| Bank Enterprise Award Program | |
| 2012 Application | |
| Table of Contents | |
| Applicant Information | |
| Worksheet 1: Estimated BEA Award Calculation | |
| Worksheet 2: Report of Transactions | |
| Instructions: | |
| Complete the Applicant Information worksheet, Worksheet 1: Estimated Award Calculation, and Worksheet 2: Report of Transactions and attach it to your BEA Signature Page in myCDFIFund. The Fund requires applicants to provide the name of their organization and other identifying information so that staff can assemble the various components of each application. | |
| Please save this document with the following naming convention: Bank Name 2012 BEA Charts | |
| Instructions: Please complete the yellow cells. Please be sure to answer all questions. Failure to respond to any of the questions could result in your application being rejected. The Applicant Organization Name and EIN must match the information provided in the SF 424. | Alaska | |
| Applicant Information | ||
| Applicant Organization Name: | Arkansas | |
| Taxpayer/Employer Identification Number (EIN): | ||
| FDIC Certificate Number: | Colorado | |
| How many hours did it take you to complete this application? | ||
| Applicant’s Total Assets (in thousands) from 12/31/2011 Call Report / TFR. | Iowa | |
| Indicate whether any of the following apply to your institution: | Idaho | |
| Minority Bank. An institution classified by the FDIC as a Minority Depository Institution as of 12/31/2010. | No | Illinois |
| Community Bank. An institution that identifies itself as a community bank. | No | Indiana |
| Certified CDFI. An institution certified as a CDFI by the CDFI Fund as of 12/31/2011. | Yes | Kentucky |
| Federal Regulator | FDIC | Louisiana |
| State in which the Applicant’s headquarters is physically located: | Massachusetts | |
| Indicate which of the following states are within your service area: | Maryland | |
| Alaska | No | Maine |
| Alabama | No | Marshall Islands |
| Arkansas | No | Michigan |
| American Samoa | No | Minnesota |
| Arizona | No | Missouri |
| California | No | Northern Mariana Isl. |
| Colorado | No | Mississippi |
| Connecticut | No | Montana |
| District of Columbia | No | North Carolina |
| Delaware | No | North Dakota |
| Florida | No | Nebraska |
| Fed. St. of Micronesia | No | New Hampshire |
| Georgia | No | New Jersey |
| Guam | No | New Mexico |
| Hawaii | No | Nevada |
| Iowa | No | New York |
| Idaho | No | Ohio |
| Illinois | No | Oklahoma |
| Indiana | No | Oregon |
| Kansas | No | Pennsylvania |
| Kentucky | No | Puerto Rico |
| Louisiana | No | Palau |
| Massachusetts | No | Rhode Island |
| Maryland | No | South Carolina |
| Maine | No | South Dakota |
| Marshall Islands | No | Tennessee |
| Michigan | No | Texas |
| Minnesota | No | Utah |
| Missouri | No | Virginia |
| Northern Mariana Isl. | No | Virgin Islands |
| Mississippi | No | Vermont |
| Montana | No | Washington |
| North Carolina | No | Wisconsin |
| North Dakota | No | West Virginia |
| Nebraska | No | Wyoming |
| New Hampshire | No | |
| New Jersey | No | |
| New Mexico | No | |
| Nevada | No | |
| New York | No | |
| Ohio | No | |
| Oklahoma | No | |
| Oregon | No | |
| Pennsylvania | No | |
| Puerto Rico | No | |
| Palau | No | |
| Rhode Island | No | |
| South Carolina | No | |
| South Dakota | No | |
| Tennessee | No | |
| Texas | No | |
| Utah | No | |
| Virginia | No | |
| Virgin Islands | No | |
| Vermont | No | |
| Washington | No | |
| Wisconsin | No | |
| West Virginia | No | |
| Wyoming | No | |
| Instructions: As stated in the BEA Program regulations and Application materials, increases in CDFI Support Activities are multiplied by 18% for a CDFI applicant, 6% for a non-CDFI applicant. Increases in Distressed Community Financing Activities and Service Activities are multiplied by 9% for a CDFI applicant, 3% for a non-CDFI applicant. The white cells are locked and can not be accessed. Organization name should pre-populate from the previous worksheet. Do not change the formatting of this form or it will not upload properly. | |||||||
| Worksheet 1: Estimated BEA Award Calculation | |||||||
| Applicant Organization Name: | ='Applicant Information'!B4 | ||||||
| CDFI RELATED ACTIVITIES | |||||||
| A | B | C | D | E | F | ||
| Reporting | Baseline Period 2009 | Assessment Period 2010 | Change in Activity | Award Percent | Estimated Award Amount | ||
| 1 | Equity Investments (CEI)/ Equity-Like Loans (ELL)/ Grants (CG) | No | $- | 15% | $- | ||
| 2 | CDFI Support Activities: Loans (LNS), CDFI Deposits/Shares (DS), Technical Assistance (TAC) | No | $- | 18% | $- | ||
| 3 | Estimated Award Amount for CDFI Related Activities: | $- | |||||
| DISTRESSED COMMUNITY FINANCING ACTIVITIES | |||||||
