Form NCUA 4001 NCUA 4001 Conversion of State Charter to Federal Charter, Federal

CONVERSION OF STATE CHARTER TO FEDERAL CHARTER

FEDERAL CREDIT UNION INVESTIGATION REPORT
This report must be filled in completely and submitted with the other completed forms listed
in the instructions to this form.
A. INFORMATION FOR CHARTER AND BYLAWS
1. Proposed Name:
Second Choice of Name:
2. Contact Person:
Bus. Tel. No./Area Code:
Res. Tel. No./Area Code:
3. The credit union will remain its office at:

3a. Proposed permanent mailing address
of credit union

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4. Define proposed field of membership:

5. The board will have (an odd number 5 to 15)
members; the credit committee (an odd number, 3 to 7)
members; the supervisory committee (3 to 5)
members. Each official must complete a Report of
Official and Agreement to Serve (NCUA 4012) which is to be submitted with this investigation report.

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B. ECONOMIC ADVISABILITY OF ORGANIZING PROPOSED CREDIT UNION
Attach a separate sheet if space available is not adequate

GENERAL INFORMATION
1. Potential membership:
NOTE: Number of employees for occupational, active
members for associational (or families for religious
groups), or population per most recent census for
community-type fields of membership

2. Potential interest (survey results)
NOTE: Sample must consist of a minimum of 250 potential members. Copy of survey
form(s) utilized should be attached.

Number of people surveyed:
Number of people responding to survey:
Number of people pledging an initial deposit:
Total dollars pledged:

$

Number pledging systematic savings:
Total dollars pledged (per month):

$

3. Number of persons attending the
charter-organization meeting:
4. Attach a business plan containing, at a minimum, the following elements:
- mission statement
- analysis of market conditions, including if applicable, geographic, demographic,
- employment, income, housing, and other economic data;
- evidence of member support;
- goals of shares, loans, and for number of members;
- financial services needed/desired;
- financial services to be provided to members of all segments within the field of
membership;
- how/when services are to be implemented;

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- organizational/management plan addressing qualification and planned training
of officials/employees;
- continuity plan for directors, committee members, and management staff;
- operating facilities, to include office space/equipment and supplies, safeguarding
of assets, insurance coverage, etc.;
- type of record keeping and data processing system;
- detailed semiannual pro financial statements (balance sheet, income and expense
projections) for 1st and 2nd year, including assumptions - e.g., loan and dividend rates;
plans for operating independently;
- written policies (shares, lending, investments, funds management, capital
accumulation, dividends, collections, etc.);
- source of funds to pay expenses during initial months of operation, including any
subsidies, assistance, etc., and terms or conditions of such resources; and
- evidence of sponsor commitment (or other source of support) if subsidies are critical
to success of the federal credit union, Evidence may be in the form of letters, contracts,
financial statements from the sponsor, and any other such document on which the
proposed federal credit union can substantiate its projections.
5. What potential difficulties do you detect in the elected officials carrying out their management
responsibilities or in the FCU achieving its stated objectives?

6. What provisions have been made to overcome potential difficulties?

First Contact Date:
Second Contact Date:
Third Contact Date:
Dates of planned contacts by organizer
to determine progress and to assist the group:

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SPECIFIC INFORMATION - OCCUPATIONAL (same company) CHARTER APPLICANTS
1. How long has the sponsor company been in existence?
2. What was the highest number of employees during the past 3 years?
Lowest number during the past three years?
If a large variance, please explain.

3. Are there any contemplated changes in the corporate
structure of the company?

Yes

No

4. Have there been any significant changes in the
corporate structure in the past three years?

Yes

No

Yes

No

If yes, please explain.

5. Are there negotiations now in progress between
management and labor that could lead to work stoppages?
If yes, please explain.

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6. If the credit union cannot operate on the employer's property, explain how the credit union will
be able to transact business effectively with the members.

7. If the employees to be served by the credit union work in more than one location or city,
identify each location with the corresponding number of employees working at each.

Location

Number of Employees

8. Are there other employees of the company
who are not being included in the proposed
field of membership?

Yes

No

If so, give the the number and location of the other employees and explain why they are not
included in the proposed credit union's field of membership.

Number of Employees

Location

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SPECIFIC INFORMATION - OCCUPATIONAL (trade, industry or profession)
CHARTER APPLICANTS
1. Explain how the credit union will be able to transact business effectively with the members.

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SPECIFIC INFORMATION - ASSOCIATIONAL CHARTER APPLICANTS
1. State the purpose and goals of the organization sponsoring this charter.

2. List the types of activities and their frequency, which the organization sponsors that
provide contact among the members and from which common loyalties, mutual benefits,
and mutual interests are developed.

3. In what year was the organization established?
Is it incorporated?
Where is the headquarters located?
4. Give statistics as to trends in membership during the last five years.

5. What is the frequency of membership meetings?
Average attendance:
Dues required:

$

6. State the geographic territory where members reside.
7. Submit a copy of current bylaws of the association, the constitution, articles of incorporation,
or equivalent documentation and recent financial statements, i.e. balance sheet, and income
and expense statement, with this application.
8. If the bylaws, constitution, articles of incorporation, or equivalent documentation provide for
more than one type of membership and if all classes of membership are to be included in
the credit union's field of membership, provide justification for the inclusion of other than
"regular" members.

