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pdfExample Only- SBICs Must Use Web-Based System To Enter Form 468
ANNUAL FINANCIAL REPORT
OMB Approval No. 3245-0063
ON SBA FORM 468
(Partnership SBICs)
Expiration Date mm/dd/yyyy
Name of Licensee:
License Number:
Street Address:
City, State, and Zip Code:
County:
Employer ID Number:
For the Reporting Period Ending:
Months:
----------------~
A- Fund Focus
B - Ownership
C- Fund IRR
Net IRR:
Gross IRR:
(for 58/Cs licensed on or after January 1, 1994}
SBA Form 468 is to be completed only by small business investment companies (SBICs) licensed by the Small
Business Administration. This form contains financial statements and supplementary information which SBA
uses to evaluate an SBIC's financial condition and compliance with its business plan and SBIC program requirements.
SBA also pools financial information provided by individual SBICs to analyze the SBIC program as a whole with
respect to the risk of financial loss to the government and the impact of SBIC financings on the growth of small
business.
Form 468 must be completed and filed electronically in the SBIC-Web system . Within the system, you may also
upload supplemental documents as the form instructs.
SBIC-Web requires an SBA-approved user account. Submit your account request to sbicwebsupport@sba.gov.
Please Note: The estimated burden for completing this form is 35 hours per response if a wind -up plan is required and 25 hours per response if a
wind-up plan is not required . You will not be required to respond to this information collection if a valid OMB approval number is not displayed . If
you have questions or comments concerning this estimate or other aspects of this information collection, please contact the U.S. Small Business
Administration, Chief Administrative Information Branch, Washington, D.C. 20416 and/or SBA Desk Officer, Office of Management and Budget, New
Executive Office Building, Room 10202, Washington, D.C. 20503. PLEASE DO NOT SEND FORMS TO OMB.
SBA Form 468.2 (02/14) Previous edition obsolete.
Page lP
Example Only- SBICs Must Use Web-Based System To Enter Form 468
STATEMENT OF FINANCIAL POSITION
ASOF
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
-----------------------
(Amounts rounded to nearest dollar)
License No.
ASSETS
LOANS AND INVESTMENTS:
Unrealized
Unrealized
Re~orted
Cost
De~reciation
A~~reciation
Value {1}
(Col. 1)
(Col. 2)
(Col. 3)
(Col. 4)
Portfolio Securities:
1 Loans
2 Debt Securities
3 Equity Securities
4 Total Portfolio Securities
Assets Acquired in Liquidation of Portfolio Sec.,.:u:.:..r:..:
it:..:
ie::s.:..
: --------"""T"-----------,...--------.-------,
5 Receivables from Sale of Assets Acquired
6 Assets Acquired
7 Total Assets Acquired
8 Operating Concerns Acquired
9 Notes and Other Securities Received
10 TOTAL LOANS AND INVESTMENTS
11 Less Current Maturities
12 Loans and Investments Net of Current Maturities
Investment in 301(d) L;.:
ic:..:.e.:..:.
ns:..:e:..:e:. . .(;~2:!....
) ------------.
13 Name/License No.
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CURRENT ASSETS
14 Cash and Cash EquivaIents
15 Invested Idle Funds
16 Interest and Dividen ds Receivable
17 Notes and Accounts Receivable
18 Receivables from Pa rent or Other Associates
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19 Less: Allowance for Losses (lines 16, 17, and 18)
20 Current Maturities of Portfolio Securities
21 Current Maturities of Assets Acquired
22 Current Maturities of Operating Concerns Acquired
23 Current Maturities of Other Securities
24 Other (specify)
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25 Other (specify)
OTHER ASSETS
26 Net Furniture and Equipment
27 Net Leverage Fees
28 Other (specify)
29 Other (specify)
30 TOTAL ASSETS
(1) Column Headings apply to items 1 through 12 only. (Cost- Unrealized Depreciation+ Unrealized Appreciation= Value)
(2) Note to item 13 should include percent owned, cost basis and changes resulting from equity method of accounting.
SBA Form 468.2 (02/14} Previous edition obsolete.
Page 2P
Example Only- SB/Cs Must Use Web-Based System To Enter Form 468
STATEMENT OF FINANCIAL POSITION
ASOF
----------------------(Amounts rounded to nearest dollar)
I
Name of Licensee :
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
License No.
