CDFI Form 0027 FY 2009 CDFI and NACA Program American Recovery and Rein

DRAFT

FY 2009 CDFI and NACA Program

American Recovery and Reinvestment Act

Quarterly Institution Level Report

I. ORGANIZATIONAL INFORMATION

A. BASIC INFORMATION

Date of Organization's Fiscal Year End

Organization Type

Organizational Structure

Year of Organization's Incorporation

Year Organization Began Financing Activities

FDIC Certification Number, Depository Institution Holding

Company Identification Number, or NCUA Charter Number

Street Address

City

State

Zip

Website Address (if available)

1. Name of person responsible for completing the QILR

2. Telephone number of person responsible for completing the QILR

(including extension if applicable)

3. E-mail address of person responsible for completing the QILR

B. POPULATIONS AND GEOGRAPHY RECEIVING FINANCIAL PRODUCTS DURING THE REPORTING PERIOD

4. Which of the following targeted populations and demographic sub-groups receive Financial Products from the Organization during the reporting period?

* American Indian

* Alaska Native

* Asian

* Black or African American

* Native Hawaiian

* Other Pacific Islander

* White

* Other

5. Did the Organization provide Financial Services to persons of Hispanic origin during the reporting period?

6. Which of the Following Geographic Areas did the Organization Provide Financing in During the Reporting Period?

* Appalachia

* Colonias

* Lower Mississippi Delta

* Native American Areas

* Rural Areas

* Major Urban Area

* Minor Urban Area

7. Are 50% or more of the Awardee’s customers or end users American Indian,

Alaska Native, or Native Hawaiian or residing in Native American Areas?

Please Check Here to Confirm That the Table Below is Complete

8. Native American Community Activities

C. STAFF AND CONSULTANTS: # OF FULL-TIME EQUIVALENTS (FTEs)

Total Staff and Consultant Activity Breakout Staff and Consultants:

9. FTEs dedicated to lending/investing

10. FTEs dedicated to Development Services

11. FTEs dedicated to Financial Services Other than lending/investing

12. FTEs dedicated to administration and other activities

13. Total FTEs as a result of Recovery Act Funding:

(a) Retained ____

(b) Created ____

14. Consultant/Contractor FTEs as a result of Recovery Act Funding:

(a) Retained ____

(b) Created ____

II. FINANCING

15. Loans/Investments Originated Table

16. Amount and Number of loans/investments Originated in Approved Target Market

Please Check Here to Confirm That the Table Below is Complete

III. COMMUNITY DEVELOPMENT IMPACTS

17. Jobs Retained in Businesses at Origination Table

18. New Jobs Created Projected in Businesses at Origination Table

Recovery Act Reporting Jobs Retained and Jobs Created Output Tables (CIIS will cumulate reports from current and past quarterly reports to provide cumulative impacts through current period):

CIIS output tables:

• Jobs Retained (CIIS will sum answers to questions 13(a), 14(a) and 17.

• Jobs Created (CIIS will sum answers to questions 13(b), 14(b) and 18.

IV. AWARD COMPLIANCE:

A. FY 2009 NACA PROGRAM/ TECHNICAL ASSISTANCE RECOVERY ACT AWARDEES

19. Expended Funds / Completed Activities Table

B. FY 2009 FINANCIAL ASSISTANCE RECOVERY ACT AWARDEES

20. Recovery Act 2009 FA Deployment Rate in Current Reporting Period

Table for Q. 12 Native American Community Activities

Name of Native American Community	Percent of Total Financing

Quarterly Institution Level Report (Recovery Act)

Table for Q. 15. Loans/Investments Originated Table

Transaction Type	Purpose	$ Originated	Primary Place of Performance (address)	Total Project Cost	Total non- Federal expenditure	Total non-Recovery Act - Federal expenditure	Total Recovery Act Federal expenditure

Table for Q. 17. Jobs Retained in Businesses at Origination Table

FTEs Retained	NAICS Code

Table for Q. 18. New Jobs Created Projected in Businesses at Origination Table

FTEs Created	NAICS Code

20. TA Expended Funds / Completed Activities Table

Award Control Number	Expended All TA Funds	Date TA Funds Expended	Completed All TA Activities	Date TA Activities Completed

3

FY 2009 Recovery Act

CIIS Quarterly Institution Level Report