SBA Form 2182 Exhi Exhibit E1

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Overview

Cover
E1-A. Fund Overview
E1-B. Portfolio Companies
E1-C. Financing Descriptions
E1-D. Covenant Defaults
E1-E. Valuations
E1-F. Portfolio Co. Financials
E1-G. Active Involvement
E1-H. Portfolio Cash Flows
E1-I. Fund Cash Flows

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Sheet 1: Cover

									OMB Approval No. 3245-0062
									Expiration Date: xx/xx/xxxx
				409 3rd St., SW • Washington, DC 20416 • (202) 205-6510
				The SBIC Program
				Form 2182: Exhibit E1
This form is used to collect detailed information about each applicant's investment track record. Only those investments that meet the eligibility criteria outlined in the "SBIC Program Application Instructions" should be presented using this form. For all other investment experience, please use Form 2182: Exhibit E2. Read the "SBIC Program Application Instructions" before completing this exhibit.
SBA Form 2182 (07-13) Previous editions obsolete

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Sheet 2: E1-A. Fund Overview

SBIC Applicant:

Principal Name:

Initials:

Vintage Year:

Total Committed Capital:

$0 M

Mgmt. Fee (%):

Total Private Commited Capital:

Preferred Return (%):

Total SBA Leverage Commitment:

Carry (%):

Total Other Leverage Commitment:

Total Paid-In Capital:

$0 M

Valuation Date:

Dec-12

Total Private Capital Called:

$0 M

Fund Type:

Total SBA Leverage Drawn:

$0 M

If Other Fund Type:

Total Other Leverage Drawn:

$0 M

<--- Insert Additional Rows if necessary

Strategy Description & Benchmark Type:

Please list and provide contact information for the 10 largest limited partners of this fund.

Limited Partner

Contact Person

Phone

Email

Notes:

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Sheet 3: E1-B. Portfolio Companies

0
0
Number of Portfolio Companies:	0	PLEASE START LIST WITH THE NAMES OF COMPANIES IN WHICH ALL FINANCINGS HAVE BEEN REALIZED
Portfolio Company	State of Co.'s Primary Offices (Abbrev.)	Industry	Description of Products / Services	Deal Source	Stage	Co-Creditors (if applicable)	Equity Investors (if applicable)		Realized/Unrealized (All Invested Securities)
x	x	x	x	x	x	x	x		x

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Sheet 4: E1-C. Financing Descriptions

0

0

Number of Financings:

0

PLEASE LIST FULLY REALIZED COMPANIES FIRST, THEN PARTIALLY REALIZED, THEN UNREALIZED

$0

Portfolio Company

Debt or Equity

Type of Security

Percentage Ownership (Fully Diluted)

Current Pay Component (CP/"Blank")

Senior Leverage Multiple (Senior Debt/EBITDA)

Total Leverage Multiple (Debt/EBITDA)

DEBT ONLY: Covenant Violations (CV), Restructing (RS) or Both

Exit Type (if realized)

Date of Initial Investment

Date of Exit (if Realized)

Realized/ Unrealized

Total Financing Amount

x

x

x

x

x

x

x

x

x

x

x

x

x

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Sheet 5: E1-D. Covenant Defaults

0
0
Portfolio Company	Security Type	Covenant Violation, Restructing or Both	Covenant Violation Type	Time in Default (Months)	Default Interest Rate Charged	Principal Lead	Discuss the reasoning behind any restructurings, the causes of any covenant violations and the measures taken to address these issues.
x	x		x	x	x		x

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Sheet 6: E1-E. Valuations

0
0
Portfolio Company	Security Type	Valuation Methodology
x	x	x

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Sheet 7: E1-F. Portfolio Co. Financials

