Form SBA Form 468.1 SBA Form 468.1 Partnership SBIC'S SHORT FORM

ANNUAL FINANCIAL REPORT
ON SBA FORM 468
(Corporate SBICs)

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

Name of Licensee:
License Number:
Street Address:
City, State, and Zip Code:
County:
Employer ID Number:
For the Reporting Period Ending:

Months:

----------------~

A- Fund Focus
B- Ownership

SBA Form 468 is to be completed only by small business investment companies (SBICs) licensed by the Small
Business Administration. This form contains financial statements and supplementary information which SBA
uses to evaluate an SBIC's financial condition and compliance with its business plan and SBIC program requirements.
SBA also pools financial information provided by individual SBICs to analyze the SBIC program as a whole with
respect to the risk of financial loss to the government and the impact of SBIC financings on the growth of small
business.
Form 468 must be completed and filed electronically in the SBIC-Web system. Within the system, you may also
upload supplemental documents as the form instructs.
SBIC-Web requires an SBA-approved user account. Submit your account request to sbicwebsupport@sba .gov.

Please Note: The estimated burden for completing this form is 35 hours per response if a wind-up plan is required and 25 hours per response if a
wind-up plan is not required. You will not be required to respond to th is information collection if a valid OMB approval number is not displayed . If
you have questions or comments concerning th is estimate or other aspects of this information collection, please contact the U.S. Small Business
Administration, Ch ief Administrative Information Branch, Washington, D.C. 20416 and/or SBA Desk Officer, Office of Management and Budget,
New Executive Office Build ing, Room 10202, Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB .

SBA Form 468.1 (02/14) Previous edition obsolete.

Page lC

STATEMENT OF FINANCIAL POSITION
ASOF ___________________

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

{Amounts rounded to nearest dollar)
Name of Licensee :

License No.

I

ASSETS

LOANS AND INVESTMENTS:

Unrealized

Unrealized

Cost

Depreciation

Appreciation

Reported
Value (1)

(Col. 1)

(Col. 2)

(Col. 3)

(Col. 4)

Portfolio Securities:
1 Loans
2 Debt Securities
3 Equity Securities
4 Total Portfolio Securities

AssetsAcquiredinUqu~ationofPortfolioSe;c=
ur~H=~=s~=~~~~~~~~~~~~~~~~~~~~~~~~~~~
5 Receivables from Sale of Assets Acquired 1-~~~~~~-+~~~~~~--1~~~~~~~+~~~~~~--1
6 Assets Acquired
7 Total Assets Acquired

8 Operating Concerns Acquired
9 Notes and Other Securities Received

10 TOTAL LOANS AND INVESTMENTS
11Less Current Maturities
12 Loans and Investments Net of Current Maturities
Investment in 301( d) Lr-ic;. e_
. ;. n..:...
se..:...e:....(:..:2~)---------------------,
13 Name/License No.

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CURRENT ASSETS
14 Cash and Cash Equiv aIents

15 Invested Idle Funds
16 Interest and Dividen ds Receivable
17 Notes and Accounts Receivable
18 Receivables from Pa rent or Other Associates
19 Less: Allowance for Losses {lines 16, 17, and 18)

20 Current Maturities of Portfolio Securities
21 Current Maturities of Assets Acquired
22 Current Maturities of Operating Concerns Acquired
23 Current Maturities of Other Securities

24 Other (specify)

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25 Other {specify)

OTHER ASSETS
26 Net Furniture and Equipment
27 Net Leverage Fees
28 Other (specify)

29 Other (specify)

30 TOTAL ASSETS
(1) Column Headings apply to items 1 through 12 only. (Cost- Unrealized Depreciation+ Unrealized Appreciation= Value)
(2) Note to item 13 should include percent owned, cost basis and changes resulting from equity method of accounting.

SBA Form 468 .1 {02/14) Previous edition obsolete.

Page 2C

OMB Approval No. 3245-0063

STATEMENT OF FINANCIAL POSITION
ASOF

-----------------------

Expiration Date mm/dd/yyyy

(Amounts rounded to nearest dollar)
Name of Licensee:

I

License No.

