Supplemental Report

U.S. Department of the Treasury

INSTRUCTIONS for the Initial Supplemental Report for Banks
Participating in the Small Business Lending Fund
GENERAL INSTRUCTIONS
The sections below constitute the Initial Supplemental Report.
Initial Baseline Calculation
Initial Adjusted Baseline Calculation
Initial Quarter-End Qualified Small Business Lending
Dividend Rate Calculation
WHO MUST REPORT ON WHICH FORMS
Every bank participating in the Small Business Lending Fund (SBLF) of the U.S. Department of the Treasury (Treasury) is required to
submit an Initial Supplemental Report within five business days before the closing date of the SBLF funding.
The bank must also submit Quarterly Supplemental Reports, beginning in the quarter in which the funding occurs, as described in the
separate Instructions for the Quarterly Supplemental Report for Banks Participating in the Small Business Lending Fund.
DEFINITIONS AND RULES OF PRACTICE
Unless otherwise stated, the Initial Supplemental Report and the Instructions for the Initial Supplemental Report incorporate the
definitions and general rules of practice embodied in the Consolidated Reports of Condition and Income for Banks, as well as the
instructions pertaining thereto.
ORGANIZATION OF THE INSTRUCTION BOOK
This instruction book is divided into two sections:
(1) The General Instructions describing overall reporting requirements.
(2) The Line Item Instructions for each section of the Initial Supplemental Report.
PREPARATION OF THE REPORT
Banks are required to prepare and file the Initial Supplemental Report in accordance with these instructions. All reports shall be
prepared in a consistent manner.
The bank’s financial records shall be maintained in such a manner and scope so as to ensure that the Initial Supplemental Report can
be prepared and filed in accordance with these instructions and will reflect a fair presentation of the bank’s small business lending.
If you have general questions regarding this form, please contact the information line for the Small Business Lending Fund at
888-832-1147 (Monday-Friday, 9:00 AM-7:00 PM ET).
SIGNATURES
The cover (signature) page of the Initial Supplemental Report shall be used to complete the signature and attestation requirement.
The bank may use digital or handwritten signatures; however, the choice will impact how the form is submitted. For details, see
SUBMISSION OF THE REPORT instruction below.
Chief Executive Officer and Chief Financial Officer Declarations
Both the Chief Executive Officer (CEO) and the Chief Financial Officer (CFO) of the bank (or the individuals performing equivalent
functions) shall sign the respective declarations on the cover (signature) page attesting to the correctness of the Initial Supplemental
Report that the bank has filed with Treasury and the appropriate supervisory agency.

Instructions for Initial Supplemental Report for Banks
Treasury Department Form: TD F 102.3A

1

OMB Number: 1505-0228

Director Attestation
National and state member banks – The correctness of the Initial Supplemental Report shall be attested to by no fewer than three
directors of the reporting bank, other than the officers signing the CEO or CFO declarations, as indicated on the cover (signature) page.
State nonmember banks – The correctness of the Initial Supplemental Report shall be attested to by no fewer than two directors of the
reporting bank, other than the officers signing the CEO or CFO declarations, as indicated on the cover (signature) page.
SUBMISSION OF THE REPORT
Each bank must file its Initial Supplemental Report by electronically entering the report data directly into the Initial Supplemental
Report and emailing the completed copy, along with the cover (signature) page, to: Treasury at [email protected].
For banks using digital signatures, the completed electronic report is submitted as a single document. For banks using handwritten
signatures, both the completed electronic report and a scanned copy of the cover (signature) page must be submitted.
One additional copy should be sent to the bank’s primary federal regulator using the following addresses, as appropriate:
FDIC

State nonmember institutions should submit supplemental reports to their appropriate regional office or
electronically through FDICconnect.

Federal
Reserve

Applicants should provide supplemental reports to the appropriate regional Federal Reserve Bank using existing
procedures for filing report-related documentation.

OCC

National banks should submit supplemental reports electronically via OCC secure mail. Please contact your OCC
District Office for instructions on how to securely submit the supplemental reports.

OTS

Please contact your OTS Regional Office for instructions on how to securely submit the supplemental reports.