0

0

Company Financials at Time of Initial Investment

Company Financials at Time of Full Exit OR as of Valuation Date

Company Name

Realized/ Unrealized

Data as of MM/DD/YY

Small Business

Number of Employees

Enterprise Value

LTM Revenue

LTM EBITDA

Cash & Equivalents

Total Debt

Data as of MM/DD/YY

Number of Employees

Enterprise Value

LTM Revenue

LTM EBITDA

Cash & Equivalents

Total Debt

Revenue CAGR

EBITDA CAGR

SUM TOTALS

0

$0.0 M

$0.0 M

$0.0 M

$0.0 M

$0.0 M

0

$0.0 M

$0.0 M

$0.0 M

$0.0 M

$0.0 M

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

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Sheet 8: E1-G. Active Involvement

0

0

PLEASE IDENTIFY THE ROLES PLAYED BY EVERY MEMBER OF THIS FUND'S INVESTMENT COMMITTEE

Pre-Investment Role

Post-Investment Active Involvement in Company

Portfolio Company

Deal Lead

Deal Co-Lead

Deal Source

Financial Analysis

Market Research

Lead Structuring

Lead Due Diligence

Made Recommendation to Investment/Credit Committee

Investment/Credit Committee

Negotiation

Discussion of Pre-Investment Role

Top Ranking Officer Added/Replaced

Officer of the company

Board of Directors

Board Observer

Exit Process

Discussion of Post-Investment Role

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

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Sheet 9: E1-H. Portfolio Cash Flows