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LIABILITIES AND CAPITAL
Liabilities
Long-Term Debt
31 Notes and Debentures payable to or guaranteed by SBA
32 Notes and Debentures Payable to Others
33 a. 4% Redeemable Preferred Stock (30l(d) Licenses Only)
b. Cumulative Undeclared 4% Dividends

Current Liabilities
34 Accounts Payable
35 Due to Parent or Other Associates
a. Management Exp enses Due to Associates
b. Other Due to Ass ociates
36. Accrued Interest Pa yable
37. Accrued Taxes Paya ble
38. Dividends Payable
39. Short-term notes Pa yable/Lines of Credit

40 Other (specify)
41 Other (specify)

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Other Liabilities
42 Deferred Credits
43 Deferred Fee Income

44 Other (specify)

r-----------------------------~

45 Total Liabilities
CAPITAL
46 Capital Stock
47 Paid-in Surplus
48 Restricted Contributed Capital Surplus
49 Capital Stock and Surplus
50 3% Preferred Stock Purchased by SBA
51 Unrealized Gains (Loss) on Securities Held
52 Non-Cash Gains/Income
53 Undistributed Net Realized Earnings
a. Restricted (Equal to Cost ofTreasury Stock)
b. Unrestricted
c. Total (53a plus 53b)
54 Undistributed Realized Earnings (line 52 plus lin e 53c)

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55 Total
56: Less: Cost of Treasury Stock

57 TOTAL CAPITAL
58 TOTAL LIABILITIES AND CAPITAL (LINES 45 AND 57)
SBA Form 468.1 (02/14) Previous edition obsolete.

Page 3C

STATEMENT OF OPERATIONS REALIZED
For
MONTHS ENDED _ _ __

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

(Amounts rounded to nearest dollar)
Name of Licensee :

I

License No.

INVESTMENT INCOME
11nterest Income
2 Dividend Income
3 Income (Loss) from Investments in Partnerships/Flow-through Entities
4 Income (Loss) from Investments in Section 301(d) Licensee
5 Fees for Management Services
6 Application, Closing and Other Fees
7 Interest on Cash Equivalents and Invested Idle Funds
8 Income from Assets Acquired in Liquidation of
Loans and Investment (net of$ _ _ _ _ _ Expenses)
9 Other Income

10 GROSS INVESTMENT INCOME
EXPENSES
lllnterest Expense
a. Interest Expense-- SBA Debentures
b. Other Interest Expense

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12 Commitment Fees & Other Financial Costs
13 Compensation and Benefits (Officer and Employee)
14 Investment Advisory and Management Services
15 Director's and Stockholder's Meetings
16 Appraisal and Investigation
17 Advertising, Communication and Travel
18 Cost of Space Occupied
19 Depreciation and Amortization
a. Amortization of Leverage Fees
b. Other Depreciation and Amortization

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20 Insurance
21 Payroll and Other Taxes
22 Provision for Losses on Receivables (exclud ing loans receivable)
23 Legal Fees
24 Audit and Examination Fees
25 Miscellaneous Expenses

a. Misc. #1 .-~------------------------------~
b. Misc. #2

c. Misc. #3
d. Misc. #4
e. Misc. #5
f . Misc. #6

26 TOTAL EXPENSES
27 NET INVESTMENT INCOME (LOSS)
28 NET REALIZED GAIN (LOSS) ON INVESTMENTS (1)
29 NET INCOME (LOSS) BEFORE NONRECURRING ITEMS
30 Extraordinary Item
31 Cumulative Effect of Change in Accounting Principle

32 NET INCOME (LOSS)
(1} Provide supporting detail for all realized gains and losses on Page 13C of this form.

SBA Form 468.1 (02/14) Previous edition obsolete .

Page 4C

STATEMENT OF CASH FLOWS
For
MONTHS ENDED----

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

(page 1 of 2}
(Amounts rounded to nearest dollar)
Name of Licensee:

I

License No .

OPERATING ACTIVITIES
Cash Inflows
11nterest Received from Portfolio Concerns
2 Dividend Received from Portfolio Concerns
3 Other Income Received from Portfolio Concerns
4 Management Services and Other Fees Received
5 Interest on Cash Equ ivalents and Invested Idle Funds
6 Cash Received from Assets Acquired in Liquidations
7 Other Operating Cash Receipts
Cash Outflows
8 Interest Paid
9 Commitment Fees and Other Financial Costs
10 Investment Advisory and Management Fees
11 Officers, Directors and Employees' Compensation and Benefits
12 Operating Expend itures (Excluding Compensation and Benefits)
13 Income Taxes paid
14 Other Operating Cash Disbursements
15 NET CASH PROVIDED BY (USED IN} OPERATING ACTIVITIES

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INVESTING ACTIVITIES
Cash Inflows
16 Loan Principal Payments Received from Portfolio Concerns
17 Returns of Capital Received from Portfolio Concerns
18 Net Proceeds from Disposition of Portfolio Securities
19 Liquidation of Idle rF..:..u.;.;.nd..:..s:.....;.;..ln;.;.v..:.es:...:t..:..m..:..e:...:..n;.;.ts;:..__ _ _ _ _ _ _ _ _ _ _ _
1
20 Other (Specify)
Cash Outflows
21 Purchase of Portfolio Securities
22 . Loans to Portfolio concerns
23 Idle Funds Investment
24 Other (Specify)
25 NET CASH PROVIDED BY (USED IN) INVESTING ACTIVITIES