LIABILITIES AND CAPITAL
liabilities
Long-Term Debt
31 Notes and Debentures payable to or guaranteed by SBA.
32 Notes and Debentures Payable to Others
33 a. Participating Securities Held or Guaranteed by SBA
b. Earned Prioritized Payments Allocated for Distribution
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c. SBA Profit Participation Allocated for Distribution
Current Liabilities
34 Accounts Payable
35 Due to Parent or Other Associates
a. Management Exp enses Due to Associates
b. Other Due to Ass ociates
36. Accrued Interest Pa yable
37. Acc rued Taxes Paya ble
38. Distributions Payab le
39 . Short-term notes Pa yable/Lines of Credit
40 Other (specify)
41 Other (specify)
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Other Liabilities
42 Deferred Credits
43 Deferred Fee Income
44 Other (specify)
.-----------------------------~
45 Total liabilities
PARTNERS' CAPITAL
46 Private Partners' Contributed Capital
a. General Partner(s)
b. Limited Partner(s)
47 Other (specify)
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48 Unrealized Gains (Lo ss) on Securities Held
49 Non-Cash Gains/lnco me
50 Undistributed Net Re alized Earnings
51 Undistributed Realize d Earnings (line 49 plus line 50)
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52 TOTAL PARTNERS' CAPITAL
58 TOTAL LIABILITIES AND PARTNERS' CAPITAL
SBA Form 468.2 (02/14) Previous edition obsolete .
Page 3P
Example Only- SBICs Must Use Web-Based System To Enter Form 468
STATEMENT OF OPERATIONS REALIZED
For
MONTHS ENDED _ _ __
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
(Amounts rounded to nearest dollar)
Name of Licensee:
License No .
INVESTMENT INCOME
11nterest Income
2 Dividend Income
3 Income (Loss) from Investments in Partnerships/Flow-through Entities
4 Income (Loss) from Investments in Section 301(d) Licensee
5 Fees for Management Series
6 Application, Closing and Other Fees
7 Interest on Cash Equivalents and Invested Idle Funds
8 Income from Assets Acquired in Liquidation of
Loans and Investment (net of$ _ _ _ _ _ Expenses)
9 Other Income
10 GROSS INVESTMENT INCOME
EXPENSES
lllnterest Expense
a. Interest Expense -- Earned Prioritized Payments, Charges & Adjustments
b. Interest Expense-- SBA Debentures
c. Other Interest Expense
12 Commitment Fees & Other Financial Costs
13 Compensation and Benefits (Officer and Employee)
14 Investment Advisory and Management Services
15 Partners' Meetings
16 Appraisal and Investigation
17 Advertising, Communication and Travel
18 Cost of Space Occupied
19 Depreciation and Amortization
a. Amortization of Leverage Fees
b. Other Depreciation and Amortization
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20 Insurance
21 Payroll and Other Taxes
22 Provision for Losses on Receivables (excluding loans receivable)
23 Legal Fees
24 Audit and Examination Fees
25 Miscellaneor-us;_E_x..:.:p...:.e;_ns_e...;,s_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _...,
a. Misc. #1
b. Misc . #2
c. Misc. #3
d. Misc. #4
e. Misc. #5
f . Misc. #6
26 TOTAL EXPENSES
27 NET INVESTMENT INCOME (LOSS)
28 NET REALIZED GAIN (LOSS) ON INVESTMENTS (1)
29 NET INCOME (LOSS) BEFORE NONRECURRING ITEMS
30 Extraordinary Item
31 Cumulative Effect of Change in Accounting Principle
32 NET INCOME (LOSS)
(1) Provide supporting detail for all realized gains and losses on Page 13P of this form.
SBA Form 468 .2 (02/14) Previous edition obsolete .
Page 4P
Example Only- SBICs Must Use Web-Based System To Enter Form 468
STATEMENT OF CASH FLOWS
MONTHS ENDED _ _ __
For
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
(page 1 of 2)
(Amounts rounded to nearest dollar)
Name of Licensee :
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License No .
OPERATING ACTIVITIES
Cash Inflows
11nterest Received from Portfolio Concerns
2 Dividend Received from Portfolio Concerns
3 Other Income Received from Portfolio Concerns
4 Management Services and Other Fees Received
5 Interest on Cash Equivalents and Invested Idle Funds
6 Cash Received from Assets Acquired in Liquidation
7 Other Operating Cash Receipts
Cash Outflows
8 Interest Paid (excl. Earned Prioritized Payments, Charges and Adjustments)
9 Commitment Fees and Other Financial Costs
10 Investment Advisory and Management Fees
11 Partners' and Employees' Compensation and Benefits
12 Operating Expenditures (Excluding Compensation and Benefits)
13 Other Operating Cash Disbursements
14 NET CASH PROVIDED BY (USED IN) OPERATING ACTIVITIES
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INVESTING ACTIVITIES
Cash Inflows
15 Loan Principal Payments Received from Portfolio Concerns
16 Returns of Capital Received from Portfolio Concerns
17 Net Proceeds from Disposition of Portfolio Securities
18 Liquidation of Idle Funds Investments
.-------------------------------------~
19 Other (Specify)
Cash Outflows
20 Purchase of Portfolio Securities
21 Loans to Portfolio concerns
22 Idle Funds Investment
~------------------.
