Reporting FR G-4

FR G-4
OMB Number 7100-0011
Approval expires June 30, 2024
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Board of Governors of the Federal Reserve System

Annual Report—FR G- 4

This report is required by law (15 U.S.C. §§ 78g and 78w; 12
C.F.R. § 221).

For the year ended June 30,

The Federal Reserve Board regards the information provided by
each respondent as confidential. If it should be determined subsequently that any information collected on this form must be
released, respondents will be notified.

The Federal Reserve may not conduct or sponsor, and an organization (or a person) is not required to respond to, a collection of
information unless it displays a currently valid OMB control
number.

Name of Registrant:
IRS Identification Number1

Address of Principal Office:
Street

County

City

General Instructions

State

Zip Code

DRAFT

Who must file: Section 221.3(b)(3) of the Federal Reserve
Regulation U requires a report on Form G-4 to be filed by every
person subject to the registration requirement of Section 221.3(b)
(1) of the rule. Any person registered under the regulation may
apply for termination of registration by filing FR Form G-2 (see
Section 221.3(b)(2)), if such person has not, during the preceding
six calendar months, had a total of $200,000 or more of credit
outstanding secured directly or indirectly by margin stock.
When and where to file: The form and attachments must be
filed by submitting Portable Document Format ("PDF") versions
to the designated email address [email protected]
within 30 calendar days following June 30 of each calendar year.
If the submission deadline falls on a weekend or holiday, the
report must be received on the first business day after the
Saturday, Sunday, or holiday.
What to file: The registrant is required to file with this report a
copy of the registrant's balance sheet, certified by an independent public accountant, as of the end of its most recent fiscal
year. If a certified balance sheet is not available, registrant should
file with this report a balance sheet in the form prescribed by
Schedule B on FR Form G-1, or if subject to supervision by a
state or federal regulatory agency, the latest balance sheet filed
with such agency.

Definitions

Terms used in this form are explained below. Precise definitions
may be found in Section 221.2 of Regulation U.

Person: Any individual, corporation, partnership, association, joint
stock company, business trust, or unincorporated organization.

Registrant: Any person who is subject to the registration
requirement of Section 221.3(b)(1).
Purpose credit: Credit extended for the purpose of purchasing or
carrying margin stock, or to reduce or retire indebtedness
previously incurred for that purpose.
Margin stock: Includes (1) stocks registered on a national
securities exchange or any OTC security designated for trading in
the National Market System, (2) debt securities that are convertible
into, or carry a warrant or right to subscribe to or purchase margin
stock, (3) any such warrant or right, and (4) shares of most mutual
funds.
Indirectly secured: In general, credit is indirectly secured by
margin stock if there is an understanding between the borrower and
the lender (1) which is designated to make the margin stock more
available to the lender in case of default than to the borrower's
other creditors, or (2) which limits the borrower from exercising full
dominion over the margin stock to sell, pledge, or donate them, or
determining where they shall be placed physically.

1. A registrant who is an individual is not required to disclose his or her Social Security number.
Public reporting burden for this collection of information is estimated to average 2 hours per response, including the time to gather and maintain data in the required form and to review
instructions and complete the information collection. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing
this burden to: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW, Washington, DC 20551; and to the Office of Management and Budget, Paperwork
Reduction Project (7100-0011), Washington, DC 20503.

06/2021

FR G-4
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Instructions for Completing Schedule of Securities Credit
A. Report all Purpose Credit secured by margin stock extended
during the reporting period, as well as all purpose credit secured
by margin stock outstanding as of June 30, on Part A of the
Schedule of Securities Credit.
B. Registrants reporting Purpose Credit secured by margin stock
in Part A must also complete Part B if any nonpurpose credit was
extended during the reporting period or is outstanding as of June
30.
C. Registrants not reporting Purpose Credit in Part A must complete

Part B if any nonpurpose credit was extended during the reporting period or is outstanding as of June 30.
D. Registrants who maintain records based upon fiscal quarters
that do not coincide with calendar quarters have an option of
reporting credit outstanding and extended in a slightly different
manner. These registrants may report the annual data required
by FR Form G-4 as of the year ended on either April 30 or May
31. A registrant reporting in this manner should change the date
in Column I of the Schedule of Securities Credit to reflect the
year-end date used.