0
0
	Realized (R) or Unrealized (U):															Realized Investments	Unrealized Investments	TOTAL (Gross)
	Company Name:
	Date of Initial Investment (Month-YY):
	Date of Exit (Month-YY):
	Debt/Equity/Other:
	Security Type:
Year	Last Date in Quarter
2002	3/31/2002	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2002	6/30/2002	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2002	9/30/2002	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2002	12/31/2002	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2003	3/31/2003	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2003	6/30/2003	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2003	9/30/2003	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2003	12/31/2003	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2004	3/31/2004	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2004	6/30/2004	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2004	9/30/2004	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2004	12/31/2004	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2005	3/31/2005	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2005	6/30/2005	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2005	9/30/2005	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2005	12/31/2005	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2006	3/31/2006	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2006	6/30/2006	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2006	9/30/2006	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2006	12/31/2006	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2007	3/31/2007	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2007	6/30/2007	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2007	9/30/2007	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2007	12/31/2007	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2008	3/31/2008	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2008	6/30/2008	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2008	9/30/2008	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2008	12/31/2008	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2009	3/31/2009	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2009	6/30/2009	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2009	9/30/2009	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2009	12/31/2009	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2010	3/31/2010	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2010	6/30/2010	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2010	9/30/2010	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2010	12/31/2010	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2011	3/31/2011	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2011	6/30/2011	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2011	9/30/2011	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2011	12/31/2011	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2012	3/31/2012	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2012	6/30/2012	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2012	9/30/2012	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
2012	12/31/2012	0	0	0	0	0	0	0	0	0	0	0	0			0	0	0
Enter Valuation Quarter Here:	12/31/2012	0	0	0	0	0	0	0	0	0	0	0	0		Total Residual Value	0	0	0
	Value of Outstanding Warrants (if applicable):	0	0	0	0	0	0	0	0	0	0	0	0		Outstanding Warrants	0	0	0
	Realized (R) or Unrealized (U):
	Company Name:	0	0	0	0	0	0	0	0	0	0	0	0		0
	Debt/Equity/Other:														Portfolio Summary Statistics
	Security Type:															Realized	Unrealized	Total Gross	Total Net
															IRR:
	IRR:														MOIC:	#DIV/0!	#DIV/0!
	Multiple of Invested Capital:														Proceeds/IC:	#DIV/0!	#DIV/0!	#DIV/0!
															Residual/IC:	#DIV/0!	#DIV/0!	#DIV/0!
	Invested Capital:	0	0	0	0	0	0	0	0	0	0	0	0
	Percent of Cost:														No. of Companies:	0	0	0
															No. of Financings:	0	0	0
	Total Cash and Non-Cash Proceeds:	0	0	0	0	0	0	0	0	0	0	0	0		Invested Capital:	$0.0 M	$0.0 M	$0.0 M
	Residual Value:	0	0	0	0	0	0	0	0	0	0	0	0		% of Cost:	#DIV/0!	#DIV/0!	#DIV/0!
	Gain / (Loss):	0	0	0	0	0	0	0	0	0	0	0	0		Gross Receipts:	$0.0 M	$0.0 M	$0.0 M
															Gross Residual Value:	$0.0 M	$0.0 M	$0.0 M
	Deal Lead:														Total Gross Gain/(Loss):	$0.0 M	$0.0 M	$0.0 M
	Deal Co-Lead:
	Deal Source:														Avg. Investment per Co.:	#DIV/0!	#DIV/0!	#DIV/0!
															Avg. Financing Size:	#DIV/0!	#DIV/0!	#DIV/0!
	Hold Period (Years):														Med. Financing Size:	#VALUE!	#VALUE!	#VALUE!
	Current Pay (CP/NCP):
	% Ownership:														Inv w/Current Pay (%):	#DIV/0!	#DIV/0!	#DIV/0!
	Leverage Multiple:														Inv w/o Current Pay (%):	#DIV/0!	#DIV/0!	#DIV/0!
	Stage:														Volatility:
	Industry:														Downside Volatility:			0.0%
	Location:														Loss Rate:	#DIV/0!	#DIV/0!	#DIV/0!
	Initial Revenue:														Avg. Hold:
	Initial EBITDA:
	Small Business:
	Toggle:
Company:	<>#
Realized (R) or Unrealized (U):	<>#	R	U
Deal Lead:	<>#
Deal Co-Lead:	<>#
Deal Source:	<>#
Instrument:	<>#
Debt/Equity/Other:	<>#	Debt	Equity	Other
CP/NCP	<>#	CP
Industry:	<>#
Stage:	<>#
State of Co's Primary Offices:	<>#
Small Business:	<>#	Y	N
Min. Investment Size (= or >):	$0 M	$0.5 M	$1.0 M	$1.5 M	$2.0 M	$2.5 M	$3.0 M	$3.5 M	$4.0 M	$4.5 M	$5.0 M	$5.5 M	$6.0 M
Max. Investment Size (= or <):	$150 M	$150 M	$149 M	$149 M	$148 M	$148 M	$147 M	$147 M	$146 M	$146 M	$145 M	$145 M	$144 M
Min. Initial Revenue (= or >):	$0 M	$10 M	$20 M	$30 M	$40 M	$50 M	$60 M	$70 M	$80 M	$90 M	$100 M	$110 M	$120 M
Max. Initial Revenue (= or <):	$2,000 M	$1,990 M	$1,980 M	$1,970 M	$1,960 M	$1,950 M	$1,940 M	$1,930 M	$1,920 M	$1,910 M	$1,900 M	$1,890 M	$1,880 M
Min. Initial EBITDA (= or >):	($500 M)	($490 M)	($480 M)	($470 M)	($460 M)	($450 M)	($440 M)	($430 M)	($420 M)	($410 M)	($400 M)	($390 M)	($380 M)
Max. Initial EBITDA (= or <):	$2,000 M	$1,990 M	$1,980 M	$1,970 M	$1,960 M	$1,950 M	$1,940 M	$1,930 M	$1,920 M	$1,910 M	$1,900 M	$1,890 M	$1,880 M
Min. Hold Period (= or >):	0	0.5	1	1.5	2	2.5	3	3.5	4	4.5	5	5.5	6
Max Hold Period (= or <):	150	149.5	149	148.5	148	147.5	147	146.5	146	145.5	145	144.5	144
Toggle:	<>#	X	<>X

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Sheet 10: E1-I. Fund Cash Flows