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FINANCING ACTIVITIES
Cash Inflows
26 Proceeds from Issuance of SBA-Guaranteed Debentures
27 Proceeds from Non-SBA Borrowing
28 Proceeds from Sale of Stock or Other Capital Contribution
29 Other (Specify)
Cash Outflows
30 SBA Leverage Fees
31 Principal Payments on SBA-Guaranteed Debentures
32 Principal Payments on Non-SBA Borrowing
33 Redemption of 4% Preferred Stock
34 Redemption of 3% Preferred Stock
35 Redemption of Stock (excluding 3% and 4% Preferred)
36 Dividends Paid
37 Other (Specify)
38 NET CASH PROVIDED BY (USED IN} FINANCING ACTIVITIES

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r---------------------,

SBA Form 468.1 (02/14) Previous edition obsolete.

Page SC

OMB Approval No. 3245-0063

STATEMENT OF CASH FLOWS
For

MONTHS ENDED _ _ __

Expiration Date mm/dd/yyyy

(page 2 of 2}
(Amounts rounded to nearest dollar)
Name of Licensee :

I

License No.

39 INCREASE (DECREASE} IN CASH AND CASH EQUIVALENTS
40 CASH AND CASH EQUALENTS AT BEGINNING OF PERIOD
41 CASH AND CASH EQUIVALENTS AT END OF PERIOD (line 14, page 2C)

42 Net Income (Loss) (Line 32, page 4C}
Adjustments to Reconcile Net Income (Loss) to Net Cash Provided by (used in) Operating Activr-it_ie_s_: _ _ _...,
43 Depreciation and Amortization (line 19, page 4C)
44 Provision for Losses on Accounts Receivable (line 22, page 4C)
45 Provision for Deferred Income Taxes
46 Realized (Gains) Losses on Investments (line 28, page 4C)
47 Other

(Sp,r-e_c_ify:..:.)_.:::===========:;----~

~: It-----~

§

Changes in Operating Assets and Liabilities Net of Noncash Items
48 (Increase) Decrease in Interest and Dividends Receivable
49 (Increase) Decrease in Other Current Assets
50 Increase (Decrease) in Accounts Payable
51 Increase (Decrease) in Accrued Interest Payable
52 Increase (Decrease) in Accrued Taxes Payable
53 Increase (Decrease) in Dividends Payable
54 Increase (Decrease) in Other Current Liabilities
55 Other (Specify)
56 Other (Specify)
57 NET CASH PROVIDED BY (USED IN} OPERATING ACTIVITIES
(Total must agree with line 15, page SC}

Supplemental disclsure of non-cash financing and investing activites may be required .
See ASC 230, "Statement of Cash Flows."

SBA Form 468 .1 (02/14) Previous edition obsolete .

Page 6C

STATEMENT OF STOCKHOLDER'S EQUITY

OMB Approval No. 3245-0063

ASOF

Expiration Date mm/dd/yyyy
(page 1 of 2)

(Amounts rounded to nearest dollar)
Name of Licensee :

PART I. CAPITAL STOCK AND PAID-IN SURPLUS

License No.

I

CAPITAL
STOCK
(page 3P, line 46a)

PAID-IN SURPLUS

TOTAL

NON-CASH
GAINS/INCOME

UNDISTRIBUTED NET
REALIZED EARNINGS

UNDISTRIBUTED
REALIZED EARNINGS

(1)

(2)

(1) + (2)

1 BALANCE AT BEGINNING OF PERIOD
2 ADDITIONS:
a. Capital stock issued for cash
b. Capital stock issued for services rendered
c. Capital stock issued for contributed non-cash assets
d. Capitalization of Retained Earnings Available for Distribution
e. Gain on Sale of Treasury Stock
f . Other credits (specify) _ _ _ _ _ _ _ _ _ _ _ __
3 Total additions (sum of 2a through 2f)
4 Subtotal (line 1 plus line 3)
S DEDUCTIONS:
a. Retirement of capital stock
b. Return of capital distributions
c. Loss on sale of Treasury Stock
d. Other debits (specify) _ _ _ _ _ _ _ _ _ _ _ __
6 Total deductions (sum of Sa through Sd)
7 BALANCE AT END OF PERIOD (line 4 minus line 6)-Total must agree with lines 46 and 47, page 3C