| A | B | C | D | E | F | ||
| Reporting | Baseline Period 2009 | Assessment Period 2010 | Change in Activity | Priority Factor | Weighted Value | ||
| 4 | Affordable Home Mortgage Loans (AHM) | No | $- | 5 | $- | ||
| 5 | Affordable Housing Development Loans and Project Investments (AHD) | No | $- | 5 | $- | ||
| 6 | Small Business Loans and Project Investments (SBL) | No | $- | 5 | $- | ||
| 7 | Home Improvement Loans (HIL) | No | $- | 5 | $- | ||
| 8 | Education Loans (EDU) | No | $- | 5 | $- | ||
| 9 | Commercial Real Estate Loans and Project Investments (CRE) | No | $- | 5 | $- | ||
| 10 | Total Score: | $- | |||||
| 11 | Estimated Award Amount for Distressed Community Financing Activities | 9% | $- | ||||
| SERVICE ACTIVITIES | |||||||
| A | B | C | D | E | F | ||
| Reporting | Baseline Period 2009 | Assessment Period 2010 | Change in Activity | Priority Factor | Weighted Value | ||
| 12 | Deposits (D) | No | $- | 5 | $- | ||
| 13 | Community Services (CS) | No | $- | 5 | $- | ||
| 14 | Financial Services (FS) | No | $- | 5 | $- | ||
| 15 | Targeted Financial Services (TFS) | No | $- | 5 | $- | ||
| 16 | Targeted Retail Savings/Investment Products (TSP) | No | $- | 5 | $- | ||
| 17 | Total Score: | $- | |||||
| 18 | Estimated Award Amount for Service Activities | 9% | $- | ||||
| ESTIMATED AWARD | |||||||
| 19 | PRIORITY ONE AWARD (CDFI Related) | $- | |||||
| 20 | PRIORITY TWO AWARD (Distressed Community Financing) | $- | |||||
| 21 | PRIORITY THREE AWARD (Service Activities) | $- | |||||
| 22 | TOTAL ESTIMATED AWARD | $- | |||||
| Instructions: Do not change the formatting, add transactions outside the assessment period, or include blank lines as this will prevent the chart from uploading into the review database. Do not change the formatting under any circumstances. | ||||||||||||
| 2011 BEA Report of Transactions | ||||||||||||
| Column A: | Column B: | Column C: | Column D: | Column E: | Column F: | Column G: | Column H: | Column I: | Column J: | Column K: | Column L: | Column M: |
| Service Provided/Borrower/ Investee | Total Dollar Value or Amount of Transactions |
Amount Disbursed to Date |
Street Address | City | State | Zip (9 digits) | Census Tract (11 digits) | Date of Execution mo/day/yyyy |
Date of Initial Disbursement mo/day/yyyy |
Date of Final Disbursement mo/day/yyyy |
Type of Activity |
Impact |
| For Service Activities, report each activity or transaction carried out during the Assessment Period by the service provided. For all other types of activities, report each activity by the borrower, investee, grantee, CDFI, or other recipient. | For Service Activities, report the grand total of each category of activity. For all other types of activities, report the total original dollar amount of each transaction. | List the total dollar amount disbursed on each transaction by the end of the Assessment Period. For Service Activities, TA provided to CDFIs, and Distressed Community Financing Activities of less than $250,000: record as fully disbursed. | For all Financing Activity transactions: enter the street address of the borrower or the location of the property (in the case of real estate loans). | For all Financing Activity transactions: enter the City of the borrower or the location of the property (in the case of real estate loans). | For all Financing Activity transactions: enter the State of the borrower or the location of the property (in the case of real estate loans). | For all Financing Activity transactions: enter the Zip of the borrower or the location of the property (in the case of real estate loans). | For CDFI Related Activities, leave this column blank. For all other types of activities, list in the census tract (including the state and county code) where the activity occurred or the borrower, investee, grantee, or other recipient is located. | List the date the activity occurred or the transaction was closed. Must occur in 2011. | List the date the Applicant made the initial disbursement. Must occur in 2011. | List the date the Applicant made the final disbursement. Leave blank if the transaction is not fully disbursed. Must be completed by 12/31/2012. | For all activities, select the type of activity using the abbreviations provided below. See sidebar for explanation of abbreviations. | For Distressed Community Financing and Service Activities, see the Application for the appropriate measures of impact. |
| Smith Contracting (example) | $500,000 | $275,000 | 123 Clover Avenue | New York | NY | 11238-1234 | 12345678900 | 2/15/2010 | 2/15/2010 | SBL | 4 | |
| John Smith (example) | $225,000 | $225,000 | 456 Regal Drive | Philadelphia | PA | 19150-1234 | 23456789001 | 9/28/2010 | 9/28/2010 | 9/28/2010 | AHM | 1 |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |