ANALYSIS OF CAPITAL STOCK AND PAID-IN SURPLUS AND COMPUTATION OF 7. Balance at End of Fiscal Year Capital stock (note 1) Paid-in surplus Total Computation of Regulatory Capital for Leverage Purposes: 8. Regulatory Deductions: (Note 3) (a) Organization Expense (Note 4).. (g) Other (Explain)*. 9. Total Regulatory Deductions (The sum of Items 8(a) through 8(g))... 10. Regulatory Capital For Leverage Purposes (Line 7 Minus Line 9).... Computation of Regulatory Capital for Overline Purposes: 11. Net Unrealized Gains as Defnied by Section 107.303(b) of the Regulations (Note 5) 12. Regulatory Capital For Overline Purpose (Line 10 Plus Line 11)... *Give complete details of these items by means of footnotes. NOTE 1.-Capital Stock is the sum of the amounts of all classes of capital stock. NOTE 2.-If Paid-in Surplus is not sufficient to absorb the entire amount of loss on the Sale of Treasury Stock, the amount of loss in excess of Paid-in Surplus will be charged against Undistributed Net Realized Earnings as shown on line 47(b) of the Statement of Financial Position. NOTE 3.-The deductions listed in Items 8(b), 8(c), 8(d) amd 8(g) are total amounts of these items from time of organization to the end of the reporting period. NOTE 4.-If the amount of cash contributed for the organization expense was never credited to Capital Stock or Paid-in Surplus, it should be so stated and explained by a footnote. NOTE 5.-Licensees who rely on this section to increase the amount of their overline limitation will submit an addition to this schedule detailing the following information: 1. Name of small business concern. 2. Market in which traded. 3. Class of security. 4. Cost. 5. Value. 6. Amount of unrealized appreciation. 7. The total amount of unrealized appreciation on the securities listed. 8. The other adjustments reported on line 13 of the statement of unrealized gain (loss) on securities held. 9. The other adjustments required by 107.303b. 10. Names of market makers. ANALYSIS OF CAPITAL STOCK, PAID-IN SURPLUS AND COMPUTATION OF REGULATORY CAPITAL Line 1 Enter the amount shown on Form 468 as the balance at the end of the prior fiscal period. Line 2(a) Capital Stock Issued for CashIn column 1 enter the amount of par value or stated value of the stock issued. In column 2 enter the amount of cash received in excess of par or stated value. In column 3 enter the total of columns 1 and 2. Line 2(b) Stock Dividends Issued for Capitalized Free Undistributed Net Realized Earnings-In column 1 enter the amount of par value or stated value of the stock issued. In column 2 enter the amount of fair market value of the stock in excess of the par or stated value of the stock. In column 3 enter the total of columns 1 and 2. This amount will be the amount charged against retained earnings. Line 2(c) Capital Stock Issued for Services Rendered-In column 1 enter the amount of par or stated value of the stock issued. In column 2 enter the amount of fair market value of the services rendered in excess of the par or stated value of the stock. In column 3 enter the total of columns 1 and 2. Line 2(d) Capital Stock Issued for Assets Other than Cash or Services-In column 1 enter the amount of par or stated value of the stock issued. In column 2 enter the amount of fair market value of the asset in excess of the par or stated value of the stock. In column 3 enter the total of columns 1 and 2. Line 2(e) Gain on Sale of Treasury Stock-Enter the amount of gain on the sale of treasury stock in columns 2 and 3. the Line 2(f) Other Credits-Enter amount of the credit in either column 1 or 2 or both and column 3. Line 3 Total Additions-Enter the total of lines 2(a) through 2(f) of columns 1, 2 and 3. Line 4 Subtotal-The total of line 1 and lines for columns 1, 2 and 3. Line 5(a) Retirement of Capital StockIn column 1 enter the amount of par or stated value of the stock being retired. In column 2 enter the amount appropriate circumstances. In column 3 enter the total of columns 1 and 2. Line 5(b) Loss of Sale of Treasury Stock-Enter the amount of loss in columns 2 and 3 but not in excess of the balance of Paid-in Surplus. Line 5(c) Distributions in Partial