Initial Supplemental Report for Community Development Loan Funds 1 

Treasury Department Form: TD F 102.3A (08/22/2011) OMB Number: 1505-0228

U.S. Department of the Treasury

Initial Supplemental Report for Community Development Loan Funds

This Initial Supplemental Report supplements the information provided in the application filed by a community development loan fund (CDLF) that 

will receive capital from the U.S. Department of the Treasury (Treasury) through the Small Business Lending Fund (SBLF). This Initial Supplemental 

Report and June 30, 2011 financial statements must be filed no later than five (5) business days before the closing date, and must be signed by the 

Chief Executive Officer (CEO) and the Chief Financial Officer (CFO) of the reporting CDLF (or by the individuals performing equivalent functions). 

We, the undersigned CEO and CFO (or equivalents) of the named CDLF, attest that this Initial Supplemental Report has been prepared in 

conformance with the instructions issued by the Treasury and is true and correct to the best of our knowledge and belief. We also attest that the 

June 30, 2011 financial statements have been prepared in accordance with generally accepted accounting principles (GAAP) in the United States, 

and that the calculations reported herein are based on these statements, as applicable.

_______________________________________________

Signature of Chief Executive Officer (or Equivalent)

_______________________________________________

Date of Signature

_______________________________________________

Signature of Chief Financial Officer (or Equivalent)

_______________________________________________

Date of Signature

________________________________________________

Legal Title of CDLF

________________________________________________

City State Zip

SBLF #

EIN # – 

Submission of Report: Please refer to Instructions for Initial Supplemental Report document for submission information.

Freedom of Information Act

Please note that any information submitted by applicants may become 

subject to public disclosure pursuant to the terms of the Freedom of 

Information Act, 5 U.S.C. 552 (FOIA) and its exemptions. Nevertheless, 

Treasury’s FOIA regulation, 31 C.F.R. 1.1 et seq., provides that, in 

certain cases, businesses that submit information to Treasury shall 

receive notice of a pending FOIA request for that information, as well 

as an opportunity to object to the disclosure of any or all of that 

information on the grounds that the information qualifies for 

withholding under FOIA Exemption 4. See 31 C.F.R. 1.6. 

To facilitate this business submitter notification process, Treasury 

encourages applicants to designate any such information that they 

believe, in good faith, is subject to FOIA Exemption 4. Such 

designations will help Treasury to recognize instances in which 

business submitter notification may be appropriate. Treasury reserves 

sole discretion to determine whether such designated information 

indeed qualifies for business submitter notification and ultimately, 

whether it qualifies for withholding pursuant to FOIA Exemption 4. 

If you wish to identify any information on this form that you believe is 

subject to FOIA Exemption 4, please identify that information and the 

reasons for your request on attached pages.

CDLF Wire and Contact Information

Please provide the following information to allow Treasury to wire

funds to your CDLF: 

CDLF Name:______________________________________________ 

Receiving Bank Name: _____________________________________ 

ABA (Routing) Number: ____________________________________ 

Account Number: _________________________________________ 

Account Name: ___________________________________________ 

Beneficiary: ______________________________________________ 

Primary Wire Contact Name: ________________________________ 

Primary Wire Contact Phone Number: ________________________ 

Primary Wire Contact Email Address:

________________________________________________________ 

Secondary Wire Contact Name: ______________________________ 

Secondary Wire Contact Phone Number: ______________________ 

Secondary Wire Contact Email Address:

________________________________________________________ 

Wire Information CDLFs Should Use to Make Interest Payments to 

Treasury

Bank Name: The Bank of New York Mellon

ABA (Routing) Number: 021000018 

BNF Acct Name: Income Collection 

BNF Acct Number: 111566 

REF: Private Placements – SBJA

Security Name & CUSIP
Initial Supplemental Report for Community Development Loan Funds 2 

Treasury Department Form: TD F 102.3A (08/22/2011) OMB Number: 1505-0228

Initial Supplemental Report

for CDLFs Participating in the Small Business Lending Fund

Table of Contents

Initial Baseline Calculation

Initial Adjusted Baseline Calculation

Initial Quarter-End Qualified CDLF Small Business Lending

Change in Qualified CDLF Small Business Lending Calculation

June 30, 2011 Ratio Calculations

Every CDLF participating in the Small Business Lending Fund (SBLF) of the U.S. Department of the Treasury (Treasury) is required to 

submit an Initial Supplemental Report and June 30, 2011 financial statements no later than five (5) business days before the closing 

date of the SBLF funding. If your CDLF’s fiscal year-end was 9/30/2010, 12/31/2010, or 3/31/2011, your CDLF is required to submit

its 6/30/2011 quarterly financial statements. If your CDLF’s fiscal year-end was 6/30/2011, your CDLF is required to submit its 

6/30/2011 annual financial statements. Please refer to the Instructions for the Initial Supplemental Report for CDLFs Participating in 

the Small Business Lending Fund for guidance.

