NAME:

Start End CAMELS Number Annual Pro-rated Quarterly Quarterly

Date Date Composite of Days Rate (b.p.) Rate (b.p.) Multiplier

07/01/20xx 08/02/20xx 2 33 5.78 0.518 0.0000518

08/03/20xx 09/30/20xx 2 59 5.63 0.903 0.0000903

Total 92 5.68 1.421 0.0001421

The annual rate total is not the summation of the individual annual rates. Rather, it is the

pro-rated quarter rate total multiplied by four.

RRPSSUM103

RRPSSUM203

RRPSSUM303

RRPSSUM403

RRPSDEM503

CERTIFICATE NUMBER: .

Assessment Rate Summary Page

FDIC 6420/28A (09-11)

FEDERAL DEPOSIT INSURANCE CORPORATION

COMPUTATION OF BLENDED RATE

This statement supports the multiplier reported on Line 5 for the enclosed "Quarterly Certified Statement Invoice for Deposit Insurance."

If you have any questions about the calculation pages, call (800) 759-6596 and select option 1

or email RRPSAdministrator@fdic.gov
Period

Reported Usable Contributions

Risk Risk Pricing to LINE

Measure Measure Multiplier Base Rate

Value Value

I 

Rating Weight

2 x 0.25 = 0.50

2 x 0.20 = 0.40

2 x 0.25 = 0.50

3 x 0.10 = 0.30

2 x 0.10 = 0.20

2 x 0.10 = 0.20

CAMELS Composite 2

2.100

II 

10.271 10.271 x (1.264) = (12.983)

1.324 1.324 x (0.720) = (0.953)

0.213 0.213 x 0.942 = 0.201

8.951 8.951 x 0.533 = 4.771

0.000 0.000 x 0.264 = 0.000

60.355 60.355 x 0.081 4.889

4.105 0.000 x 0.061 = 0.000

(4.075) 1

III

7.352 2

2.100 x 1.519 = 3.190 3

6.467 4

6.47 5

(0.69) 6

0.00 7

0.00 8

Assessment Rate 5.78 9

Quarterly (Basis Points)3 33 of 92 days 0.518 10

0.0000518 11

Increase/(Decrease) to Base Rate Schedule2

Leverage Ratio

Brokered Deposit Ratio

Net Income before Taxes / Total Assets

One-year Asset Growth

Nonperforming Loans and Leases / Gross Assets

Other Real Estate Owneded / Gross Assets

Loan Mix Index

Assessment Rate Calculation

Uniform Amount 

Weighted Average CAMELS Components Rating

Sum of Contributions (Lines 1 + 2 + 3)1

Unsecured Debt Adjustment

Depository Institution Debt Adjustment

Quarterly Assessment Multiplier (Line 10 x 0.0001)

Annual (Basis Points) (Lines 5 + 6 + 7 + 8)

FDIC 6420/07C (09-11)

ASSESSMENT RATE CALCULATION

Sensitivity

Asset Quality

Established Small Institution

20xx-07-01 through 20xx-08-02

Pricing Methodology

CAMELS Ratings

Liquidity

Management

Certificate Number

Dates to which rate applies

FG1

Earnings

Initial Base Assessment Rate (IBAR)

Capital Group Well Capitalized

Capital Adequacy

Sum of Financial Ratio Contributions to Assessment Rate

Financial Ratios

Weighted Average CAMELS Components Rating
Period

IV Unsecured Debt Adjustment

12

13

14

15

16

17

18

19

V Depository Institution Debt Adjustment (DIDA)

20

21

22

23

24

25

1 Sum of "Contributions" (Line 5) cannot be less than the minimum or more than the maximum base rate.

2 This FDIC Board approved adjustment, applicable to all institutions, reflects the rate differential above or below the base

rate schedule.

3 The quarterly assessment rate is equal to one-quarter of the annual assessment rate pro-rated for the number of days indicated. 

The dates for which the rate is effective can be found at the top of this form.