Privacy Act Statement
Authority

Routine Uses

Sections 3, 7, 17, and 23 of the Securities Exchange Act of 1934
(15 USC 78c, 78g, 78q, and 78w), and Regulation U (12 CFR 221).

The information you provide will be stored in the system of
records entitled BGFRS-16, "FRB—Regulation U Reports of
Nonbank Lenders”. General routine uses A, C, D, G, I, and J
apply to this system. These general routine uses are located at
https://www.federalreserve.gov/files/SORN-page-general-routineuses-of-board-systems-of-records.pdf and are published in the
Federal Register at 83 FR 43872 at 43873-74 (August 28, 2018).
Records may be used:

Purpose
These records are collected and maintained to assist the Board
in maintaining a current list of persons registered as margin
lenders under the securities laws. The information submitted on
the annual report is required pursuant to Regulation U (Section
221.4) to enable the Federal Reserve to monitor the amount of
credit that is secured by margin stock and that is extended by
nonbank lenders.

DRAFT

Disclosure

The provision of requested information is mandatory.

1. to disclose, upon request, the name of a registered individual
who extends credit secured by margin stock; and
2. to disclose information, when appropriate, to foreign
governmental authorities in accordance with law, and formal
or informal international agreements.

Employee Stock Option, Purchase, and Ownership Plan Credit

1. Is part or all of the credit extended pursuant to an employee stock option, purchase, or ownership plan?
Yes

No

2. A. If "Yes," does the credit qualify under the special provisions set forth in Section 221.4 of Regulation U?
Yes

No

B. If credit reported in Column I of the Schedule of Securities Credit includes outstanding employee stock option, purchase,
or ownership plan credit, please report the following:
i. Outstanding "Plan-Lender" credit pursuant to Section 221.4(a) $
$
ii. Outstanding credit to an ESOP pursuant to Section 221.4(c)
3. Has any of the credit reported above been extended pursuant to a plan adopted since the submission of the last annual report?
Yes

No

If "Yes," please submit two copies of the plan and any supporting documents.

06/2021

FR G-4
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Schedule of Securities Credit

Dollar Amounts in Thousands
A. Credit to purchase or carry margin stock (Purpose Loans):
1. Secured directly by margin stock:
a. Listed stocks and OTC margin stocks ..............................................................
b. Debt securities convertible into margin stock .....................................................
c. Mutual funds and other margin stock ...............................................................
2. Secured indirectly by margin stock ....................................................................
3. Total (Purpose Credit) .....................................................................................

Total Credit
Outstanding
as of
June 30,
(Dollars)2

Credit Extended
During Reporting
Period
(Dollars)3

Amount

Amount

B. Other credit (Nonpurpose Loans):
1. Secured directly by margin stock:
a. Listed stocks and OTC margin stocks ..............................................................
b. Debt securities convertible into margin stock .....................................................
c. Mutual funds and other margin stock ...............................................................
2. Secured indirectly by margin stock ....................................................................
3. Total (Nonpurpose Credit) ................................................................................

1.a.
1.b.
1.c.
2.
3.

1.a.
1.b.
1.c.
2.
3.

DRAFT

2. "Credit outstanding" includes credit extended by the registrant during the year covered by this report, and during previous years, that has not been
extinguished before the end of the year covered by this report.
3. "Credit extended" is credit extended at any time during the year covered by this report. The second column includes all new credit extended during the
year regardless of whether such credit was extinguished at the end of the year. An increase in an existing loan is new credit.

06/2018

FR G-4
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Changes in Background Information
For material included in background information, see the second page of FR Form G-1 Registration Statement.

Have there been any changes in background information since the previous G-4 report (G-1 report for a registrant filing its first
G-4 report)?
Yes

No

If "Yes," describe any such changes pertaining to name, address, IRS Identification No., organizational structure (e.g., a sole proprietorship becoming incorporated), name of person responsible for maintaining Regulation U records, control, or location of records.

DRAFT
Certification
The registrant filing this annual report and any attachment thereto and the person by whom it is executed represent hereby that all
information contained therein is true and complete.

Signature of Sole Proprietor, General Partner, Managing Agent, or Principal Officer

Date

Print or Type Name

Area Code / Phone Number

Title

This mandatory report is needed to elicit certain background and financial information about a Regulation U lender and the types
and amount of credit activities engaged in that are secured by margin stock.
Honest, accurate, and timely statements are required by law.
(15 U.S.C. § 78ff; 18 U.S.C. § 1001)
01/2011