State-chartered institutions must also provide a copy of the Initial Supplemental Report to their state regulator using the applicable
email address listed below:
Missouri [email protected]
Alabama ................... [email protected]
[email protected]
Alaska ....................... [email protected]
[email protected]
Arizona ..................... [email protected]
New Hampshire [email protected]
Arkansas ................... [email protected]
New [email protected]
California .................. [email protected]
New York [email protected]
Colorado................... [email protected]
North
Carolina [email protected]
Connecticut .............. [email protected]
North Dakota [email protected]
District of Columbia . [email protected]
Ohio [email protected]
Florida ...................... [email protected]
Oregon [email protected]
Georgia ..................... [email protected]
Pennsylvania
[email protected]
Hawaii ...................... [email protected]
Rhode Island [email protected]
Idaho ........................ [email protected]
South Carolina [email protected]
Illinois ....................... [email protected]
Tennessee [email protected]
Indiana ..................... [email protected]
Texas [email protected]
Iowa ......................... [email protected]
Utah [email protected]
Kansas ...................... smallbusinesslendingapplication@
Vermont [email protected]
osbckansas.org
[email protected]
Kentucky .................. [email protected]
Washington [email protected]
Louisiana .................. [email protected]
West Virginia [email protected]
Maine ....................... [email protected]
Wisconsin [email protected]
Massachusetts ......... [email protected]
Wyoming [email protected]
Michigan .................. [email protected]
Mississippi ................ [email protected]
State-chartered banks in the following states or territories should contact their appropriate state regulator directly for submission
instructions: Delaware, Maryland, Minnesota, Montana, New Mexico, Oklahoma, South Dakota, Guam, and Puerto Rico.

Instructions for Initial Supplemental Report for Banks
Treasury Department Form: TD F 102.3A

2

OMB Number: 1505-0228

Submission Date
A bank’s completed Initial Supplemental Report must be filed with the federal bank supervisory authorities and Treasury within five
business days prior to the closing date. The Call Report used to pull data should be from the second preceding quarter. For example, if
the submission date is May 1, use the Call Report from December 31 of the previous year.
RETENTION OF REPORTS
In general, a bank should maintain in its files a signed and attested record of its completed Initial Supplemental Report, including any
amended reports, for five years after the report date, unless any applicable state requirements mandate a longer retention period.
MISCELLANEOUS GENERAL INSTRUCTIONS
Rounding
All dollar amounts must be reported in thousands with the figures rounded to the nearest thousand. Items less than $500 must be
reported as zero.
Verification
All fields must be completed. All addition and subtraction should be double-checked before reports are submitted. Totals and
subtotals in supporting materials should be cross-checked to corresponding items elsewhere in the reports.
RELEASE OF INDIVIDUAL BANK REPORTS
All sections of the Initial Supplemental Report submitted by each reporting bank may be made available to the public by the federal
bank supervisory agencies or Treasury.

LINE ITEM INSTRUCTIONS
Initial Baseline Calculation
If your institution’s Qualified Small Business Lending increased as a result of mergers and acquisitions or loan purchases from 10/1/09
through 6/30/10, complete Worksheet A on the following page to calculate pro forma balances reported on line items 1 – 4 (pro forma
balances in 3a – 3d are entered into 1a – 1d; pro forma balances in 6a – 6d are entered into 2a – 2d; pro forma balances in 9a – 9d are
entered into 3a – 3d; and pro forma balances in 12a – 12d are entered into 4a – 4d).
Item No. Caption and Instructions
1a – 1d

Balances of commercial and industrial loans (as reflected on Call Report Schedule RC-C, Part I, item 4), complete for each of the
four quarters

2a – 2d

Balances of loans secured by owner-occupied nonfarm nonresidential properties (as reflected on Call Report Schedule RCC, Part I, item 1.e.(1)), complete for each of the four quarters

3a – 3d

Balances of loans to finance agricultural production and other loans to farmers (as reflected on Call Report Schedule RC-C,
Part I, item 3), complete for each of the four quarters

4a – 4d

Balances of loans secured by farmland (as reflected on Call Report Schedule RC-C, Part I, item 1.b), complete for each of the
four quarters

Instructions for Initial Supplemental Report for Banks
Treasury Department Form: TD F 102.3A

3

OMB Number: 1505-0228

Worksheet A
9/30/09
1. Balances of commercial and industrial loans (as
reflected on Call Report Schedule RC-C, Part I,
item 4)