23 Other (Specify)
24 NET CASH PROVIDED BY (USED IN) INVESTING ACTIVITIES
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FINANCING ACTIVITIES
Cash Inflows
25 Proceeds from Issuance of SBA-Guaranteed Debentures
25 Proceeds from Issuance of SBA-Guaranteed Partcipating Securities
27 Proceeds from Non-SBA Borrowing
28 Proceeds from Sale of Stock or Other Capital Contribution
29 Other (Specify)
Cash Outflows
30 SBA Leverage Fees
31 Principal Payments on SBA-Guaranteed Debentures
32 Principal Payments on Non-SBA Borrowing
33 Redemption of Participating Securities
34 Redemption of Private Partnership Interests
35 Prioritized Payments, Charges and Adjustments Paid
36 SBA Profit Participation Paid
37 Other Distributions Paid
~~----------------.
38 Other (Specify)
39 NET CASH PROVIDED BY (USED IN) FINANCING ACTIVITIES
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SBA Form 468.2 (02/14) Previous edition obsolete .
Page SP
Example Only- SBICs Must Use Web-Based System To Enter Form 468
STATEMENT OF CASH FLOWS
For
OMB Approval No. 3245-0063
MONTHS ENDED----
Expiration Date mm/dd/yyyy
(page 2 of 2)
(Amounts rounded to nearest dollar)
I
Name of Licensee:
License No.
411NCREASE (DECREASE) IN CASH AND CASH EQUIVALENTS
42 CASH AND CASH EQUALENTS AT BEGINNING OF PERIOD
43 CASH AND CASH EQUIVALENTS AT END OF PERIOD (line 14, page 2P)
RECONCILIATION OF NET INCOME (LOSS) TO NET CASH PROVIDED BY (USED IN) OPERATING ACTIVITIES
44 Net Income (Loss) (Line 32, page 4P)
. _ I_ _ _ _ _ _ _ _ ,
Adjustments to Reconcile Net Income (Loss) to Net Cash Provided by (used in) Operating Activitr-ie_s_: - - - - - - ,
45 Depreciation and Amortization (line 19, page 4P)
46 Provision for Losses on Accounts Receivable (line 22, page 4P)
47 Earned Prioritized Payments, Charges, and Adjustments
48 Realized (Gains) Losses on Investments (line 28, page 4P)
49 Other (Sp~e~c~ify:..:_l_.:::===========::;--------:
a.
~----------------~
________________
~---------------~
b. .__
c.
~
§
Changes in Operating Assets and Liabilities Net of Noncash Items
50 (Increase) Decrease in Interest and Dividends Receivable
51 (Increase) Decrease in Other Current Assets
52 Increase (Decrease) in Accounts Payable
53 Increase (Decrease) in Accrued Interest Payable
54 Increase (Decrease) in Accrued Taxes Payable
55 Increase (Decrease) in Distributions Payable
56 Increase (Decrease) in Other Current Liabilities
57 Other (Specify)
58 Other (Specify)
59 NET CASH PROVIDED BY (USED IN) OPERATING ACTIVITIES
(Total must agree with line 14, page SP)
Supplemental disclsure of non-cash financing and investing activites may be required.
See ASC 230, "Statement of Cash Flows" .
SBA Form 468.2 (02/14) Previous edition obsolete .
Page 6P
Example Only - 58/Cs Must Use Web-Based System To Enter Form 468
STATEMENT OF PARTNERS' CAPITAL
ASOF _____________
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
(page 1 of 2)
(Amounts rounded to nearest dollar)
Name of Licensee :
License No .