Liquidation-Enter the amount of the partial liquidation in either column 1 or 2 or both, appropriate to the facts and in column 3. Line 5(d) Other Debits-Enter amount of the debit in either column 1 or 2 or both and column 3. the Line 6 Total Deductions-Enter the total of lines 5(a) through 5(d) of columns 1, 2 and 3. Line 7 Balance at the End of the Fiscal Period-Subtract line 6 from line 4 for columns 1, 2 and 3. Line 8(a) Organization Expense-Enter the amount of organization expenses whether or not amortized. Line 8(b) Capital Stock Issued for Services-Enter the amount credited to both Capital and Paid-in Surplus for services since date of organization. Line 8(c) Capitol Stock Issued for Assets Other than Cash or Services-Enter the amount credited to both Capital Stock and Paid-in Surplus for assets other than cash or services since date of organization. At such time as the asset is converted to cash the amount of cash received may be considered to have been for stock issued. An adjustment to Paid-in Surplus may be necessary when the asset is converted to cash. Line 8(d) Other Non-monetary ItemsEnter the amount of other non-monetary items credited to either Capital Stock or Paid-in Surplus or both since date of organization. Line 8(e) Investment in 301(d) LicenseeEnter the amount of investment in 301(d) licensee. Line 8(f) Treasury Stock at Cost-Enter the cost of Treasury Stock. Line 8(g) Other-Enter any other necessary adjustments. Line 9 Total Regulatory AdjustmentsEnter the sum of lines 8(a) through 8(f). Line 10 Regulatory Capital for Leverage Purposes-Subtract line 9 from line 7 and enter. Line 11 Net unrealized gains as defined by § 107.303(b)-Go to Note 5 prepare the necessary information and enter the result here. Line 12 Regulatory Capital for Overline Purposes-Add line 11 to line 10 and enter. (Use Only If Licensee Is a Corporation) Name of Licensee.. License Number Statement of Changes in Financial Position for--Months Ended 1. Beginning Cash and Invested Funds Position Funds Were Provided From: 2. Net Investment Income 3. Depreciation, Amorization, Provision for Loss on Receivable. 4. Realized Gain (Loss) on Sale of Securities. 5. Decrease in Portfolio Securities...... 6. Decrease in Assets Acquired. 7. Decrease in Operating Concerns Acquired. 8. Decrease in Other Securities. 9. Decrease in Current Assets (Excluding Cash and Invest ed Idle Funds) 10. Decrease in Other Assets 11. Increase in Current Liabilities 12. Increase in Other Liabilities. 13. Increase in Long-Term Debt: a. Due to or Guaranteed by SBA b. Due to Others..... 14. Sale of Licensee's Stock.. 15. Total Funds Provided 16. Total Funds Available... Funds Were Used For: 17. Increase in Portfolio Securities........................... 18. Increase in Assets Acquired.. 19. Increase in Operating Concerns Acquired 20. Increase in Other Securities.... 21. Increase in Current Assets (Excluding Cash and Invested Idle Funds) 22. Increase in Other Assets 23. Decrease in Current Liabilties (Excluding Dividends) 24. Decrease in Other Liabilities.. 25. Decrease in Long-Term Debt: a. Due to or Guaranteed by SBA b. Due to Others 26. Payment of Dividends. 27. Redemption of Stock 28. Total Funds Used 29. Ending Cash and Invested Idle Funds Position......... NOTE.-Unrealized Gain (Loss) on Securities Held is not reflected in the above statement as it has no effect upon source or application of funds. All increases and decreases from the balance sheet in the above schedule are net after the deduction of non-cash items EXCEPT THE NON-CASH ITEMS REPORTED ON LINE 3 ABOVE. Furnish a schedule of non-cash items for each applicable category. F. Statement of Changes in Financial The Statement of Change in Financial Position is to be inclusive of all changes in financial position resulting from transactions. However, the statement does not include changes in unrealized gains (loss) on securities held which are based on subjective determinations by the Board of Directors and not based on transactions. The objectives of this statement are (1) to summarize the extent to which the licensee has generated cash and invested idle funds and (2) to complete the