Bil
1a

Mil

Thou

3/31/10
Bil

Mil

Thou

6/30/10
Bil

Mil

Thou

Bil

1b

1c

1d

2b

2c

2d

3a

3b

3c

3d

4a

4b

4c

4d

5b

5c

5d

6a

6b

6c

6d

7a

7b

7c

7d

8b

8c

8d

9a

9b

9c

9d

10a

10b

10c

10d

11b

11c

11d

12b

12c

12d

2. Dollar value of such loans either gained through
an acquisition of, or merger with, another
institution or purchased from another institution
during the quarter
3. Pro forma balances including such loans gained
through an acquisition, merger, or purchase (line
item 3a equals line items 1a+2b+2c+2d; line item
3b equals line items 1b+2c+2d; line item 3c
equals line items 1c+2d; line item 3d equals line
item 1d)

12/31/09

Mil

Thou

4. Balances of loans secured by owner-occupied
nonfarm nonresidential properties (as reflected
on Call Report Schedule RC-C, Part I, item 1.e.(1))
5. Dollar value of such loans either gained through
an acquisition of, or merger with, another
institution or purchased from another institution
during the quarter
6. Pro forma balances including such loans gained
through an acquisition, merger, or purchase (line
item 6a equals line items 4a+5b+5c+5d; line
item 6b equals line items 4b+5c+5d; line item 6c
equals 4c+5d; line item 6d equals line item 4d)
7. Balances of loans to finance agricultural
production and other loans to farmers (as
reflected on Call Report Schedule RC-C, Part I,
item 3)
8. Dollar value of such loans either gained through
an acquisition of, or merger with, another
institution or purchased from another institution
during the quarter
9. Pro forma balances including loans gained
through an acquisition, merger, or purchase (line
item 9a equals line items 7a+8b+8c+8d; line
item 9b equals line items 7b+8c+8d; line item 9c
equals line item 7c+8d; line item 9d equals line
item 7d)
10. Balances of loans secured by farmland (as
reflected on Call Report Schedule RC-C, Part I,
item 1.b)
11. Dollar value of such loans either gained through
an acquisition of, or merger with, another
institution or purchased from another institution
during the quarter
12. Pro forma balances including loans gained
through an acquisition, merger, or purchase
(line item 12a equals line items
10a+11b+11c+11d; line item 12b equals line
items 10b+11c+11d; line item 12c equals line
item 10c+11d; line item 12d equals line item
10d)

12a

Instructions for Initial Supplemental Report for Banks
Treasury Department Form: TD F 102.3A

4

OMB Number: 1505-0228

Item No. Caption and Instructions
5a – 5d

Subtotal (sum lines 1 – 4 for each column)

6a – 6d

Dollar portion of any such loans or group of such loans to the same borrower and its affiliates with an original principal or
commitment amount greater than $10 million

7a – 7d

Dollar portion of such loans to businesses with more than $50 million in revenues, unless included in line 6
Include loans made to a business with more than $50 million in revenues during the most recent fiscal year ended as
of the date of the loan origination. If the recipient’s revenues for that fiscal year are unknown, use available annual
revenue information reasonably proximate to that fiscal year.

8a – 8d

Dollar portion of line 5 guaranteed by the U.S. government, unless included in lines 6 or 7
Include only the portion of the loan which is guaranteed by the U.S. government

9a – 9d

Dollar portion of line 5 where a third party has assumed an interest, unless included in lines 6, 7, or 8
Include only the portion where a third party has assumed an interest

10a – 10d Total qualified loans (line 10 equals line 5 minus lines 6, 7, 8 and 9 for each date column)
11
12

Total of four quarters' qualified loans (sum line items 10a through 10d)
Initial Small Business Lending Baseline (line 12 equals line 11 divided by 4)
Include four quarters of qualified business loans divided by four to determine the average qualified lending baseline

Initial Adjusted Baseline Calculation
This section is used to adjust an institution’s Initial Small Business Lending Baseline for increases in qualified loan balances resulting
from mergers, acquisitions, or purchases of such loans on or after 7/1/2010. Amounts should reflect increases from 7/1/2010
through the quarter-end prior to the quarter in which the closing date occurs. Therefore, data shown should be as of two quarters
prior to the quarter in which the closing date occurs (e.g. if closing occurs on 4/1/2011, the information reflected should be as of
7/1/1/2010 through 12/31/2010).
Item No. Caption and Instructions
13

Initial Small Business Lending Baseline (line 12)

14

Balance increases in commercial and industrial loans resulting from an acquisition of, or merger with, another institution,
and purchases of such loans on or after 7/1/2010