GENERAL
PART I. PRIVATE PARTNERS' CONTRIBUTED CAPITAL
PARTNER(S)
LIMITED PARTNER(S)
(page 3P, line 46a)
(page 3P, line 468)
NON-CASH
GAINS/INCOME
UNDISTRIBUTED NET
REALIZED EARNINGS
REALIZED EARNINGS
(1)
(2)
(1) + (2)
TOTAL
1 BALANCE AT BEGINNING OF PERIOD
2 ADDITIONS:
a. Partnership interests issued for cash
b. Partnership interests issued for services rendered
c. Partnership interests issued for contributed non-cash assets
d. Capitalization of Retained Earnings Available for Distribution
e. Other credits (specify) _ _ _ _ _ _ _ _ _ _ _ __
3 Total additions (sum of 2a through 2E)
4 Subtotal (line 1 plus line 3)
S DEDUCTIONS:
a. Liquidation of of Partnership interests
b. Other debits (specify) _ _ _ _ _ _ _ _ _ _ _ __
6 Total deductions (sum of Sa through Sb)
7 BALANCE AT END OF PERIOD (line 4 minus line G)-Total must agree with lines 46a and 46b, page 3P
PART II. UNDISTRIBUTED REALIZED EARNINGS
UNDISTRIBUTED
1 BALANCE AT BEGINNING OF PERIOD
2 ADDITIONS:
a. Net investment income
b. Interest Expense- Earned Prioritized Payments, Charges &
Adjustments (line lla, page4P)
c. Realized gain (loss) on investments
d. Gain on appreciation of securities distributed in kind
e. Other (specify) _ _ _ _ _ _ _ _ _ _ _ __
3 Total additions (sum of 2a through 2e)
4 Subtotal (line 1 plus line 3)
S DEDUCTIONS:
a. Cash Distributions
b. Distribtions allocated but not paid
c. In-Kind Distributions (at fair value)
d. Capitalization of Retained Earnings available for Distribution
e. Other (specify) _ _ _ _ _ _ _ _ _ _ _ __
6 Total deductions (sum of Sa through Se)
7 Total before collection of non-cash gains/income
(line 4 minus line 6)
8 Collection of non-cash gains/income
9 BALANCE AT END OF PERIOD (line 7 plus line 8)Totals must agree with lines 49, SO, and 51, page 3P
SBA Form 468.2 (02/14) Previous edition obsolete.
Page 7P
Example Only- SBICs Must Use Web-Based System To Enter Form 468
I. RETAINED EARNINGS AVAILABLE FOR DISTRIBUTION
II. REGULATORY AND LEVERAGEABLE CAPITAL
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
AS OF - - - - - - (Amounts rounded to nearest dollar)
Name of Licensee :
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License No .
PART I. RETAINED EARNINGS AVAILABLE FOR DISTRIBUTION OR CAPITALIZATION.
1 Undistributed net Realized Earnings (line 50, page 3P)
2 LESS : Unrealized Depreciation (line 10, column 2, page 2P)
3 RETAINED EARNINGS AVAILABLE FOR DISTRIBUTION OR CAPITALIZATION
PART II. SCHEDULE OF REGULATORY AND LEVERAGEABLE CAPITAL
1 Private Partners' Contributed Capital (line 46, page 3P)
2ADD:
a. Unfunded binding commitments from Institutional Investors
b. Waived management fees credited as capital contributions
3 LESS : Regulatory Distributions
a. Organization Expenses Not Approved by SBA (1)
b. Partnership interests Issued for Services
c. Partnership interests Issued for Non-cash Assets (unless approved by
SBA for inclusion in Regulatory Capital or converted to cash)
d. Other ( s p e c i f y ) - - - - - - - - - - - 4 Total Regulatory Deductions (Sum of 3a through 3d)
5 Other Adjustments to Regulatory Capital (specify) _ _ _ _ _ _ _ _ _ _ _ __
6 REGULATORY CAPITAL (sum of lines 1, 2, 4, and 5)
7 LESS : Unfunded binding commitments from Institutional Investors
8 LESS : Non-cash assets included in Regulatory Capital, other than eligible investments in Small Concerns
9 LESS: Other deductions (specify) - - - - - - - - - - - - - - - - - - 10 LEVERAGEABLE CAPITAL (sum of lines 6 through 9)
PART Ill. CUMULATIVE PRIVATE INVESTOR CAPITAL CONTRIBUTIONS & DISTRIBUTIONS
(for 58/Cs licensed on or after January 1, 1994}
1 All Private Capital Contributions Ever Paid-In
2 All Distributions to Private Investors Ever Paid Out- Including Fair Market Value of Non-Cash Distributions
NOTES
(1) Deduct only those organizational expenses which were not accepted as reasonable by SBA.
SBA Form 468.2 (02/14) Previous edition obsolete .