disclosure of changes in financial position during the period. The following description by line item explains how the amounts on the Statement of Changes in Financial Position are developed. Item 1, Beginning Cash and Invested Funds Position-The total of line item 14, Cash, and line item 15, Invested Idle Funds Assets, as reported on Form 468 at the end of the prior fiscal period. Funds were Provided From: Item 2, Net Investment Income (Loss)— Enter the amount shown on line 33 of the Statement of Operations Realized. Item 3, Depreciation, Amortization, Provision for Loss on Receivables-Enter the total of amounts shown in line items 24 and 28 of the Statement of Operations Realized and the amount of account 672 included in item 29 of the Statement of Operations Realized. Item 4, Realized Gain (Loss) on Sale of Securities-Enter the amount shown on line 38 of the Statement of Operations Realized. Item 5, Decrease in Portfolio Securities— Enter the amount of net change in Item 4, Cost column of the Statement of Financial Position if that amount is a decrease during the period. Do not include current maturities. Item 6, Decrease in Assets Acquired-Enter the amount of net change in Item 7, Cost column of the Statement of Financial Position if that amount is a decrease during that period. Do not include current maturities. Item 7, Decrease in Operating Concerns Acquired-Enter the amount of net change in Item 8, Cost column of the Statement of Financial Position if that amount is a decrease during the period. Do not include current maturities. Item 8, Decrease in Other Securities— Enter the amount of net change in Item 9, Cost column of the Statement of Financial Position if that amount is a decrease during the period. Do not include current maturities. Item 9, Decrease in Current Assets (Excluding Cash and Invested Idle Funds)— Enter the amount of net change in Items 16 through 23 of the Statement of Financial Position if that amount is a decrease during that period. Item 10, Decrease in Other Assets-Enter the amount of net change in Items 13, 24 and 25 of the Statement of Financial Position if that amount is a decrease during the period. Item 11, Increase in Current Liabilities— Enter the amount of net change in Items 30 through 35 of the Statement of Financial Position if that amount is an increase during the period. Item 12, Increase in Other Liabilities— Enter the amount of net change in Items 37, 38 and 39 of the Statement of Financial Position if that amount is an increase during the period. Do not include the amount of account 448. Item 13(a), Due to or Guaranteed by SBA-Enter the amount of net change in Item 27 of the Statement of Financial Position if that amount is an increase during the period. Item 13(b), Due Others-Enter the amount of net change in Item 28 of the Statement of Financial Position if that amount is an increase during the period. Item 14, Sale of Licensee's Stock-Enter that amount of net change in Items 41 through 44 of the Statement of Financial Position if that amount is an increase during the period and the licensee is a corporation. Item 15, Total Funds Provided-Enter the total of Items 2 through 14 of the Statement of Change in Financial Position. Item 16, Total Funds Available-Enter the total of Items 1 and 16 of the Statement of Change in Financial Position. Item 17, Increase in Portfolio Securities— Enter the amount of net change in Item 4 of the Cost column of the Statement of Financial Position if that amount is an increase during the period. Item 18, Increase in Assets Acquired— Enter the amount of net change in Item 7, Cost column of the Statement of Financial Position if that amount is an increase during the period. Item 19, Increase in Operating Concerns Acquired-Enter the amount of net change in Item 8, Cost column of the Statement of Financial Position if that amount is an increase during the period. Item 20, Increase in Other Securities— Enter the amount of net change in Item 9, Cost column of the Statement of Financial Position if that amount is an increase during the period. Item 21, Increase in Current Assets (Excluding Cash and Invested Idle Funds)Enter the amount