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SPECIFIC INFORMATION - MULTIPLE COMMON BOND CHARTER APPLICANTS
1. Explain how the credit union will be able to transact business effectively with the members.

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SPECIFIC INFORMATION - COMMUNITY CHARTER APPLICANTS

1. Community charters must be based on a well-defined local community, neighborhood,
or rural district where individuals have common interests and/or interact. Please refer
to Chapter 2, Section V of the "Charter and Field of Membership Manual" when
answering this question.

2. Provide a map which clearly outlines the credit union's proposed community boundaries
and identify proposed service facilities.

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C. CHARACTER AND FITNESS OF SUBSCRIBERS
1. List of subscribers who have signed the Organization Certificate (7 not more than 10 persons).
Names should be IDENTICAL to signature on the Organization Certificate (NCUA 4008). Each
subscriber listed below has subscribed to at least one share in accordance with Section 103 of
the Federal Credit Union Act:
Name:
Name:
Address:

Address:

Occupation:

Occupation:

Years of Residence:

Years of Residence:

Name:

Name:

Address:

Address:

Occupation:

Occupation:

Years of Residence:

Years of Residence:

Name:

Name:

Address:

Address:

Occupation:

Occupation:

Years of Residence:

Years of Residence:

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Name:

Name:

Address:

Address:

Occupation:

Occupation:

Years of Residence:
Years of Residence:
2. Are all the subscribers within the field of membership?
Yes

Do they appear to be representative of the group
described in the definition of the field of membership?

No

Yes

No

Yes

No

If not, explain.

3. Does your investigation indicate that the
subscribers are persons of good character?
If not, explain.

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4. From your investigation, is it your judgment that the
directors and committee members are persons of good
character, and that they have the ability and determination
to operate a credit union satisfactorily?

Yes

No

Yes

No

If not, explain.

5. Does it appear that there are any factors within the group
which may render smooth and efficient credit union
operations difficult?

If so, explain.

6. Is there any indication that the proposed credit union
would be used for selfish gain by any person or group
of persons within the group to be served?

Yes

No

7. Is an application for a State Charter now pending?

Yes

No

8. Has the group ever had a credit union?

Yes

No

If so, when did it liquidate or merge?

ANY ADDITIONAL COMMENTS OR INFORMATION THAT IS DEEMED PERTINENT OR HELFPUL
IN GIVING CONSIDERATION TO THIS APPLICATION SHOULD BE INCLUDED AS AN ATTACHMENT.

The undersigned certifies that to the best of their knowledge and belief the above information is true and correct.

I do

do not recommend that a charter be granted to this group.

Signature: __________________________________________________, Organizer
Organizer's Address:
Tel. Number:
Date:

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FORM 4001 INSTRUCTIONS
A. INFORMATION FOR CHARTER AND BYLAWS
The subscriber should select a name for the proposed credit union. It is
the responsibility of the federal credit union organizers to ensure that the
proposed federal credit union name does not constitute an infringement
on the name of any corporation in its trade area. The last three words in
the name must be "Federal Credit Union." Since the name selected
should not duplicate exactly the name of an existing credit union, Item 1
provides space for a second choice.
The territory of operations of a Federal Credit Union is described in the
field of membership, item 4. The principal office of the credit union will
usually be maintained at a location described in the field of membership.
The proposed field of membership should be defined so clearly that it
leaves no room for any doubt as to whom the credit union is to serve or
the area which it is to operate. Corporations and other organizations
referred to in the definition of the field of membership should be
designated by the exact names rather than by some local or popular
contraction of these names. The field of membership for each type of
common bond and samples are discussed in detail in Chapter 2 of the
"Chartering and Field of Membership Manual."
With the guidance of the organizer, the subscribers to the Organization
Certificate decide on the number of directors and credit committee
members. The board and credit committee must be composed of an odd
number of members. The supervisory committee is appointed by the
board of directors.
B. ECONOMIC ADVISABILITY OF ORGANIZING PROPOSED CREDIT
UNION
This section of the report contains information on the required business
plan elements and other information needed to make a decision on the
economic advisability of chartering the proposed credit union.
C. CHARACTER AND FITNESS OF SUBSCRIBERS
The names and addresses of the subscribers should be recorded legibly
and completely in item C. 1. of this report. It is from this information that
the National Credit Union Administration prepares Section 3 of the
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charter. The names of the subscribers must be IDENTICAL to their
signatures on the Organization Certificate.
D. SUBMITTAL OF CHARTER APPLICATION
In addition to this Investigation Report, the following should be submitted
to the appropriate regional director of NCUA:
1. Organization Certificate, NCUA 4008 - one notarized original. At least seven,
but no more than ten persons, must sign the organization certificate. The person
administering the oath must not be one of the subscribers. The oath on the
organization certificate must be executed and show the notary's seal and date the
commission expires as required by State law;
2. Report of Official and Agreement to Serve, NCUA 4012 – one original for each
board member, credit committee member, and supervisory committee member;
3. Business Plan - refer to Part B, question 4 of this form and Chapter 1 of the
Chartering and Field of Membership Manual for a discussion of the components
of an acceptable business plan;
4. Application and Agreements for Insurance of Accounts, NCUA 9500 - one
original; and
5. Certification of Resolutions, NCUA 9501 - one original.

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