Supplemental Report

U.S. Department of the Treasury

INSTRUCTIONS for the Quarterly Supplemental Report for Banks
Participating in the Small Business Lending Fund
GENERAL INSTRUCTIONS
The sections below constitute the Quarterly Supplemental Report.
Quarter-End Adjusted Baseline Calculation
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) is required to submit a Quarterly Supplemental Report no more
than 30 calendar days after the quarter in which SBLF funding is received and in each of the following nine quarters.
The bank must also submit an Initial Supplemental Report within five business days prior to the closing date, as described in the
separate Instructions for the Initial Supplemental Report for Banks Participating in the Small Business Lending Fund.
DEFINITIONS AND RULES OF PRACTICE
Unless otherwise stated, the Quarterly Supplemental Report and the Instructions for the Quarterly 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 Quarterly Supplemental Report.
PREPARATION OF THE REPORT
Banks are required to prepare and file the Quarterly 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 Quarterly 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 Quarterly 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 Quarterly
Supplemental Report that the bank has filed with the Treasury and the appropriate supervisory agency.

Instructions for Quarterly Supplemental Report for Banks
Treasury Department Form: TD F 102.4A

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OMB Number: 1505-0228

Director Attestation
National and state member banks – The correctness of the Quarterly 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 Quarterly 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 Quarterly Supplemental Report by electronically entering the report data directly into the Quarterly
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 Quarterly 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 Quarterly Supplemental Report for Banks
Treasury Department Form: TD F 102.4A

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OMB Number: 1505-0228

Submission Date
A bank’s completed Quarterly Supplemental Report must be filed with the federal bank supervisory authorities and Treasury no later
than 30 calendar days after the end of the quarter, which is the same date the Call Report used to pull the data is due. For example,
the report pertaining to the quarter ending March 31 must be filed by the following April 30. However, if the closing date (the date the
bank receives the funds) occurs after the bank’s Call Report is due for the preceding quarter, the bank’s first Quarterly Supplemental
Report is due within five business days prior the closing date. For example, if the closing date occurs May 10, the report must be
received by May 3, using data reflected on the March 31 Call Report.
RETENTION OF REPORTS
In general, a bank should maintain in its files a signed and attested record of its completed Quarterly 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. Before a report is
submitted, all amounts should be compared with the corresponding amounts in the previous report. If there are any unusual
changes from the previous report, a brief explanation of the changes should be attached to the submitted report.
RELEASE OF INDIVIDUAL BANK REPORTS
All sections of the Quarterly 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
Quarter-End Adjusted Baseline Calculation
This section is used to adjust an institution’s Small Business Lending Baseline for increases in qualified loan balances resulting from
mergers, acquisitions, or purchases of such loans. If the bank has gained qualifying loans by merger, acquisition, or purchase since
7/1/2010 through the report date, the amount must be added to the baseline.
Item No. Caption and Instructions
1

Initial Small Business Lending Baseline (line 12 of the Initial Supplemental Report)

2

Prior quarter cumulative reported qualified small business lending increases resulting from an acquisition of, or merger
with, another institution, and purchases of such loans. Enter balance reported in:
•

Line 23 of the prior quarter’s report if the last report filed was the Initial Supplemental Report

•

Line 12 of the prior quarter’s report if the last report filed was a Quarterly Supplemental Report

3

Balance increases in commercial and industrial loans resulting from an acquisition of, or merger with, another institution,
and purchases of such loans in the quarter being reported

4

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 in the quarter being reported

5

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 in the quarter being reported

6

Balance increases in loans secured by farmland resulting from an acquisition of, or merger with, another institution, and
purchases of such loans in the quarter being reported

7

Subtotal (sum lines 3, 4, 5, and 6)
Instructions for Quarterly Supplemental Report for Banks

Treasury Department Form: TD F 102.4A

3

OMB Number: 1505-0228

Item No. Caption and Instructions
8

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

9

Dollar portion of such loans to businesses with more than $50 million in revenues, unless included in line 8
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.

10

Dollar portion of line 7 guaranteed by the U.S. government, unless included in lines 8 or 9
Include only the portion of the loan which is guaranteed by the U.S. government

11

Dollar portion of line 7 where a third party has assumed an interest, unless included in lines 8, 9, or 10

12

Total cumulative reported qualified business lending increases resulting from an acquisition of, or merger with, another
institution, and purchases of such loans (line 12 equals line 2 plus line 7 minus lines 8, 9, 10, and 11)

13

Quarter-End Adjusted Small Business Lending Baseline (line 13 equals line 1 plus line 12)

Include only the portion where a third party has assumed an interest

Quarter-End Qualified Small Business Lending
Item No. Caption and Instructions
14

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

15

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

16

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

17

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

18

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

19

Dollar portion of any such loan 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

Total quarter-end qualified small business loans (line 23 equals line 18 minus lines 19, 20, 21, and 22)

Net Charge-off Adjustments
Item No. Caption and Instructions
24

Net charge-offs from prior quarter's report. Enter balance reported in:
•
•

Line 44 of the Initial Supplemental Report if this is your first time completing the Quarterly Supplemental
Report
Line 34 of the prior quarter’s Quarterly Supplemental Report if you have previously filed a Quarterly
Supplemental Report

25

Net charge-offs on commercial and industrial loans

26

Net charge-offs on loans secured by owner-occupied nonfarm nonresidential properties

27

Net charge-offs on loans to finance agricultural production and other loans to farmers

28

Net charge-offs on loans secured by farmland

29

Subtotal (sum lines 24, 25, 26, 27, and 28)
Instructions for Quarterly Supplemental Report for Banks