Page 8P
Example Only- SB/Cs Must Use Web-Based System To Enter Farm 468
SCHEDULE OF COMMITMENTS
ASOF
Name of Small Business
SBA Form 468.2 (02/14) Previous edition obsolete.
Emolover ID
Amount of
Commitment
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
Loan, Debt, or
Date Made
Date
New investment or
follow-on?
Page 9P
Example Only- SBICs Must Use Web-Based System To Enter Form 468
OMB Approval No. 3245-0063
SCHEDULE OF GUARANTEES
ASOF
Name of Small Business I Emolover ID
SBA Form 468.2 (02/14) Previous edition obsolete.
Guarantee
Amount
Date
Made
Expiration Date mm/dd/yyyy
Expiration Date
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Name of Guaranteed
Partv
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Is guarantee
collaterialized? If so, by
what?
Description of underlying
nhlia:ation of Small Business
Page lOP
Example Only- SB/Cs Must Use Web-Based System To Enter Form 468
SCHEDULE 1
SCHEDULE OF LOANS AND INVESTMENTS
OMB Approval No. 3245-0063
ASOF
Expiration Date mm/dd/yyyy
Name of Licensee:
License No.
I
Note: Items in red font only apply to SBICs in the Office of Liquidation or as specifically requested by SBA.
Portfolio Company Name
I
Employer ID
Loans and Investments (ordered bv date ascending)
1mt1a11nvest.
Investment Date
Investment Type
Amount
I
% Own
cost at Beg. of
Period
Other Notes:
!)maller Enterprise?
Comments:
Qualifies as start-up per CFR 107.50?1
Equity Capital?!
Eguitlllnformation
Type of Shares:
Equity Features :
Number of Shares:
Market/Liquidity:
Warrants? Terms :
Expiration Date:
Other type of OL Asset? __ If yes:
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%Vote
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Cost at End of Period
AdditiOnS/
Deductions
Descnpt1on of
Addition/Deduction
SBA Form 468.2 (02/14) Previous edition obsolete.
Cost at tna or
Period
unreauzea App
(Dep)
I
Total Reported Value
Reported Value
Class I and II AQQreciation
Class I Appreciation Amount:
Class II Appreciation Amount:
If Class II, Date of Up Round?
LoanfDebt Information
Maturity Date:
Repay. Terms :
Collateral:
Date of Last Payment:
Balloon Payment Due:
Type:
Amount:
Unrealized App (Dep)
Description of Asset:
Description of Liens :
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Type:
Status :
Interest Rate :
Balloon % at maturity:
Future Estimated Recoveries :
Date Investment Concluded :
Page llP-2
Example Only- SBICs Must Use Web-Based System Ta Enter Farm 468
1 A. SUMMARY OF LOANS AND INVESTMENTS
1 B. SMALLER ENTERPRISE FINANCINGS
ASOF
SCHEDULE 1 A/B
Name of Licensee :
I
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
License No.
I
1 A. SUMMARY OF LOANS AND INVESTMENTS
1
2
3
4
5
6
Unrealized
Investment Category
Cost at Beginning of
Additions/
Cost at End of
Appreciation
Period
(Deductions)
Period
(Depreciation)
Reported Value
Total Loans (linel, page 2P)
Total Debt Securities (line 2, page 2P)
Total Equity Securities (line 3, page 2P)
Total Portfolio Securities (line 4, page 2P)
Total Assets Acquired (line 7, page 2P)
Total Operating Concerns Acquired (line 8, page 2P)
Total Notes and Other Sees. Received (line 9, page 2P)
Total Loans and Investments (line 10, page 2P)
1 B. SMALLER ENTERPRISE FINANCINGS
1 Cumulative dollar amount of Smaller Enterprise Financings extended between April 25, 1994 and close of reporting fiscal year.
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2 Cumulative dollar amount of all Financing extended between April 25, 1994 and close of reporting fiscal year.
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3 Percentage of total Financings extended to Smaller Enterprises (line 1 divided by line 2}
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SEE 13 CFR 107.710 FOR PERCENTAGE OF TOTAL FINANCINGS WHICH MUST BE IN SMALLER ENTERPRISES.
SBA Form 468.2 (02/14) Previous edition obsolete .
