table F3.2 Applicable Portfolio Investments





SBIC Applicant/Principal: ;



















Instructions: All applicable portfolio investments for this partial fund should be included within your synthesized fund groups. In the table below, please identify the names of all investments you will be including in the synthesized fund group that apply to this partial fund and the associated synthesized group file name.









Name of Company
Synthesized Group File Name


Sheet 4: Table 3.3

i







Next Step



Table F3.3 Overall Fund Cashflows










SBIC Applicant/Principal: ;


































1. Calculate Residual Value






















+ a. Value of Investments


Enter the value of the investments






+ b. Cash and Cash Equivalents


Enter the amount of cash on this fund's balance sheet






- c. Liabilities


Enter the fund's liabilities as a positive number. Include any debentures, loans, money owed for management/fund expenses and carried interest.




Gross Residual Value $-







- d. Residual Value Going to Carry


Enter the amount of carried interest as a positive number the fund would receive if fund were to exit its investments at the value you previously indicated in 1a.




Net Residual Value $-



















2. By Year Investor Cash Flows, Expenses, and Other Revenues























*Note: Years that are shaded indicate that the associated principal(s) were not present at the fund during this time period.





















Non-released Commitments $- From Table 3.1, calculated as 6(g) Total Capital Commitments - 6(h) Total Capital Commitments Released









(a) Investor Cashflows and Residual Value Cum Dist to Paid In Capital




i) Amount of Takedown/ Paid-in Capital ii) Distribution Information





Year Amount of Distribution Cash Non-cash Net Residual Value Investor Net Cashflows



Total $- $- $- $- $-




1899
$-

$- $-



1900
$-

$- $-



1901
$-

$- $-



1902
$-

$- $-



1903
$-

$- $-



1904
$-

$- $-



1905
$-

$- $-



1906
$-

$- $-



1907
$-

$- $-



1908
$-

$- $-



1909
$-

$- $-



1910
$-

$- $-



1911
$-

$- $-



1912
$-

$- $-



1913
$-

$- $-



1914
$-

$- $-



1915
$-

$- $-



1916
$-

$- $-



1917
$-

$- $-



1918
$-

$- $-



1919
$-

$- $-














3. Cash Remaining for Follow-on, New Investments, and Management Expenses =
























+ Investor Commitments Not Drawn and Not Released

$-







+ a. Cash and Cash Equivalents

$-







- b. Liabilities

$-









Cash and Commitments Remaining $-


































Amount Cash Balance




4. Commitments outstanding to portfolio companies not yet funded




$-




5. Reserves for follow-on investments not committed




$-




6. Reserves for future management fees




$-








Capital Available for New investments $-

















7. Fund Performance Calculations















Your Fund Venture Avg for VY 1899







FUND IRR Err:523 #N/A








RESIDUAL VALUE TO PAID IN CAPITAL #DIV/0!









DISTRIBUTIONS TO PAID IN CAPITAL #DIV/0! #N/A








TOTAL VALUE TO PAID IN CAPITAL #DIV/0!
















Sheet 5: Table 3.4

i




























Table F3.4 - Overall Fund Statistics






As of Date: 12/1899




















SBIC Applicant/Principal: ;





Number of Investments: 20













































































































FUND SUMMARY STATISTICS


























































































Net Financing/Investment Statistics (After Management Expenses)

Entire Fund While at Fund Percentage of Entire Fund





















































Total Commitments

$-

























Total Takedowns/Paid-In Capital

$- $- #DIV/0!























Total Distributions (After Carry)

$- $- #DIV/0!























Total Residual Value

$-

























Distributions + Residual - Take-downs

$-




























Entire Fund Venture Comparison
























Net IRR (Includes Residual Value)

Err:523 #N/A
























Distributions to Paid In Capital

#DIV/0! #N/A
























Residual Value to Paid in Capital

#DIV/0!

























Total Value to Paid in Capital

#DIV/0!

























Vintage Year of Fund




























Age of Fund (Years After Start)

#VALUE!

























Years to Payback

N/A























































Total Management Fees and Carry


























































Management Fees

$-

























Carried Interest

$-

























Residual Value Carry

$-

























Total

$-
























Sheet 6: File Name Help


File Name Help



Return to Instructions



















Select type of Exhibit 3


F2 Complete Complete Exhibit F2 - Complete.xls If you were with a venture fund for the entire fund's life or if fund is still ongoing.








F3 Partial Partial Exhibit F3 - Partial.xls If you were with a venture fund for only part of the fund's timeframe.

10 character name acronym identifying your applicant name

New Ven II


F4 Synthesized Syn Exhibit F4 - Synthesized.xls Groups of separate investments not done within a single venture fund. Investments must be at least $250,000 by total company financing OR a minimum of $100,000 with a board seat.








F5 Other Other Exhibit F5 - Other.xls All other investments.

First Year of Investment for this Fund or Group

1994





















First and last name initials for each principal for which the workbook applies (separated by commas)












DJ




















Date when this report was prepared
9/30/2003






















Resulting File Name: F4-New Ven II; Syn1994; DJ; 20030930.xls
























F4-New Ven II; Syn1994; DJ; 20030930.xls























File Typeapplication/vnd.ms-excel
AuthorTMJamers
Last Modified ByCBRich
File Modified2007-04-04
File Created2003-10-20

© 2024 OMB.report | Privacy Policy