PART II. UNDISTRIBUTED REALIZED EARNINGS
1 BALANCE AT BEGINNING OF PERIOD
2 ADDITIONS:
a. Net investment income
b. Realized gain (loss) on investments
c. Gain on appreciation of securities distributed in kind
d. Other (specify) _ _ _ _ _ _ _ _ _ _ __
3 Total additions (sum of 2a through 2d)
4 Subtotal (line 1 plus line 3)
S DEDUCTIONS:
a. Dividends- Cash
b. Dividends - Stock
c. Dividends- In-Kind (at fair value)
d. Capitalization of Retained Earnings available for Distribution
e. Other (specify) _ _ _ _ _ _ _ _ _ _ __
6 Total deductions (sum of Sa through Se)
7 Total before collection of non-cash gains/income
(line 4 minus line 6)
8 Collection of non-cash gains/income
9 BALANCE AT END OF PERIOD (line 7 plus line 8)Totals must agree with lines 52, 53c and 54, page 3C

SBA Form 468 .1 (02/14) Previous edition obsolete.

Page 7C

I. RETAINED EARNINGS AVAILABLE FOR DISTRIBUTION
II. REGULATORY AND LEVERAGEABLE CAPITAL

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

ASOF -------------(Amounts rounded to nearest dollar)
Name of Licensee:

I

License No.

PART I. RETAINED EARNINGS AVAILABLE FOR DISTRIBUTION OR CAPITALIZATION.
1 Undistributed net Realized Earnings (line 53b, page 3C)
2 LESS: Unrealized Depreciation (line 10, column 2, page 2C)
3 ADD: Cumulative Unpaid distributions on 4% Redeemable
Preferred Stock--Section 301(d) Licensees only {line 33b, page 3C)
4 RETAINED EARNINGS AVAILABLE FOR DISTRIBUTION OR CAPITALIZATION

PART II. SCHEDULE OF REGULATORY AND LEVERAGEABLE CAPITAL
1 Capital Stock and Paid-in Surplus (sum of lines 46 and 47, page 3C)
2 ADD: Unfunded binding commitments from Institutional Investors
3 LESS : Regulatory Distributions
a. Organization Expenses Not Approved by SBA (1)
b. Capital Stock Issued for Services
c. Capital Stock Issued for Non-cash Assets (unless approved by
SBA for inclusion in Regulatory Capital or converted to cash)
d. Treasury Stock at Cost
e. Other (specify) _ _ _ _ _ _ _ _ _ _ _ __
4 Total Regulatory Deductions (Sum of 3a through 3e)
5 Other Adjustments to Regulatory Capital (specify) _ _ _ _ _ _ _ _ _ _ _ __

6 REGULATORY CAPITAL (sum of lines 1, 2, 4, and 5)
7 LESS : Unfunded binding commitments from Institutional Investors

8 LESS: Non-cash assets included in Regulatory Capital, other than eligible investments in Small Concerns
9 LESS: Other deductions (specify) - - - - - - - - - - - - - - - - - 10 LEVERAGEABLE CAPITAL (sum of lines 6 through 9}

PART lla. ADJUSTMENT TO REGULATORY CAPITAL FOR CAPITAL IMPAIRMENT AND OVERLINE PURPOSES
PART 1/a ONLY APPLIES IF LICENSEE HAS COMPLETED THE REPURCHASE OF ITS 3% PREFERRED STOCK FROM SBA.

11 REGULATORY CAPITAL (Part II, line 6}

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12 ADD: Restricted Contributed Capital Surplus {line 49, page 3C)

1--------1

13 ADJUSTED REGULATORY CAPITAL FOR CAPITAL IMPAIRMENT AND OVERLINE PURPOSES (line 11 plus line

L...-------------1

NOTES
(1) Deduct only those organizational expenses which were not accepted as reasonable by SBA.

SBA Form 468.1 (02/14) Previous edition obsolete .

Page 8C

SCHEDULE OF COMMITMENTS
ASOF

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

Amount of
Name of Small Business

SBA Form 468.1 (02/14) Previous edition obsolete.

Employer ID

Commitment

Date Made

Expiration Date

Loan, Debt, or
Equity?

New investment or
follow-on?

Page 9C

SCHEDULE OF GUARANTEES
ASOF

Name of Small Business I Employer ID

SBA Form 468.1 (02/14) Previous edition obsolete .

Guarantee
Amount

Date
Made

Expiration Date

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Name of Guaranteed
Party

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Is guarantee
collaterialized? If so, by Description of underlying
what?
obligation of Small Business

Page lOC

OMB Approval No. 3245-0063

SCHEDULE OF LOANS AND INVESTMENTS

SCHEDULE 1

Expiration Date mm/dd/yyyy

ASOF

License No.