The CDLF must also submit Quarterly Supplemental Reports, beginning in the quarter in which the funding occurs, as described in 

the separate Instructions for the Quarterly Supplemental Report for CDLFs Participating in the Small Business Lending Fund. All

CDLFs participating in the SBLF are required to submit their first Quarterly Supplemental Report for June 30, 2011 no later than five 

(5) business days before the closing date of the SBLF funding.

If you have general questions regarding this form, please contact the information line for the Small Business Lending Fund 

at 888-832-1147 (Monday-Friday, 9:00 AM-7:00 PM ET). 

The Federal Government may not collect, and the public is not required to respond to, a collection of information that does not display a currently valid OMB Control Number. The control 

number for this collection is 1505-0228. 
Initial Supplemental Report for Community Development Loan Funds 3 

Treasury Department Form: TD F 102.3A (08/22/2011) OMB Number: 1505-0228

Initial Supplemental Report

for CDLFs Participating in the Small Business Lending Fund

Initial Baseline Calculation

All CDLFs participating in the Small Business Lending Fund must complete this Initial Baseline Calculation. If an adjustment to the

amount of Qualified CDLF Small Business Lending occurred as a result of mergers, acquisitions, or loan purchases from 10/1/09 

through 6/30/10, use Worksheet A in the Instructions for the Initial Supplemental Report to determine amounts for lines 1-4. All 

figures are to be reported in thousands of dollars. Report the amount outstanding as of the last day of the quarter being requested.

9/30/09 12/31/09 3/31/10 6/30/10 Total of four quarters

Dollar amounts in thousands Bil Mil Thou Bil Mil Thou Bil Mil Thou Bil Mil Thou Bil Mil Thou

1. Balances of commercial 

and industrial loans 1a 1b 1c 1d

2. Balances of loans secured 

by owner-occupied 

nonfarm, nonresidential

properties 2a 2b 2c 2d

3. Balances of loans to 

finance agricultural 

production and other 

loans to farmers 3a 3b 3c 3d

4. Balances of loans secured 

by farmland 4a 4b 4c 4d

5. Subtotal (sum lines 1-4) 5a 5b 5c 5d

6. Dollar portion of any such 

loans or group of such 

loans to the same 

borrower and its affiliates 

with an original principal 

or commitment amount 

greater than $10 million 6a 6b 6c 6d

7. Dollar portion of such 

loans to businesses with 

more than $50 million in 

revenues, unless included 

in line 6 7a 7b 7c 7d

8. Dollar portion of line 5 

guaranteed by the U.S. 

government, unless 

included in lines 6 or 7 8a 8b 8c 8d

9. Dollar portion of line 5 

where a third party has 

assumed an interest, 

unless included in lines 6, 

7, or 8 9a 9b 9c 9d

10. Total (line 5 minus lines 6, 

7, 8, and 9) 10a 10b 10c 10d

11. Total of four quarters’ 

qualified loans (sum line 

items 10a through 10d) 11

12. Initial CLDF Small Business Lending Baseline (line 12 equals line 11 divided by 4) 12
Initial Supplemental Report for Community Development Loan Funds 4 

Treasury Department Form: TD F 102.3A (08/22/2011) OMB Number: 1505-0228

Initial Supplemental Report

for CDLFs Participating in the Small Business Lending Fund

Initial Adjusted Baseline Calculation

All CDLFs participating in the Small Business Lending Fund must complete the Initial Adjusted Baseline Calculation. All figures are to 

be reported in thousands of dollars. In the table below, report balance increases as of 3/31/2011 that resulted from an 

acquisition of, or merger with, another fund, and purchases of such loans on or after 7/1/2010. 