15

Balance increases in loans secured by owner-occupied nonfarm nonresidential properties resulting from an acquisition of, or
merger with, another institution, and purchases of such loans on or after 7/1/2010

16

Balance increases in loans to finance agricultural production and other loans to farmers resulting from an acquisition of,
or merger with, another institution, and purchases of such loans on or after 7/1/2010

17

Balance increases in loans secured by farmland resulting from an acquisition of, or merger with, another institution, and
purchases of such loans on or after 7/1/2010

18

Subtotal (sum lines 14, 15, 16, and 17)

19

Dollar portion of any such loans or group of such loans to the same borrower and its affiliates with an original principal or
commitment amount greater than $10 million

20

Dollar portion of such loans to businesses with more than $50 million in revenues, unless included in line 19
Include loans made to a business with more than $50 million in revenues during the most recent fiscal year ended as
of the date of the loan origination. If the recipient’s revenues for that fiscal year are unknown, use available annual
revenue information reasonably proximate to that fiscal year.

21

Dollar portion of line 18 guaranteed by the U.S. government, unless included in lines 19 or 20

22

Dollar portion of line 18 where a third party has assumed an interest, unless included in lines 19, 20, or 21

Include only the portion of the loan which is guaranteed by the U.S. government
Include only the portion where a third party has assumed an interest
23

Qualified balance increases (line 23 equals line 18 minus lines 19, 20, 21, and 22)

24

Initial Adjusted Small Business Lending Baseline (line 24 equals line 13 plus line 23)

Instructions for Initial Supplemental Report for Banks
Treasury Department Form: TD F 102.3A

5

OMB Number: 1505-0228

Initial Quarter-End Qualified Small Business Lending
All banks participating in the Small Business Lending Fund must complete this section. All figures are to be reported in thousands of
dollars. Amounts should reflect information published in the quarter prior to the quarter in which the closing date occurs.
Therefore, data shown should be as of two quarters prior to the quarter in which the closing date occurs (e.g. if closing occurs on
4/1/2011, the information reflected should be as of 12/31/2010).
Item No. Caption and Instructions
25

Balances of commercial and industrial loans (as reflected on Call Report Schedule RC-C, Part I, item 4)

26

Balances of loans secured by owner-occupied nonfarm nonresidential properties (as reflected on Call Report Schedule RCC, Part I, item 1.e.(1))

27

Balances of loans to finance agricultural production and other loans to farmers (as reflected on Call Report in Schedule
RC-C, Part I, item 3)

28

Balances of loans secured by farmland (as reflected on Call Report Schedule RC-C, Part I, item 1.b)

29

Subtotal (sum lines 25, 26, 27, and 28)

30

Dollar portion of such loans or group of such loans to the same borrower and its affiliates with an original principal or
commitment amount greater than $10 million

31

Dollar portion of such loans to businesses with more than $50 million in revenues, unless included in line 30
Include loans made to a business with more than $50 million in revenues during the most recent fiscal year ended as
of the date of the loan origination. If the recipient’s revenues for that fiscal year are unknown, use available annual
revenue information reasonably proximate to that fiscal year.

32

Dollar portion of line 29 guaranteed by the U.S. government, unless included in lines 30 or 31
Include only the portion of the loan which is guaranteed by the U.S. government

33

Dollar portion of line 29 where a third party has assumed an interest, unless included in lines 30, 31, or 32
Include only the portion where a third party has assumed an interest

34

Total quarter-end qualified loans (line 34 equals line 29 minus lines 30, 31, 32, and 33)

Net Charge-off Adjustments
35

Net charge-offs on commercial and industrial loans on or after 7/1/2010

36

Net charge-offs on loans secured by owner-occupied nonfarm nonresidential properties on or after 7/1/2010

37

Net charge-offs on loans to finance agricultural production and other loans to farmers on or after 7/1/2010

38

Net charge-offs on loans secured by farmland on or after 7/1/2010

39

Subtotal (sum lines 35, 36, 37, and 38)

40

Dollar portion of net charge-offs on any such loans or group of such loans to the same borrower and its affiliates with an
original principal or commitment amount greater than $10 million

41

Dollar portion of net charge-offs on loans to businesses with more than $50 million in revenues, unless included in line 40

42

Dollar portion of net charge-offs on loans guaranteed by the U.S. government, unless included in lines 40 or 41