Page 12P
Example Only - SBICs Must Use Web-Based System Ta Enter Farm 468
SCHEDULE 2
SCHEDULE OF REALIZED GAINS AND
OMB Approval No. 3245-0063
LOSSES ON LOANS AND INVESTMENTS
Expiration Date mm/dd/yyyy
FOR
Name of Small Business I Employer
Security
1Transaction Type
ID
/
___
Date
/
I
MONTHS ENDED
Name and Address of
Net Sales
Price
Realized
Cost
Gai
Cash
Date
__
Escrow Exp. Comments
(1) Security Type: L= loans, D=Debt, E=Equity, AA=Assets Acquired, OC=Operating concerns acquired, NS=Notes and Other Securities Received
(2) Transaction Type: S= Sale, E=Exchange, C=Charge-off, D=Distribution of Securities
SBA Form 468.2 (02/14) Previous edition obsolete.
Page 13P
Example Only - SBICs Must Use Web-Based System Ta Enter Form 468
SCHEDULE 3
OMB Approval No. 3245-0063
SCHEDULE OF NON-CASH GAINS/INCOME
Expiration Date mm/dd/yyyy
ASOF
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Name of Licensee :
License No.
2
1
3
4
5
6
7
Collections
Balance at End of
Amount of "Includible Non-cash
During Period
Period
Gains" for Capital Impairment
Balance at
Name of Small Business I
Description of Non-cash
Beginnning of
Employer ID
Gains/Income (1)
Period
Additions
!
TOTAL
(1) Examples of non-cash gains and income include the following:
- Non-cash gains on sale or exchange of securities
- Interest income accrued on deferred interest notes, zero coupon bonds or similar instruments
- Dividends received in kind
-Accrued interest converted into a new note or added to principal of an existing note. The amount of any such interest which was previously included in Undistributed
Net Realized Earnings must be reclassified to Non-cash Gains/Income.
SBA Form 468.2 (02/14) Previous edition obsolete.
Page 14P
Example Only- SBICs Must Use Web-Based System To Enter Farm 468
SCHEDULE 4
SCHEDULE OF DELINQUENT
OMB Approval No. 3245-0063
LOANS AND INVESTMENTS
Expiration Date mm/dd/yyyy
ASOF
Interest
Name of Small Business I
ID
Outstanding
Balance
I
Amount Past
Due
I
Days Past
Due Ill
I
Amount
Past Due
Days Past
Due
Date of Last Pavml"nt
Interest
Amount of Last Pavml"nt
Interest
Fair Makrket
Value OF
Collateral
(1) Based on oldest delinquency.
SBA Form 468.2 {02/14) Previous edition obsolete .
Page 15P
Example Only- SBICs Must Use Web-Based System To Enter Form 468
SCHEDULE 5
SCHEDULE OF CASH AND INVESTED IDLE FUNDS
ASOF
Name of Licensee:
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
License No.
COMPLETE SCHEDULE ONLY IF LICENSEE HAS, OR PLANS TO APPLY FOR, SBA LEVERAGE.
I. U.S. GOVERNMENT OBLIGATIONS (direct or guaranteed)
Description
Maturity Date
Amount
Maturity Date
Amount
II. REPURCHASE AGREEMENTS WITH FEDERALLY-INSURED INSTITUTION
Name and Location of Financial Institution
Ill. CERTIFICATES OF DEPOSIT ISSUED BY FEDERALLY-INSURED INSTITUTIONS
Name and Location of Financial Institution
Maturity Date
Amount
IV. DEMAND DEPOSIT, MONEY MARKET, AND SAVING ACCOUNTS IN FEDERALLY-INSURED INSTITUTIONS
Name and Location of Financial Institution
Maturity Date
Amount
Maturity Date
Amount
V. OTHER CASH AND INVESTED IDLE FUNDS
Description
TOTAL CASH, CASH EQUIVALENTS AND IDLE FUNDSL......------------J
(total must agree with sum of lines 14 and 15, page 2P)
SBA Form 468.2 (02/14) Previous edition obsolete .
Page 16P
Example Only- 58/Cs Must Use Web-Based System To Enter Form 468
SCHEDULE 6
Name of Licensee :
SCHEDULE OF ACTIVITY
ASOF
I
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
License No .
PART I. FIRST ACTIVITY TEST
1. Cash and Cash Equivalents (line 14, page 2P)
2. Invested Idle Funds (line 15, line 2P)
3. Total Cash and Idle Funds
4. Total Assets at Cost:
a. Total Assets (line 30, page 2P)
b. ADD: Unrealized Depreciation (line 10, col. 2, page 2P)
c. LESS: Unrealized Appreciation (line 10, col 3, page 2P)
d. Total Assets at Cost
5. Line 3 Divided by Line 4d (expressed as a percentage)
IF LINE 5 IS LESS THAN OR EQUAL TO 20%, LICENSEE IS NOT INACTIVE-- DO NOT COMPLETE PART II
IF LINE 5 IS GREATER THAN 20%, COMPLETE THE SECOND ACTIVITY TEST IN PART II
PART II. SECOND ACTIVITY TEST
6. Financings during the Past 18 Months:
a. Loans
b. Debt
c. Equity
d. Guarantees
7. Total (lines 6a through 6d)
8. Regulatory Capital
9. Line 7 divided by Line 8 (expressed as a percentage)
IF LINE 9 IS LESS THAN 20%, LICENSEE MAY BE INACTIVE UNDER SECTION 107.590ATIACH EXPLANATION OF INACTIVITY AND PLANNED CORRECTIVE ACTION .