Dollar amounts in thousands Bil Mil Thou

13. Initial CDLF Small Business Lending Baseline (line 12) 13

14. Balance increases in commercial and industrial loans resulting from an acquisition of, or merger with, another fund, and purchases of such loans on or after 

7/1/2010 14

15. Balance increases in loans secured by owner-occupied nonfarm, nonresidential properties resulting from an acquisition of, or merger with, another fund, 

and purchases of such loans on or after 7/1/2010 15

16. Balance increases in loans to finance agricultural production and other loans to farmers resulting from an acquisition of, or merger with, another fund, and 

purchases of such loans on or after 7/1/2010 16

17. Balance increases in loans secured by farmland resulting from an acquisition of, or merger with, another fund, and purchases of such loans on or after

7/1/2010 17

18. Subtotal (sum lines 14, 15, 16, and 17) 18

19. Dollar portion of any such loans or group of such loans to the same borrower and its affiliates with an original principal or commitment amount greater 

than $10 million 19

20. Dollar portion of any such loans to businesses with more than $50 million in revenues, unless included in line 19

20

21. Dollar portion of line 18 guaranteed by the U.S. government, unless included in line 19 or 20 21

22. Dollar portion of line 18 where a third party has assumed an interest, unless included in line 19, 20, or 21 22

23. Qualified balance increases (line 23 equals line 18 minus lines 19, 20, 21, and 22) 23

24. Initial Adjusted CDLF Small Business Lending Baseline (line 24 equals line 13 plus line 23) 24

Initial Quarter-End Qualified CDLF Small Business Lending

All CDLFs participating in the Small Business Lending Fund must complete this section. All figures are to be reported in thousands of 

dollars. Report balances as of 3/31/2011.

Quarter end

Dollar amounts in thousands Bil Mil Thou

25. Balances of commercial and industrial loans 

25

26. Balances of loans secured by owner-occupied nonfarm, nonresidential properties 26

27. Balances of loans to finance agricultural production and other loans to farmers 27

28. Balances of loans secured by farmland 28

29. Subtotal (sum lines 25, 26, 27, and 28) 29

30. Dollar portion of any such loans or group of such loans to the same borrower and its affiliates with an original principal or commitment amount greater 

than $10 million 30

31. Dollar portion of such loans to businesses with more than $50 million in revenues, unless included in line 30

31

32. Dollar portion of line 29 guaranteed by the U.S. government, unless included in line 30 or 31

32

33. Dollar portion of line 29 where a third party has assumed an interest, unless included in line 30, 31, or 32 33

34. Total initial quarter-end qualified CDLF small business loans (line 34 equals line 29 minus lines 30, 31, 32, and 33) 34
Initial Supplemental Report for Community Development Loan Funds 5 

Treasury Department Form: TD F 102.3A (08/22/2011) OMB Number: 1505-0228

Initial Supplemental Report

for CDLFs Participating in the Small Business Lending Fund

Net Charge-Off Adjustments to Initial Quarter-End

All figures are to be reported in thousands of dollars. Report net charge-offs as of 3/31/2011 for the period from 7/1/2010 through

3/31/2011.

Net charge-offs on or after 

7/1/2010

Dollar amounts in thousands Bil Mil Thou

35. Net charge-offs on commercial and industrial loans on or after 7/1/2010 35

36. Net charge-offs on loans secured by owner-occupied nonfarm, nonresidential properties on or after 7/1/2010 36

37. Net charge-offs on loans to finance agricultural production and other loans to farmers on or after 7/1/2010 37

38. Net charge-offs on loans secured by farmland on or after 7/1/2010 

38

39. Subtotal (sum lines 35, 36, 37, and 38) 39

40. Dollar portion of net charge-offs on any such loans or group of such loans to the same borrower and its affiliates with an original principal or commitment 

amount greater than $10 million 40

41. Dollar portion of net charge-offs on loans to businesses with more than $50 million in revenues, unless included in line 40 41

42. Dollar portion of net charge-offs on loans guaranteed by the U.S. government, unless included in line 40 or 41 42

43. Dollar portion of net charge-offs on loans where a third party has assumed an interest, unless included in line 40, 41, or 42 43

44. Total net charge-offs (line 44 equals line 39 minus lines 40, 41, 42, and 43) 44

45. Quarter-End Adjusted Qualified CDLF Small Business Lending (line 45 equals line 34 plus line 44) 45

Change in Qualified CDLF Small Business Lending Calculation

Complete this section to determine your CDLF’s percent change in Qualified CDLF Small Business Lending.

Bil Mil Thou Hund

46. Dollar value of funding from the Small Business Lending Fund 46

47. Dollar value of Initial Adjusted CDLF Small Business Lending Baseline (line 24) 47 000

48. Dollar value of Quarter-End Adjusted Qualified CDLF Small Business Lending (line 45) 48 000

49. Dollar value of increase in Qualified CDLF Small Business Lending from baseline (line 49 equals line 48 minus line 47; if negative, refer to the 

Instructions for the Initial Supplemental Report) 49 000

50. Percent increase in Qualified CDLF Small Business Lending (line 50 equals line 49 divided by line 47) 50 % 
Initial Supplemental Report for Community Development Loan Funds 6 

Treasury Department Form: TD F 102.3A (08/22/2011) OMB Number: 1505-0228

Initial Supplemental Report

for CDLFs Participating in the Small Business Lending Fund

Step 1: Complete the following five (5) tables. These tables correspond to tables B, D, E, F, and G, respectively, from the Eligibility 

Worksheet in your application. If your CDLF’s fiscal year-end was 9/30/2010, 12/31/2010, or 3/31/2011, please complete only

Step 1; if your CDLF’s fiscal year-end was 6/30/2011, complete Step 1 and Step 2.