43

Dollar portion of net charge-offs on loans where a third party has assumed an interest, unless included in lines 40, 41,
or 42

44

Total net charge-offs (line 44 equals line 39 minus lines 40, 41, 42, and 43)

45

Quarter-End Adjusted Qualified Small Business Lending (line 45 equals line 34 plus line 44)

Instructions for Initial Supplemental Report for Banks
Treasury Department Form: TD F 102.3A

6

OMB Number: 1505-0228

Dividend Rate Calculation
This section is only applicable if the institution is not part of a bank holding company. The dividend rate for those institutions will be
determined using the Initial Supplemental Report for Bank Holding Companies Participating in the Small Business Lending Fund
form.
Item No. Caption and Instructions
46

Dollar value of funding from the Small Business Lending Fund

47

Dollar value of Initial Adjusted Small Business Lending Baseline (line 24)

48

Dollar value of Quarter-End Adjusted Qualified Small Business Lending (line 45)

49

Dollar value of increase in Qualified Small Business Lending from baseline (line 49 equals line 48 minus line 47)

50

Percent increase in Qualified Small Business Lending (line 50 equals line 49 divided by line 47)

51

If line 46 is greater than line 49, enter the amount from line 49. If line 49 is greater, enter the amount from line 46.

52

Applicable Dividend Rate
Refer to the dividend table below to locate the applicable dividend rate associated with the growth percentage shown in
line 50.
Increase from Baseline
Less than 2.5%
2.5% or more, but less than 5%
5% or more, but less than 7.5%
7.5% or more, but less than 10%
10% or more

Dividend Rate
5%
4%
3%
2%
1%

This is the rate that will be applied to the amount in line 51. Any unused portion of the SBLF funding amount is subject to
a 5% dividend rate.
53

If line 46 is greater than line 49, enter the difference (line 46 minus line 49). Otherwise, not applicable.

54

Applicable Dividend Rate for the amount in line 53, if needed (5%)

55

Weighted Average Dividend Rate for SBLF capital amount for the quarter in which funding occurs.
Calculate as follows:
a. Multiply line 51 and line 52
b. Multiply line 53 and line 54
c. Sum the results from steps a and b
d. Divide the results from step c by line 46 (the capital amount) and enter the resulting rate, going out seven
decimal points

Example:
ABC Bank:
• Receives $10 million from the Small Business Lending Fund on 4/1/2011.
• Reports an Initial Adjusted Small Business Lending Baseline of $200 million.
• Reports a Quarter-End Adjusted Qualified Small Business Lending balance of $209.9 million. This includes the impact of
changes in loan balances due to new loans made, payments/maturations, and charge-offs, plus an adjustment to add back
charge-offs.
ABC Bank’s Initial Supplemental Report – Dividend Rate Determination would appear as follows:
Dollar amounts in thousands

Bil

46. Dollar value of funding from the Small Business Lending Fund
47. Dollar value of Initial Adjusted Small Business Lending Baseline (line 24)
48. Dollar value of Quarter-End Adjusted Qualified Small Business Lending (line 45)
49. Dollar value of increase in Qualified Small Business Lending from baseline (line 49 equals line 48 minus line 47)

46
47
48
49

50. Percent increase in Qualified Small Business Lending (line 50 equals line 49 divided by line 47)

50

4.95

Mil
10
200
209
9

Thou
000
000
900
900
%

Instructions for Initial Supplemental Report for Banks
Treasury Department Form: TD F 102.3A

7

OMB Number: 1505-0228

51. If line 46 is greater than line 49, enter the amount from line 49; if line 49 is greater, enter the amount from line 46
52. Applicable Dividend Rate (from table in Instructions for Initial Supplemental Report) for amount in line 51
53. If line 46 is greater than line 49, enter the difference (line 46 minus line 49); otherwise, not applicable
54. Applicable Dividend Rate for amount in line 53, if needed
55. Weighted Average Dividend Rate for SBLF capital amount for the quarter in which funding occurs (must go out seven decimal points; see Instructions
for Initial Supplemental Report for details)

51
52
53
54

9,900,00
4.0
100,000
5.0

$
%
$
%

55

4.0100000

%

For an example illustrating the calculation in subsequent quarters, refer to the Instructions for the Quarterly Supplemental Report.

Instructions for Initial Supplemental Report for Banks
Treasury Department Form: TD F 102.3A

8

OMB Number: 1505-0228