of net change in Items 16 through 23, of the Statement of Financial Position if that amount is an increase during the period. Item 22, Increase in Other Assets-Enter the amount of net change in Items 13, 24 and 25 of the Statement of Financial Position if that amount is an increase during the period. Item 23, Decrease in Current Liabilities (Excluding Dividends)-Enter the amount of net change in Items 30 through 35 of the Statement of Financial Position if that amount is a decrease during the period. Item 24, Decrease in Other Liabilities— Enter the net amount of change in Items 37, 38 and 39 of the Statement of Financial Position if that amount is a decrease during the period. Do not include the amount of account 448. Item 25(a), Due or Guaranteed by SBAEnter the net amount of change in Item 27 of the Statement of Financial Position if that amount is a decrease during the period. Item 25(b), Due Others-Enter the net amount of change in Item 28 of the Statement of Financial Position if that amount is a decrease during the period. Item 26, Payment of Dividends-Enter the amounts shown in accounts 360 through 364. Item 27, Redemption of Stock-Enter the amount of net change in Items 41 through 44 of the Statement of Financial Position if that amount is a decrease during the period. Item 28, Total Funds Used-Enter the sum of Items 17 through 27 of the Statement of Change in Financial Position. Item 29, Ending Cash and Invested Idle Funds Position-Subtract Item 28 from Item 16. The balance will equal the sum of Items 14 plus 15 of the Statement of Financial Position. Note (1) Disclose by footnote the amount of any potential fees that would be due on the amount REALIZED LOSS EXPERIENCE ON RECEIVABLES, LOANS AND INVESTMENTS G. Statement of Unrealized Gain (Loss) on Securities Held This statement summarizes the results of the valuation process of securities held as of the statement date as compared to the previous statement date and discloses the net change in the Unrealized Gain (Loss) on Securities Held. The types of securities held are the primary groupings of loans and investments as set forth in items 1 through 10 of the Statement of Financial Position and are (1) Portfolio Securities, (2) Assets Acquired in Liquidation of Portfolio Securities, (3) Operating concerns acquired, and (4) other securities. In arriving at net unrealized gain (loss) on securities held, consideration must be given to unrealized appreciation (valuation above cost) and unrealized depreciation (valuation below cost) of such securities. After adjusting the net unrealized appreciation (depreciation) for the appropriate tax effect, the remaining amount will represent unrealized gain (loss) on securities held. Items 1 through 11 are without the estimated tax effect. Item-the amount shown in column 3 Item 4 of the Statement of Financial Position. Item 2-the amount shown in column 3 Item 7 of the Statement of Financial Position. Item 3-the amount shown in column 3 Item 8 of the Statement of Financial Position. Item 4-the amount shown in column 3 Item 9 of the Statement of Financial Position. Item 5-the amount shown in column 3 Item 10 of the Statement of Financial Position. Item 6-the amount shown in column 2 Item 4 of the Statement of Financial Position. Item 7-the amount shown in column 2 Item 7 of the Statement of Financial Position. Item 8-the amount shown in column 2 Item 8 of the Statement of Financial Position. Item 9-the amount shown in column 2 Item 9 of the Statement of Financial Position. Item 10-the amount shown in column 2 Item 10 of the Statement of Financial Position. Item 11-Item 5 minus Item 10. Item 12 will be the estimated taxes that would be due. CAUTION DO NOT COMPUTE A TAX BENEFIT IF ITEM 13 IS A NET UNREALIZED DEPRECIATION Realized Loss Experience on Receivables, Loans and Investments. Furnish in this schedule by categories shown, the amount of loss experienced on loans and investments as well as receivables resulting from income realization. The loss experience will be the actual loss experience during the current period. The amounts shall be rounded to the nearest thousand. Name of Licensee:. License Number: |