SBA Form 468 .2 (02/14) Previous edition obsolete .
Page 17P
Example Only- SB/Cs Must Use Web-Based System To Enter Form 468
SCHEDULE 7
GENERAL PARTNERS, LIMITED PARTNERS,
AND ADVISORY MANAGEMENT
OMB Approval No. 3245-0063
ASOF
Name of Licensee:
1
Name and Address
2
General Partner/ Umited
Partner I Manager - give
exact titles
SBA Form 468.2 (02/14) Previous edition obsolete.
3
4
5
Percent Owned or Controlled of Total
Interests Outstanding
Are partnership
Number of
interests legally owned,
beneficially owned, or
Partnership Units
controlled?
Owned or Controlled Beginning of Period
I
End of Period
Page 18P
Example Only - SB/Cs Must Use Web-Based System To Enter Form 468
OPERATING PLAN UPDATE
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
Name of Licensee :
I
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License No .
INSTRUCTIONS
Any Licensee which has SBA leverage outstanding, or which expects to apply for leverage in the current fiscal
year, must prepare an annual update of its plan of operations. The update is one of the supplementary
information documents that is filed with the Licensee's Annual Financial Report on SBA Form 468, and must be
uploaded within the SBIC-Web system as a .pdf document.
The plan update must include analysis and discussion of key events of the past year, as well as expectations for
the current year. SBA expects that most Licensees will be able to provide the required information in a
narrative of no more than 3 pages.
Content of the Report
1. For the fiscal year ended, the Licensee should discuss the following:
a. Major positive and negative events which affected overall performance during the year, including
exits/distributions/write-offs of investments; highlight any significant differences between last year's
plan and actual performance.
b. Any significant changes in the operations of the Licensee, such as changes in organizational structure,
scope of operations, level or phase of investment activity, or types of investments being made .
c.
Any management changes.
d.
Any lawsuits or other events giving rise to contingent liabilities.
2. For the current fiscal year, the Licensee should discuss the following:
a. Levels of new and follow-on investment anticipated
b. Anticipated exits/distributions/write-offs from investments
c.
d.
e.
f.
Any
Any
Any
Any
material changes expected in investment strategy or portfolio composition
material changes expected in overhead expenditures
changes expected in management
other anticipated events which may have a significant effect on Licensee's performance.
3. If an SBIC is in Liquidation, wind-up or has been otherwise requested to provide a wind-up plan, the SBIC
shall provide a wind-up plan as part of the Operating Plan Update. Per 13 CFR 107.590, SBICs in Operations
must submit wind-up plans for SBA approval. After SBICs receive approval, they should provide updated windup plans on an annual basis as part ofthis Operating Plan Update. (See attached supplement.)
SBA Form 468.2 {02/14) Previous edition obsolete.
Page 19P
Example Only- SBICs Must Use Web-Based System Ta Enter Form 468
SCHEDULE 8
Unaudited Portfolio Company Information
OMB Approval No. 3245-0063
ASOF
Expiration Date mm/dd/yyyy
License No.
Cost at End of Period
Unrealized App (Dep)
I
Total Reported
Rounded to nearest$
Business Description
1st Date Invested:
~~~~~ :
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Exchange :!
NAICS:
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Overline?
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As of Date
Basis Period t - - - - - - - - - : = + - - - - - - - - - f - - - - - - - - - 1
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Stock Symbol :!
If orignal investment company's name changed, was acquired/merged,
company name of original investment:
Add'"'l
City/State:
Zip Code:
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LMI:
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Other Comments :
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Portfolio Company Waterfall/Capitalization Table
Financial Statement Type :
Statement Opinion: _ _ _ _ __
_ Signficant Litigation
_Going Concern
_Other
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Full-time employees: 1 - - - - - - - - - f
Federal Taxes Paid:
State Taxes Paid
PDF File Uploaded:
Instructions: Upload latest waterfall/capitalization table in PDF format if you hold an equity investment in the portfolio company or you hold warrants that you have valued over cost. If the
portfolio company is public and you only hold debt securities or common stock, you do not need to provide this information.