0
0
		Starting Cash Balance																										Starting Balance
		0		Non-Portfolio Income Flowing to the Fund (+)				Non-Portfolio Expenses Flowing from Fund (-)							Contributions to the Fund (+)						Distributions from the Fund (-)							0			Net Cash Flows (NCF) to Investors						Cumulative Cash Flows to Investors
		Net Portfolio Cash Flow		Fees	Other Receipts (Explain - A)	Total Non-Investment Income		Management Fees	Interest Expense - SBA	Interest Expense - All Other Lenders	Carried Interest	Other Expenses (Explain - B)	Total Expenses		LP Capital Draws	Leverage Drawn - SBA	Leverage Drawn - All Other Lenders	Other Capital Drawn (Explain - C)	Total Capital Inflows		Distributions to LPs	Leverage Repayments - SBA	Leverage Repayments - All Other Lenders	Other (Explain - D)	Total Capital Outflows		Quarterly Cash Balance	CUMULATIVE CASH BALANCE			NCF to LPs	NCF to SBA	NCF to All Other Lenders	Other Cash Flows	Unlevered NCF		Cumulative Net Cash Flows to LPs	Cumulative Net Cash Flow to Lenders	Cumulative Net Cash Flow to Other	Cumulative Net Unlevered Cash Flow to Capital Providers
2002	3/31/2002	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2002	6/30/2002	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2002	9/30/2002	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2002	12/31/2002	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2003	3/31/2003	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2003	6/30/2003	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2003	9/30/2003	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2003	12/31/2003	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2004	3/31/2004	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2004	6/30/2004	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2004	9/30/2004	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2004	12/31/2004	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2005	3/31/2005	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2005	6/30/2005	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2005	9/30/2005	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2005	12/31/2005	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2006	3/31/2006	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2006	6/30/2006	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2006	9/30/2006	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2006	12/31/2006	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2007	3/31/2007	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2007	6/30/2007	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2007	9/30/2007	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2007	12/31/2007	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2008	3/31/2008	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2008	6/30/2008	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2008	9/30/2008	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2008	12/31/2008	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2009	3/31/2009	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2009	6/30/2009	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2009	9/30/2009	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2009	12/31/2009	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2010	3/31/2010	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2010	6/30/2010	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2010	9/30/2010	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2010	12/31/2010	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2011	3/31/2011	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2011	6/30/2011	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2011	9/30/2011	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2011	12/31/2011	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2012	3/31/2012	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2012	6/30/2012	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2012	9/30/2012	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2012	12/31/2012	0		0	0	0		0	0	0	0	0	0		0	0	0	0	0		0	0	0	0	0		0	0			0	0	0	0	0		0	0	0	0
2012	12/31/2012																														0	0	0	0	0		0	0	0	0
Final Fund Cash Flows:		RESIDUAL VALUE OF PORTFOLIO		Fees Receivable	Other Receivables	TOTAL FUND RESIDUAL VALUE		Fees Payable	Interest Payable	Interest Payable - A	Carried Interest on Residual	Other Payables	TOTAL EXPENSES DUE		Total Paid-In Capital	Total SBA Leverage Drawn	Total Other Leverage Drawn	Total Other Capital Drawn	Total Capital Drawn		Final Distribution to LPs	Final Repayment of Leverage	Final Repayment of Other Leverage	Other Final Financing Flows	TOTAL REMAINING OUTFLOWS		FINAL CASH BALANCE				NCF to LPs	NCF to SBA	NCF to Lenders	NCF to Other	Unlevered NCF
As of:	12/31/2012	0		0	0	0		0	0	0	0	0	0		$0 M	$0 M	$0 M	$0 M	$0 M		0	0	0	0	0		0		Net IRR:
																													TVPI:
																													DPI:
																													RPI:
																													Mgmt. Fees as % of Committed Capital:
Notes:
General Notes:
Explain A:
Explain B:
Explain C:
Explain D: