RD 1951-4 Report of Lending Activities

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Overview

Page 1
Page 2
Page 3 a.
Page 4
Page 5

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Sheet 1: Page 1

Name of Organization			IRP/RDLF/RMAP Fund Number:				Report Period		Date
Address:			Telephone No.:		Contact Person:		Date Intermediary IRP/RDLF/RMAP
							Loan was approved:
			Tax I.D. No.:				DUNS No.:
							REPORT PERIOD		TO DATE
LOANS
1.	Amount of IRP/RDLF/RMAP Loan						$		$
2.	Principal of loans disbursed						$		$
3.	Principal of loans received						$		$
4.	Net Lending (line 2 minus 3)						$		$
AVAILABLE ASSETS									END OF PERIOD
5.	Total Assets (less furniture & equipment)								$
6.	Loans Outstanding								$
7.	Loan Loss Reserve (5% required) - RMAP								$
	(6% required) - IRP
8.	Funds Available for Relending (line 5 minus line 6 and 7)								$
9.	Percent of Assets Available for Relending (Line 8 divided by Line 5)								%
BALANCE SHEET
ASSETS
1.	Cash (minus Loan Loss Reserve)								$
2.	Loan Loss Reserve								$
3.	Loans Outstanding								$
4.	Interest-Bearing Deposits								$
5.	Other Assets (specify)		Fixed Assets (furniture and fixtures)						$
									$
									$
6.	TOTAL ASSETS								$
LIABILITIES
7.	Loan Payable to RBS								$
8.	Accounts Payable								$
9.	Other Liabilities
									$
									$
10.	TOTAL LIABILITIES								$
									$
11.	FUND BALANCE (Assets minus Liabilities)								$
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0570-NEW. The time required to complete this information collection is estimated to average 4 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.

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Sheet 2: Page 2

IRP/RDLF/RMAP INCOME AND EXPENSE STATEMENT
Report Period
12/30/99
					USDA Approved	Prior	Reporting	Program to
					Budget	Fiscal Year	Period	Date
1. IRP/RDLF/RMAP INCOME (All Sources)					$	$	$	$
2. EXPENSES (IRP/RDLF/RMAP Related Expenses)
a. Employee Salaries					$	$	$	$
b. Employee Fringe Benefits					$	$	$	$
c. IRP/RDLF/RMAP-related Travel					$	$	$	$
d. Loan Processing/Closing Costs					$	$	$	$
e. Interest Paid RBS					$	$	$	$
f. Professional Services					$	$	$	$
g. Marketing					$	$	$	$
h. Staff Training					$	$	$	$
i. Equipment - Rental					$	$	$	$
- Acquisition					$	$	$	$
j. Bad Debt (Loan Losses)					$	$	$	$
k. Loan Loss Recovery (negative number)					$	$	$	$
l. Space (rent)					$	$	$	$
m. Audit					$	$	$	$
n. Indirect Costs					$	$	$	$
o. Other (Specify)					$	$	$	$
3. TOTAL EXPENSES (sum line 2.a. thru line 2.o)					$	$	$	$
4. NET IRP/RDLF/RMAP INCOME (line 1 minus line 3)					$	$	$	$
5. EXPENSES as % of IRP/RDLF/RMAP INCOME (line 3/line 1)					%	%	%	%
6. If salaries & expenses are not charged against the IRP/RDLF/RMAP fund, how are theses expenses paid ?
EXPLANATION:
7. What is the total program income that was used to cover administrative costs?							$
8 . Describe any encumbrances, liens, compensating balances, or assignments on any of the assets in the IRP/RDLF/RMAP, including those
pursuant to any guarantees made.
Description:
CERTIFICATION OF AUTHORIZED REPRESENTATIVE : I certify that the above information and any attachments
thereto are complete and accurate to the best of my knowledge and belief.
By: __________________________________________________________							Date:________________________
Name and Position: ______________________________________________________________

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Sheet 3: Page 3 a.