Name of Licensee :

I

Note: Items in red font only apply to SBICs in the Office of Liquidation or as specifically requested by SBA.
Portfolio Company Name

I

Employer ID

Loans and Investments (ordered bv date ascendin1d
mma1 mvest.
Amount
Investment Date
Investment Type
Other Notes:
Smaller Enterprise?
Comments:

% Own

\..OSt at tseg. or
Period

I

%Vote

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AODitiOnS/
Deductions

Unrealized App (Dep)

Cost at End of Period

uescnptlon or
Addition/Deduction

Number of Shares:
!Market/Liquidity:

Expiration Date :

Other type of OL Asset? __ If yes:

LoanLDebt Information
Maturity Date :
Repay. Terms :
Collateral :
Date of Last Payment:
Balloon Payment Due :

Type :
Amount:

SBA Form 468.1 (02/14) Previous edition obsolete.

cost at Ena ot
Period

I

unreauzea App
(Dep)

Total Reported Value

Reported Value

Class I and II A~~reciation
Class I Appreciation Amount:
Class II Appreciation Amount:
If Class II, Date of Up Round?

Qualifies as start-up per CFR 107.50?1
Equity Capital? I

Eguitlllnformation
Type of Shares:
Equity Features:

Warrants? Terms :

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Description of Asset:
Description of Liens:

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Type :

Status :!
Interest Rate :

Balloon % at maturity:
Future Estimated Recoveries:
Date Investment Concluded:

Page llC

OMB Approval No. 3245-0063

1 A. SUMMARY OF LOANS AND INVESTMENTS

SCHEDULE 1 A/B

Expiration Date mm/dd/yyyy

1 B. SMALLER ENTERPRISE FINANCINGS
ASOF

Name of Licensee:

I

License No.

i

1 A. SUMMARY OF LOANS AND INVESTMENTS
1

2

3

4

5

Cost at Beginning

Additions/

Cost at End of

Appreciation

of Period

(Deductions)

Period

(Depreciation)

6

Unrealized
Investment Category

Reported Value

Total Loans {line1, page 2C}
Total Debt Securities {line 2, page 2C}
Total Equity Securities {line 3, page 2C}
Total Portfolio Securities (line 4, page 2C)

Total Assets Acquired {line 7, page 2C}
Total Operating Concerns Acquired {line 8, page 2C}
Total Notes and Other Sees. Received {line 9, page 2C}
Total Loans and Investments (line 10, page 2C)

1 B. SMALLER ENTERPRISE FINANCINGS

1 Cumulative dollar amount of Smaller Enterprise Financings extended between April 25, 1994 and close of reporting fiscal year.

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2 Cumulative dollar amount of all Financing extended between April 25, 1994 and close of reporting fiscal year.

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3 Percentage of total Financings extended to Smaller Enterprises {line 1 divided by line 2)

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SEE 13 CFR 107.710 FOR PERCENTAGE OF TOTAL FINANCING$ WHICH MUST BE IN SMALLER ENTERPRISES.

SBA Form 468.1 {02/14) Previous edition obsolete.

Page 12C

OMB Approval No. 3245-0063

SCHEDULE OF REALIZED GAINS AND

SCHEDULE 2

Expiration Date mm/ddfyyyy

LOSSES ON LOANS AND INVESTMENTS
FOR
MONTHS ENDED

Name of Small Business I Employer

Security

10

/

___

!Transaction Type
Date

/

I

Net Sales
Price

Realized
ies to sales and l!'xchang""§!

Cost

__
Escrow Exp. Comments

(1) Security Type: L= Loans, D=Debt, E=Equity, AA=Assets Acquired, OC=Operating concerns acquired, NS=Notes and Other Securities Received
(2) Transaction Type: S= Sale, E=Exchange, C=Charge-off, D=Distribution of Securities
SBA Form 468.1 (02/14) Previous edition obsolete .

Page 13C

OMB Approval No. 3245-0063

SCHEDULE OF NON-CASH GAINS/INCOME

SCHEDULE 3

Expiration Date mm/dd/yyyy

ASOF

I

Name of Licensee:

!

License No.

2

1

3

4

5

6

7

Collections

Balance at End of

Amount of "Includible Non-cash

Additions

During Period

Period

Gains" for Capital Impairment

Balance at
Name of Small Business I

Description of Non-cash

Beginnning of

Employer ID

Gains/Income (1)

Period

TOTAL
-~

(1) Examples of non-cash gains and income include the following:
- Non-cash gains on sale or exchange of securities
- Interest income accrued on deferred interest notes, zero coupon bonds or similar instruments
- Dividends received in kind
-Accrued interest converted into a new note or added to principal of an existing note. The amount of any such interest which was previously includ_ed in Undistributed
Net Realized Earnings must be reclassified to Non-cash Gains/Income.

SBA Form 468.1 (02/14) Previous edition obsolete .

