Rd 1951-4

FORM APPROVED

REPORT OF IRP/RDLF LENDING ACTIVITY
(Intermediary Relending Program- Rural Development Loan Fund)

Form RD 1951-4
(Rev. 12-04)

Name of Organization

IRP/RDLF Fund Number::

Address:

Telephone No.:

OMB NO. 0570-0015

Date

Report Period

Contact Person:

Date Intermediary IRP/RDLF
Loan was approved:

Tax I.D. No:
TO DATE

REPORT PERIOD
LOANS
1.

Amount of IRP/RDLF Loan

$

$

2.

Principal of loans disbursed

3.

Principal of loans received

$
$

$
$

4.

Net Lending (line 2 minus 3)

$

0.00

$

0.00

END OF PERIOD

AVAILABLE ASSETS
5.

Total Assets (less furniture & equipment)

6.

Loans Outstanding

$
$

7.

Loan Loss Reserve (After 3 yrs., 6% required)

$

8.

Funds Available for Relending (line 5 minus line 6 and 7)

$

0.00

9.

Percent of Assets Available for Relending (Line 8 divided by Line 5)

%

0.00

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

$

0.00

LIABILITIES
7. Loan Payable to RBS

$
$

8. Accounts Payable
9. Other Liabilities

$
$
$
$
$

10. TOTAL LIABILITIES
11. FUND BALANCE (Assets minus Liabilities)

0.00
0.00

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
0570-0015. 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.

Page 1

Form RD 1951-4
(Rev. 12-04)

IRP/RDLF INCOME AND EXPENSE STATEMENT
Report Period 1/0/00
Prior
Fiscal Year

USDA Approved
Budget
1. IRP/RDLF INCOME (All Sources)

Reporting
Period

Program to
Date

$

$

$

$

a. Employee Salaries

$

$

$

$

b. Employee Fringe Benefits

$

$

$

$

c. IRP/ RDLF -related Travel

$

$

$

$
$

2. EXPENSES (IRP/RDLF Related Expenses)

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)
1. 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 INCOME (line 1 minus line 3)
5. EXPENSES as % of IRP/RDLF INCOME (line 3/line 1)

$

$

$

$

$

0.00 $

0.00 $

0.00 $

0.00

$

0.00 $

0.00 $

0.00 $

0.00

%

0 %

0%

0 %

0

6. If salaries & expenses are not charged against the IRP/RDLF 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, including those
pursuant to any guarantees made.
Description:

CERTIFICATION OF AUTHORIZED REPRESENTATIVE: I certify that the above information and any attachments
thereto arc complete and accurate to the best of my knowledge and belief.

By:

Date:

Name and Position:

Page 2

Form RD 1951-4
(Rev. 12-04)

ULTIMATE RECIPIENT INFORMATION
Recipient Name:

Recipient Tax ID#:

Applicant Type:
Indian Tribe
Profit-making Corporation
Proprietorship
Public Body

Partnership
Trust
Other
Non-Profit Corporation

Facility Location

Street Address

Borrower's Address:
(if different)

City:
State:

Zip Code

County:

Project Information
Job Saved
Jobs Created

I

NAICS Code

Third Party Document
Approved

F

RECIPIENT LOAN IN FORMATION:
Loan Amount:
$
Loan Balance:
$
Term:( Months)
Interest Rate:
%

Closing Date:
Status:

Ahead
Current
Delinquent
Loss/Charged Off
Paid in Full

Interest Rate Type

Fixed

Variable

Suspend/Deferred
Terms Renegotiated:

I
Pay-Off Date:

Recipient Loan Funded by:

F

Initial USDA Loan Funds and approved by RD

Agency Contribution:

$

Advance Date (ACH):
Intermediary Contributions:

$

Modifications to Amortization:

Revolving Funds

T)l IP Payment
Delayed
Other

Balloon Payment
Interest Only Payment:

Collateral Information:
Personal Guarantees

Equipment
Real Estate

Other
3rd p
Position
Other

1st Position

Lien Position:

2nd Position

I

Other Description
Supplemental Funding Amounts:
State/Local
Bank Loans

$

$

Federal Funds
Other

$

$

Source of USDA Funding For This Loan

PAYMENT INFORMATION
Payment Frequency:

Annually

Other

Monthly
Number of Payments:
Due (since inception)
# Made on Time

Other Description

Made Late (30 days past due or less)
Made Late (more than 30 days)

Comments:

For Official Use
Only
Race Information

Black/African American
American Indian/Alaskan Native
Asian
Native Hawaiian or Other Pacific Islander

Verified
Jobs Created

Veteran
~
'IHispanic
p
orLLatino

Ethnicity

Not Hispanic or Latino

S,
x
Sex:

Jobs Saved

Male
Female
Public Body

Total

Page 3

Form RD 1951-4
(Rev, 12-04)

RECIPIENT LOAN INFORMATION

ULTIMATE RECIPIENT INFORMATION

Recipient Name

Jobs
Saved

Jobs
Created

Date
Verified

Original
Loan Amount

Supplemental Funding
Private
Equity
Other
Funding
Injection
Funding

Current
Balance

PAYMENT INFORMATION
**
Loan
Status

Loan Status Codes:
C - Current
S - Suspended/Dererred
D - Delinquent
P - Paid-Out
DD-Default
L-Loss

Page 4

For Official
Use Only

Loan Loss
Amount

Loan Loss
Recovery

# Due

# Made
on time

#>
30 days

#<
30 days

Race

Ethnicity

Sex

Form RD 1951-4
(Rev., 4-03)

PART I- PORTFOLIO STATUS
Status of Loans.

Current Principal
Balance

Orig. Loan Amount

#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

-$
-$
-$
0.00

0

-$

0.00

-$

$

PART II: PORTFOLIO SUMMARY
A. Summary of Loan Activities:

Provide information below on Active Loans and Total Loans closed to date.
Total Loans

Active Loans
1. # IRP/RDLF Loans
2. Total $$ Loaned:

$

$

a. Private

$

$

b. Other

$

$

c. Equity Injection

$

$

d. Total Leveraged $$ (a+b+c)

$

0.00

$

0.00

$

0.00

$

0.00

3. Non-IRP/RDLF Leveraged

4. Total Project Leverage (2 + 3d)
5. Private Sector Jobs:
a. Created
b. Saved

0

c. Total jobs (a + b)

0

For Official Use Only
B. Summary of Demographics:

Provide information below on each borrower regarding race and ethnicity.
Total Loans

1. # of IRP/ RDLF Loans to Borrowers per Race:
a. White
b. Black/African American
c. American Indian/Alaskan Native
d. Asian
c. Native Hawaiian/Other Pacific Islander
2. # of IRP/RDLF Loans to Borrowers per Ethnicity:
a. Hispanic or Latino
b. Not-Hispanic or Latino
3. # of IRP/RDLF Loans to Borrowers per Sex:
a. Male
b. Female

Page 5