A. Operating liquidity ratios for the four most recent quarters ended are 1.0 or greater. 9/30/10 12/31/10 3/31/11 6/30/11

1. Cash and cash equivalents 1 $ 

2. Operating expenses 2 $ 

3. Operating liquidity ratios for each QE (line 1 divided by line 2, rounded to the nearest tenth) 3 x 

B. Net assets plus the amount of liabilities (if any) relating to equity equivalents (EQ2) to total 

assets (excluding assets for which the CDLF bears no economic risk) is at least 20%. 6/30/11

4. Total assets 4 $ 

5. Assets for which the CDLF bears no economic risk (e.g., loans managed for other creditors or 

capitalized with non-recourse debt provided by a third-party) 5 $ 

6. Total assets excluding assets for which the CDLF bears no economic risk (line 4 minus line 5) 6 $ 

7. Total net assets 7 $ 

8. Total liabilities (if any) relating to EQ2s 8 $ 

9. Total net assets plus EQ2s (line 7 plus line 8) 9 $ 

10. Net assets plus EQ2s as a percentage of total assets, excluding assets for which the CDLF 

bears no economic risk (line 9 divided by line 6, multiplied by ‘100’) 10 % 

C. Ratio of loan loss reserves to loans and leases 90 days or more 

delinquent (including loans sold with full recourse) is at least 30%. 6/30/11

11. Loan loss reserves 11 $ 

12. Loans and leases 90 days or more delinquent, including loans sold with full recourse 12 $ 

13. Reserves as a percentage of delinquency (line 11 divided by line 12, multiplied by ‘100’) 13 % 

D. Ratio of loans and leases 90 days or more delinquent (including loans sold with full 

recourse) to unrestricted net assets plus loan loss reserves is less than 40%. 6/30/11

14. Loans and leases 90 days or more delinquent, including loans sold with full recourse (line 12) 14 $ 

15. Unrestricted net assets 15 $ 

16. Loan loss reserves not included in unrestricted net assets 16 $ 

17. Unrestricted net assets plus loan loss reserves (line 15 plus line 16) 17 $ 

18. Delinquency as a percentage of unrestricted net assets plus loan loss reserves (line 14 divided 

by line 17, multiplied by ‘100’) 18 % 

E. Outstanding loans eligible for inclusion in Qualified CDLF Small Business Lending* are 

equal to or greater than 10% of total loans outstanding. Outstanding balances as of 6/30/11

19. Total Qualified CDLF Small Business Lending (second column, line 6 of the SBLF Initial Call 

Report for Community Development Loan Funds) 19 $ 

20. Total of all loans outstanding (first column, line 6 of the SBLF Initial Call Report for 

Community Development Loan Funds) 20 $ 

21. Qualified CDLF Small Business Lending as a percentage of total loans outstanding (line 19

divided by line 20, multiplied by ‘100’) 21 % 

Step 2: If your CDLF’s fiscal year-end was 6/30/2011, complete the following tables. These tables correspond to tables A and C,

respectively, from the Eligibility Worksheet in your application.

F. Average net income for the three most recent fiscal years is positive.

22. Net income for 6/30/11 22 $ 

23. Net income for 6/30/10 23 $ 

24. Net income for 6/30/09 24 $ 

25. Sum of last three years of net income (sum of lines 22-24) 25 $ 

26. Average net income (line 25 divided by ‘3’) 26 $ 

G. Operating liquidity ratios for one or both of the two most recent fiscal years ended are 1.0 

or greater. 6/30/10 6/30/11

27. Cash and cash equivalents 27 $ 

28. Annual operating expenses 28 $ 

29. 25% of annual operating expenses (line 28 multiplied by 25%) 29 $ 

30. Operating liquidity ratios for two most recent FYE (line 27 divided by line 29, rounded to the 

nearest tenth) 30 x 

*These loans must meet the criteria for Qualified CDLF Small Business Lending, as defined in the “Initial Call Report for Community Development Loan Funds.”

June 30, 2011 Ratio Calculations