Page 14C

SCHEDULE 4

SCHEDULE OF DELINQUENT
LOANS AND INVESTMENTS
ASOF

Interest
Name of Small Business I
Emolover ID

Outstanding
Princioal Balance

I

Amount Past
Due

I

Days Past
Due Ill

I

Amount
Past Due

I

Days Past
Due

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

Amount of Last P:ovmo>nt

Date of Last

Interest

Interest

Fair Makrket
Value OF
Collateral

(1) Based on oldest delinquency.
SBA Form 468.1 {02/14) Previous edition obsolete.

Page 15C

SCHEDULE 5

SCHEDULE OF CASH AND INVESTED IDLE FUNDS
ASOF

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
License No.

Name of Licensee:

COMPLETE SCHEDULE ONLY IF LICENSEE HAS, OR PLANS TO APPLY FOR, SBA LEVERAGE.
I. U.S. GOVERNMENT OBLIGATIONS (direct or guaranteed)
Description

Maturity Date

Amount

II. REPURCHASE AGREEMENTS WITH FEDERALLY-INSURED INSTITUTION
Name and Location of Financial Institution

Maturity Date

Amount

Ill. CERTIFICATES OF DEPOSIT ISSUED BY FEDERALLY-INSURED INSTITUTIONS
Name and Location of Financial Institution

Maturity Date

Amount

IV. DEMAND DEPOSIT, MONEY MARKET, AND SAVING ACCOUNTS IN FEDERALLY-INSURED INSTITUTIONS
Name and Location of Financial Institution

Maturity Date

Amount

Maturity Date

Amount

V. OTHER CASH AND INVESTED IDLE FUNDS
Description

TOTAL CASH, CASH EQUIVALENTS AND IDLE FUNDSL...------------'
(total must agree with sum of lines 14 and 15, page 2C)

SBA Form 468.1 (02/14) Previous edition obsolete.

Page 16C

SCHEDULE 6

SCHEDULE OF ACTIVITY

OMB Approval No. 3245-0063

ASOF
Name of Licensee :

Expiration Date mm/dd/yyyy
License No.

PART I. FIRST ACTIVITY TEST

1. Cash and Cash Equivalents (line 14, page 2C}
2. Invested Idle Funds (line 15, line 2C}
3. Total Cash and Idle Funds
4 . Total Assets at Cost:
a. Total Assets (line 30, page 2C}
b. ADD: Unrealized Depreciation (line 10, col. 2, page 2C}
c. LESS: Unrealized Appreciation (line 10, col 3, page 2C}
d . Total Assets at Cost
5. Line 3 Divided by Line 4d (expressed as a percentage)

IF LINE 5 IS LESS THAN OR EQUAL TO 20%, LICENSEE IS NOT INACTIVE-- DO NOT COMPLETE PART II
IF LINE 5 IS GREATER THAN 20%, COMPLETE THE SECOND ACTIVITY TEST IN PART II

PART II. SECOND ACTIVITY TEST
6. Financings during the Past 18 Months :
a. Loans
b. Debt
c. Equity
d. Guarantees
7. Total (lines 6a through 6d)
8. Regulatory Capital
9. Line 7 divided by Line 8 (expressed as a percentage)

IF LINE 9 IS LESS THAN 20%, LICENSEE MAY BE INACTIVE UNDER SECTION 107.590ATIACH EXPLANATION OF INACTIVITY AND PLANNED CORRECTIVE ACTION .

SBA Form 468.1 {02/14) Previous edition obsolete .

Page 17C

SCHEDULE 7

SHAREHOLDERS, OFFICERS, DIRECTORS AND MANAGEMENT
ASOF

Name and Address

Expiration Date mm/dd/yyyy

I

Name of Licensee:

1

OMB Approval No. 3245-0063

2

OfficerI DirectorI
Manager -- give exact
titles

SBA Form 468.1 (02/14) Previous edition obsolete.

License No .

5

3

4

Title of Class
Owned or

Shares legally
owned,
beneficially
owned, or

Number of

Controlled

controlled?

Shares

6
Percent Owned or Controlled of Total
Class
Beginning of Period

I

End of Period

Page 18C

OPERATING PLAN UPDATE

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

Name of Licensee :

I

I

License No.

INSTRUCTIONS

Any Licensee which has SBA leverage outstanding, or which expects to apply for leverage in the current fiscal
year, must prepare an annual update of its plan of operations. The update is one of the supplementary
information documents that is filed with the Licensee's Annual Financial Report on SBA Form 468, and must be
uploaded within the SBIC-Web system as a .pdf document.