(Long-term debt less 3% Tier 1 capital / assessment base) * 50 bps

Asset assessment base ($000)

(Total long-term debt / assessment base) * (40 bp + IBAR)

Initial base assessment rate (basis points)

Unsecured debt adjustment (basis points) (Line 16 limited)

Base assessment rate after the unsecured debt adjustment (basis points)

Long-term unsecured debt issued by another IDI ($000)

Asset assessment base ($000)

ASSESSMENT RATE CALCULATION PAGE2

Certificate Number FG1

Total allowable long-term debt ($000)

Allowable long-term senior unsecured debt ($000)

Allowable long-term subordinated debt ($000)

0

3,424,062

0

5.78

51,095

0

51,095

3,424,062

6.47

(0.69)

0.693

If you have any questions about the calculation pages, call (800) 759-6596 and select option 1 or email RRPSAdministrator@fdic.gov

FDIC 6420/07C (09-11)

5.78

0.00

Base assessment rate after DIDA adjustment (basis points) 5.78

Base assessment rate after the unsecured debt adjustment (basis points)

Depository institution debt adjustment (basis points) (Line 22)
Period

Reported Usable Contributions

Risk Risk Pricing to LINE

Measure Measure Multiplier Base Rate

Value Value

I 

Rating Weight

2 x 0.25 = 0.50

2 x 0.20 = 0.40

2 x 0.25 = 0.50

2 x 0.10 = 0.50

2 x 0.10 = 0.20

2 x 0.10 = 0.20

CAMELS Composite 2

2.000

II 

10.271 10.271 x (1.264) = (12.983)

1.324 1.324 x (0.720) = (0.953)

0.213 0.213 x 0.942 = 0.201

8.951 8.951 x 0.533 = 4.771

0.000 0.000 x 0.264 = 0.000

60.355 60.355 x 0.081 4.889

4.105 0.000 x 0.061 = 0.000

(4.075) 1

III

7.352 2

2.000 x 1.519 = 3.038 3

6.315 4

6.32 5

(0.69) 6

0.00 7

0.00 8

Assessment Rate 5.63 9

Quarterly (Basis Points)3 59 of 92 days 0.903 10

0.0000903 11

Annual (Basis Points) (Lines 5 + 6 + 7 + 8)

Quarterly Assessment Multiplier (Line 10 x 0.0001)

FDIC 6420/07C (09-11)

Depository Institution Debt Adjustment

Increase/(Decrease) to Base Rate Schedule2

Unsecured Debt Adjustment

Brokered Deposit Ratio

Loan Mix Index

One-year Asset Growth

Sum of Financial Ratio Contributions to Assessment Rate

Assessment Rate Calculation

Uniform Amount 

Weighted Average CAMELS Components Rating

Sum of Contributions (Lines 1 + 2 + 3)1

Initial Base Assessment Rate (IBAR)

Other Real Estate Owneded / Gross Assets

Asset Quality

Management

Earnings

Liquidity

Sensitivity

Weighted Average CAMELS Components Rating

Financial Ratios

Leverage Ratio

Net Income before Taxes / Total Assets

Nonperforming Loans and Leases / Gross Assets

Capital Adequacy

ASSESSMENT RATE CALCULATION

Certificate Number FG1

Dates to which rate applies 20xx-08-03 through 20xx-09-30

Pricing Methodology Established Small Institution

Capital Group Well Capitalized

CAMELS Ratings
Period

IV Unsecured Debt Adjustment

12

13

14

15

16

17

18

19

V Depository Institution Debt Adjustment (DIDA)

20

21

22

23

24

25

1 Sum of "Contributions" (Line 5) cannot be less than the minimum or more than the maximum base rate.

2 This FDIC Board approved adjustment, applicable to all institutions, reflects the rate differential above or below the base

rate schedule.

3 The quarterly assessment rate is equal to one-quarter of the annual assessment rate pro-rated for the number of days indicated. 

The dates for which the rate is effective can be found at the top of this form.

Base assessment rate after DIDA adjustment (basis points) 5.63

If you have any questions about the calculation pages, call (800) 759-6596 and select option 1 or email RRPSAdministrator@fdic.gov

FDIC 6420/07C (09-11)

(Long-term debt less 3% Tier 1 capital / assessment base) * 50 bps 0

Base assessment rate after the unsecured debt adjustment (basis points) 5.63

Depository institution debt adjustment (basis points) (Line 22) 0.00

Base assessment rate after the unsecured debt adjustment (basis points) 5.63

Long-term unsecured debt issued by another IDI ($000) 0

Asset assessment base ($000) 3,424,062

(Total long-term debt / assessment base) * (40 bp + IBAR) 0.693

Initial base assessment rate (basis points) 6.32

Unsecured debt adjustment (basis points) (Line 16 limited) (0.69)

Allowable long-term subordinated debt ($000) 0

Total allowable long-term debt ($000) 51,095

Asset assessment base ($000) 3,424,062

ASSESSMENT RATE CALCULATION PAGE2

Certificate Number FG1

Allowable long-term senior unsecured debt ($000) 51,095