	ULTIMATE RECIPIENT/MICROENTERPRISE INFORMATION:
	Recipient Name:					Recipient Tax ID#:
	Applicant Type:
	Indian Tribe (IRP/RMAP)				Partnership
	Profit-making Corporation				Trust
	Proprietorship				Other
	Public Body				Non-Profit Corporation
	Institution of Higher Learning (RMAP 0nly)				Non-Profit Entity (RMAP Only)
	Facility Location
	Street Address:					Borrower's Address:
						(if different)
	City:
	State:				Zip Code						-
	County:				-
	Project Information
	Jobs Saved:
	Jobs Created:					NAICS Code
	Third Party Document
	Approved
	RECIPIENT LOAN INFORMATION:
	Loan Amount :			$		Closing Date:
	Loan Balance:			$		Status:			Ahead
	Term: (Months)								Current
	Interest Rate :			%					Delinquent
	Interest Rate Type:								Loss/Charged Off
			Fixed		Variable				Paid in Full
									Suspended/Deferred
			Terms Renegotiated:
						Pay-Off Date:
	Recipient Loan Funded by:
			Initial USDA Loan Funds and approved by RD					Revolving Funds
		Agency Contribution:				$
		Advanced Date (ACH):
		Intermediary Contribution:				$
	Modifications to Amortization:
			Balloon Payments					Delayed Payment
			Interest Only Payments					Other
	Collateral Information:
			Equipment				Personal Guarantees
			Real Estate				Other
		Lien Position:				1st Position			3rd Position
						2nd Position			Other
							Other Description
	Supplemental Funding Amounts:
	State/Local			$		Federal Funds			$
	Bank Loans			$		Other			$
	Sources of USDA Funding For This Loan
	PAYMENT INFORMATION :
	Payment Frequency:			Annually			Other
				Monthly		Other Description:
	Number of Payments:
	Due (since inception)				Made Late (30 days past due or less)
	# Made on Time				Made Late (more than 30 days)
Comments:
For Official Use Only
	Race Information		White						Veteran
			Black/African American
			American Indian/Alaskan Native				Ethnicity		Hispanic or Latino
			Asian						Not Hispanic or Latino
			Native Hawaiian or Other Pacific Islander
								Sex:
									Male
									Female
									Public Body

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Sheet 4: Page 4

ULTIMATE RECIPIENT/MICROENTERPRISE INFORMATION

RECIPIENT LOAN INFORMATION

PAYMENT INFORMATION

For Official

Supplemental Funding

**

Use Only

Jobs

Jobs

Date

Original

Private

In-Kind

Indirect

Other

Equity

Current

Loan

Loan Loss

Loan Loss

# Made

# >

#<

Recipient Name

Saved

Created

Verified

Loan Amount

Funding

Funding

Costs

Funding

Injection

Balance

Status

Amount

Recovery

# Due

on time

30 days

30 days

Satellite Pro 4600: SGreene: Must be marked W for White, B for Black/African American, AA for American Indian, A Asian or H for Native Hawaiian/Pacific Islander Race

Satellite Pro 4600: Must be marked H for Hispanic or NH for Non-Hispanic Ethnicity

Satellite Pro 4600: Must be marked F for Female or M for Male Sex

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Sheet 5: Page 5

PART I: PORTFOLIO STATUS
Status of Loans						Current Principal	#	Orig. Loan Amount
						Balance	Loans
1.	Total Loans Made:						-	$
2.	Fully Repaid						-	$
3.	Current					$	-	$
4.	Delinquent (>30 days)					$	-	$
5.	Default					$	-	$
6.	Total Active Loans (Add lines 3, 4, and 5)					$	-	$
7.	Total Written Off					$	-	$
PART II: PORTFOLIO SUMMARY
A. Summary of Loan Activities:			Provide information below on Active Loans and Total Loans closed to date.
						Active Loans		Total Loans
1.	# IRP/RDLF/RMAP Loans
2.	Total $$ Loaned:				$		$
3.	Non-IRP/RDLF/RMAP Leveraged
	a. Private				$		$
	b. Other				$		$
	c. Equity Injection
	d. Total Leveraged $$ (a+b+c)				$		$
4.	Total Project Leverage (2 + 3d)				$		$
5.	Private Sector Jobs:
	a. Created
	b. Saved
	c. Total Jobs (a + b)
For Official Use Only
B. Summary of Demographics:			Provide information below on each borrower regarding race and ethnicity.
								Total Loans
1.	# of IRP/RDLF/RMAP Loans to Borrowers per Race:
	a. White
	b. Black/African American
	c. American Indian/Alaskan Native
	d. Asian
	e. Native Hawaiian/Other Pacific Islander
2.	# of IRP/RDLF/RMAP Loans to Borrowers per Ethnicity:
	a. Hispanic or Latino
	b. Not-Hispanic or Latino
3.	# of IRP/RDLF/RMAP Loans to Borrowers per Sex:
	a. Male
	b. Female