The plan update must include analysis and discussion of key events of the past year, as well as expectations for
the current year. SBA expects that most Licensees will be able to provide the required information in a
narrative of no more than 3 pages.
Content of the Report

1. For the fiscal year ended, the Licensee should discuss the following :
a.
Major positive and negative events which affected overall performance during the year, including
exits/distributions/write-offs of investments; highlight any significant differences between last year's
plan and actual performance.
b. Any significant changes in the operations of the Licensee, such as changes in organizational structure,
scope of operations, level or phase of investment activity, or types of investments being made .
c. Any management changes.
d. Any lawsuits or other events giving rise to contingent liabilities.
2. For the current fiscal year, the Licensee should discuss the following:
a. Levels of new and follow-on investment anticipated
b. Anticipated exits/distributions/write-offs from investments
c. Any material changes expected in investment strategy or portfolio composition
d. Any material changes expected in overhead expenditures
e. Any changes expected in management
f. Any other anticipated events which may have a significant effect on Licensee's performance.
3. If an SBIC is in Liquidation, wind-up or has been otherwise requested to provide a wind-up plan, the SBIC
shall provide a wind-up plan as part of the Operating Plan Update. Per 13 CFR 107.590, SBICs in Operations
must submit wind-up plans for SBA approval. After SBICs receive approval, they should provide updated windup plans on an annual basis as part of this Operating Plan Update. (See attached supplement.)

SBA Form 468.1 {02/14) Previous edition obsolete .

Page 19C

SCHEDULE 8

Unaudited Portfolio Company Information

OMB Approval No. 3245-0063

ASOF

Expiration Date mm/dd/yyyy

Name of Licensee :

License No. J

Note: Items in red font only apply to SB/Cs in the Office of Liquidation or as specifically requested by SBA

I

Portfolio Company Name

Employer ID

I
General Portfolio

I

%Own

I

I

%Vote

Cost at End of Period

1st Date Invested :
Current stage :

I

Exchange:!

NAICS:

Rounded to nearest$

....

I

I

Overline?

I

I

Stock Symbol:!

Add"'"

I
I

ILMI :

I

Portfolio Com~anl£ Waterfall

Period 3

Revenues
Gross Profit
EBITDA
Interest Charges
Net Income

.... ,

I

~I

i

I

Cashflow from Ops .
Burn Rate
Cash Balance
Current Assets
Fixed Assets
Total Assets
Current Liabilities
Debt
Total Liabilities
EOY Equity Value (Market)
EOY Enterprise Value
Additional Information for Most Recent FY End for SBICs in Liguidation
Financial Statement Type :
Statement Opinion:
Statement Notes:
_ Signficant Litigation
_ Going Concern
If other explain:

Other Comments:

I

Portfolio Comoanv Financial Information
Period 1
Period 2

As of Date

If orignal investment company's name changed, was acquired/merged,
company name of original investment: I

City/State:
Zip Code:

Total Reported Value

I

Com~anl£lnformation

Business Description

Unrealized App (Dep)

I

Economic Data for Recent FY End
Full-time employees:
Federal Taxes Paid:

Other

State Taxes Paid:

Spreadsheet Uploaded:

Instructions: Upload waterfall spreadsheet if you hold an equity investment in the portfolio company or you hold warrants that you have valued over cost. Waterfall information should
minimally include all financings since your initial investment,including those in which you did not participate . Information should include all relevant information associated with each
security, including: date closed, security issued, post-money valuation associated with round, total round size, SBIC's participation within round, co-investors in round (representing over
10% of round), liquidation preferences, seniority, accruing dividends, etc ...
If the SBIC has been transferred to the Office of Liquidation, you must also describe any investor rights you hold, such as negative covenants, board membership or observation rights, or
other rights (such as veto or springing) .

SBA Form 468.1 (02/14) Previous edition obsolete.

Page 20C

CERTIFICATIONS

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

Name of Licensee :

I

I

License No.

MANAGEMENT CERTIFICATION
I,
(License), do hereby certify as follows :

the Chief Financial Officer of
submittted by

1. The audited Financial Report for the fiscal year end

2.
(Licensee) has filed all federal, state and local tax returns required through
the date hereof, including but not limited to income and payroll tax returns .
STATEMENTS AND SCHEDULES OMITIED :

CAUTION: By signing below, you are certifying as to the truth and accuracy of the audited Annual Financial Report in all
respects, and acknowledging that officials in the Small Business Administration (SBA) will be relying on this certification.
Knowingly making a false statement to or concealing a material fact from the SBA can lead to imprisonment of up to 30
years and/or a fine of up to $1,000,000 under 18 U.S.C. § 1014.
Date:

By:
Name:
Title:

SECRETARY'S CERTIFICATION

I,

1.

the duly elected, qualified and acting Secretary of
(Licensee), do hereby certify as follows:
(Licensee) is in good standing under the laws of the State of

2. The minutes of the meeting of the Board of Directors of
(Licensee) on
document that the Board at such meeting, reviewed and approved the audited Annual Financial
Report of such company for the fiscal year ended
CAUTION: By signing below, you are certifying as to the truth and accuracy of the audited Annual Financial Report in all
respects, and acknowledging that officials in the Small Business Administration (SBA) will be relying on this certification.
Knowingly making a false statement to or concealing a material fact from the SBA can lead to imprisonment of up to 30
years and/or a fine of up to $1,000,000 under 18 U.S.C. § 1014.