Treasury Department Form: TD F 102.4A

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OMB Number: 1505-0228

Item No. Caption and Instructions
30

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

31

Dollar portion of net charge-offs on such loans to businesses with more than $50 million in revenues, unless included in
line 30

32

Dollar portion of net charge-offs on loans guaranteed by the U.S. government, unless included in lines 30 and 31

33

Dollar portion of net charge-offs on loans where a third party has assumed an interest, unless included in lines 30, 31, and 32

34

Total cumulative net charge-offs (line 34 equals line 29 minus lines 30, 31, 32, and 33)

35

Quarter-End Adjusted Qualified Small Business Lending (line 35 equals line 23 plus line 34)

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 Quarterly Supplemental Report for Bank Holding Companies Participating in the Small Business Lending Fund
form.
Calculate applicable Dividend Rates as follows under Quarterly Supplemental Reports:
Report Date

Submission Date

Quarterly Supplemental Reports
End of first calendar
Calendar quarter of
quarter preceding
closing date (30th day
closing date
of quarter or closing
date, whichever is later)
End of calendar quarter First calendar quarter
of closing date
after closing date (30th
day of quarter)
End of first through
Second through eighth
seventh calendar
calendar quarters after
quarters after closing
closing date (30th day
date
of quarter)
End of eighth calendar
Ninth calendar quarter
quarter after closing
after closing date (30th
date
day of quarter)

Rate Effective Period

Dividend Rate

First calendar quarter
after closing date

Between 1% and 5% as determined from
the Dividend Rate Chart

Second calendar
quarter after closing
date
Third through ninth
calendar quarters after
closing date
Tenth calendar quarter
after investment date
until end of four and
one-half year period
after closing date

If the final Supplemental Report shows
any increase in qualified lending,
between 1% and 5% as determined from
the Dividend Rate Chart
If the final Supplemental Report shows
no increase in qualified lending, 7%

Item No. Caption and Instructions
36

Dollar value of funding from the Small Business Lending Fund

37

Dollar value of Quarter-End Adjusted Small Business Lending Baseline (line 13)

38

Dollar value of Quarter-End Adjusted Qualified Small Business Lending (line 35)

39

Dollar value of increase in Qualified Small Business Lending from baseline (line 39 equals line 38 minus line 37)

40

Percent increase in Qualified Small Business Lending (line 40 equals line 39 divided by line 37)

41

If line 36 is greater than line 39, enter the amount from line 39; if line 39 is greater, enter the amount from line 36

Instructions for Quarterly Supplemental Report for Banks
Treasury Department Form: TD F 102.4A

5

OMB Number: 1505-0228

Item No. Caption and Instructions
42

Applicable Dividend Rate
Refer to the dividend table below to locate the applicable dividend rate associated with the growth percentage shown in
line 40
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 41. Any unused portion of the SBLF funding amount is subject
to a 5% dividend rate.
43

If line 36 is greater than line 39, enter the difference (line 36 minus line 39). Otherwise, not applicable.

44

Applicable Dividend Rate for amount in line 43, if needed (5%)

45

Weighted Average Dividend Rate for SBLF capital amount for the following quarter. Calculate as follows:
a. Multiply line 41 and line 42
b. Multiply line 43 and line 44
c. Sum the results from steps a and b
d. Divide the results from step c by line 36 (the capital amount) and enter the resulting rate, going out seven
decimal points
For the 10th quarter following the quarter in which funding occurred, if line 40 is greater than zero, the rate calculated in line
45 applies until four-and-one-half years following funding. Otherwise, a Dividend Rate of 7% applies. After the 10th quarter,
disregard lines 41 through 44 and instead enter the rate in line 45 that was shown on the previous quarter’s report.

Example:
ABC Bank:
• Receives $10 million from the Small Business Lending Fund on 4/1/2011.
• Reports an Adjusted Small Business Lending Baseline of $200 million.
• Reports a Quarter-End Adjusted Qualified Small Business Lending balance of $219.9 million. This includes the impact of
changes in loan balances due to new loans made, payments, and charge-offs, plus an adjustment to add back charge-offs.
ABC Bank’s Quarterly Supplemental Report – Dividend Rate Determination would appear as follows for 12/31/2011:
Dollar amounts in thousands

Bil

36. Dollar value of funding from the Small Business Lending Fund
37. Dollar value of Quarter-End Adjusted Small Business Lending Baseline (line 13)
38. Dollar value of Quarter-End Adjusted Qualified Small Business Lending (line 35)
39. Dollar value of increase in Qualified Small Business Lending from baseline (line 39 equals line 38 minus line 37)

36
37
38
39

40. Percent increase in Qualified Small Business Lending (line 40 equals line 39 divided by line 37)

40

41.
42.
43.
44.
45.

If line 36 is greater than line 39, enter the amount from line 39; if line 39 is greater, enter the amount from line 36
Applicable Dividend Rate (from tables in Instructions for Quarterly Supplemental Report) for amount in line 41
If line 36 is greater than line 39, enter the difference (line 36 minus line 39); otherwise, not applicable
Applicable Dividend Rate for amount in line 43, if needed
Weighted Average Dividend Rate for SBLF capital amount for the following quarter (must go out seven decimal points; see instructions for details)

41
42
43
44
45

Mil
10
200
219
19

9.95

Thou
000
000
900
900
%

10,000,000
2.0
n/a
5.0
2.0000000

Instructions for Quarterly Supplemental Report for Banks
Treasury Department Form: TD F 102.4A

$
%
$
%
%

6

OMB Number: 1505-0228