Date:

By:
Name:
Title :

SBA Form 468.1 (02/14) Previous edition obsolete.

Page 21C

SBA Form 468 Operating Plan Update Supplement: Wind-up Plan for Specified SBICs
As
SBIC:

ofl

OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy

12/31/20131

L

I

License Number!

Note: Detail for proceeds from income and exits and follow-on investments are on separate schedules.
Capital & Beginning Balances

Cash & Cash Equivalents BalanceL.I_ _ _ _ ___J

Total Capital Committed to Fundt--------i
Total Private Capital Paid l n f - - - - - - - - i
Total Regulatory Distributionst--------i
Total Non-regulatory Distributions I - - - - - - - t
Leverageable Capital Balancet--------i
Unfunded Regulatory Commitments
t-------1
Regulatory Capital.__ _ _ _ __.

Total SBA Leverage Drawnl--------i
Total Redemptions I - - - - - - - t
Total Non-redemption SBA Distributionsl--------1
SBA Leverage Balance I - - - - - - - t
Unfunded SBA Leverage Commitments I - - - - - - - I
Earned Prioritized Payment Balancel--------1
Unearned Prioritized Payment BalanceL-------l

Pro Forma Cash Flows

1/1/2014 to
12[31[2014

In thousands of$
Cash In Flows
Private Capital Draws (Paid In)
SBA Leverage/Loan Draws
Idle Interest & Other Income

I

2015

I

2016

I

Post

2016

Pro
Forma
Total

Comments

I

Loan & Investment Income/Proceeds (Schedule A)
Cash Out Flows
Expenses
Management Fees
SBA Interest, Leverage Fees, & Annual Charges
Other Expenses
Investments (Follow-Ons) (Schedule B)

~-------------~--~

LP Distributions
READ
Return of LP Capital
Total to LPs
SBA Distributions
SBA Leverage Redemptions
If Participating, Other SBA Distributions
Total SBA Distributions

CashOut~------~------~~--------------~------~----------------------~

Net Cash Flow
Ending Balances
RegCap
Leverageable Capital
SBA LevBalance
Cash & Cash Equivalents

12/31/2013

-

Unfunded Private Commitments

-

Unfunded SBA Commitments

-

SBA Form 468.1 (02/14) Previous edition obsolete.

-

-

-

-

-

-

-

-

-

-

-

-

-

Operating Plan Supplement Page 1

SBA Form 468 Operating Plan Update Supplement: Wind-up Plan for Specified SBICs
Schedule A- SBIC Forecast Anticipated Income/Proceeds

Expiration Date mm/dd/yyyy

- -:::J

As of: I
SBIC Name

OMB Approval No. 3245-0063

I

License NumberJ

Anticl ated Exit Proceeds

E..,
~.. ~>

~

Portfolio Company Name

Timin of Likely Exit Income/Proceeds

Liquidations Only

Total Future
Cost of

"

Ant. Exit

468 Reported
Val

Invest.

Type

Minimum

Thru end of
Current Year

Likely

Maximum

2016

2015

Post 2016

-

Estimated

Source of

Recoveries

FMV

Actual Cum.
Cash Receipts
Est. Exit Year

inOL

Date Concluded

Comments:

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

I

l

I

-T

I

I

I

I

I

I

I

Comm ents:

- l

Comments:
---------

ITOTALS

I$

SBA Form 468.1 (02/14) Previous edition obsolete.

$

$

$

$

$

$

$

I$

-~-]

I$

I$

I$

Operating Plan Supplement Page 2

I

SBA Form 468 Operating Plan Update Supplement: Wind-up Plan for Specified SBICs

OMB Approval No. 3245-0063

Schedule B- Anticipated Follow-on Investments for Wind-up Plan

Expiration Date mm/dd/YYYYI
As of: I

SBIC Name

l

I

l

License Number[

An :icipated Follow-on Investments

Timing of SBIC Follow-On

Investment
Company Name

Type

Small Business
Total Round Size

SBIC's Pro-Rata
Investment

SBIC Follow-on
Participation

Thru end of
Current Year

2015

2016

Post 2016

Comments

-

Totals

SBA Form 468.1 (02/14) Previous edition obsolete.

1

Operating Plan Supplement Page 3