Include all relevant information associated with each security, including information needed to assess value of your holdings. Relevant information may include : date closed, security issued,
price, total round size, SBIC's participation within round, if available and not confidential name of significant investors (over 10% ownership in security), liquidation preferences, seniority,
accruing dividends, etc ... If the SBIC has been transferred to the Office of Liquidation, you must also describe any investor rights you hold, such as negative covenants, board membership or
observation rights, or other rights (such as veto or springing) .
SBA Form 468.2 (02/14) Previous edition obsolete .
Page 20P
Example Only- SB/Cs Must Use Web-Based System To Enter Form 468
SCHEDULE 9
UNAUDITED SBIC CUMULATIVE INVESTMENT
PERFORMANCE
Expiration Date m
ASOF
all investments, both realized and unrealized, made by the SBIC since the fund commencement date or October 1, 1993, whichever is later. If historical information is unavailable in the
requested, you may omit (1) investments realized or written off on or before June 30, 2011, and (2} for investments held as of July 1, 2011, gross receipts received on or before June 30,
Name of Small Business
ID
Date 1st
Invested
Total Dollars
Invested
Cash
Total
SBA Reported
Value
Gross Receipts to
Total Dollars
Invested
(Gross Receipts+ Reported
Value) to Total Dollars
Invested
* Note: Gross Receipts includes all cash and qualifying equity securities received by SBIC for portfolio company investment. Cash receipts may include interest, dividends, repayment of debt, profit
distributions, etc ... Equity securities may only be included if they have been distributed by the SBIC to its investors; in which case, they should be entered based on the distributed value . Equity
securities or notes still held by the SBIC should be included in the Residual Value .
SBA Form 468.2 (02/14) Previous edition obsolete .
Page 21P
Example Only- SB/Cs Must Use Web-Based System To Enter Form 468
CERTIFICATIONS
OMB Approval No. 3245-0063
Expiration Date mm/dd/yyyy
Name of Licensee :
I
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License No.
MANAGEMENT CERTIFICATION
1,[
[
(Licensee),]
the General Partner of
a General Partne r of
a General Partner of
(Licensee),]
[
a Managing Member of
the General Partner of
[
(Licensee),]
the President of
the General Partner of
(Licensee),] do hereby certify as follows :
1. The audited Annual Financial Report for the fiscal year ended
submitted by
(Licensee) to the Small Business Administration on SBA Form 468 is true and correct in
all resoects. The statements and schedules listed below have been omitted from the submission .
2. The General Partner of
(Licensee) has reviewed and approved the audited
Annua l Financial Report of such company for the fiscal year ended
3.
(Licensee) has filed all federal, state and local tax returns required through
the date hereof, including but not lim ited to payroll tax returns and informational returns for income tax purposes .
4.
(Licensee) is in good standing.under the laws of the State of
STATEMENTS AND SCHEDULES OMITIED:
CAUTION: By signing below, you are certifying as to the truth and accuracy of the audited Annual Financial Report in all
respects, and acknowledging that officials in the Small Business Administration (SBA) will be relying on this certification.
Knowingly making a false statement to or concealing a material fact from the SBA can lead to imprisonment of up to 30
years and/or a fine of up to $1,000,000 under 18 U.S.C. § 1014.
Date :
SBA Form 468.2 (02/14) Previous edition obsolete.
By:
Name:
Title :
Page 22P
SBA Form 468 Operating Plan Update Supplement: Wind-up Plan for Specified SBICs
OMB Approval No. 324S-0063
12/31/20131
Expiration Date mm/dd/yyyy
As
SBIC:
ofl
L
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License Numbed
Note: Detail for proceeds from mcome and extts and follow-on investments ore on separate schedules.
Capital & Beginning Balances
Cash & Cash Equivalents BalanceL.I--------1
Total SBA Leverage Drawn
Total Redemption s
Total Non-redemption SBA Distribution s
SBA Leverage Balance
Unfunded SBA Leverage Commitments
Earned Prioritized Payment Balance
Unearned Prioritized Payment Balance
Total Capital Committed to Fundl-------1
To::lt:~:~~~:e~:~:~::u~~:~~~===========~
Total Non-regulatory Distributions I - - - - - - - I
Leverageable Capital Balance I - - - - - - - I
Unfunded Regulatory Commitments
t-------1
Regulatory CapitaiL-_ _ _ _ _.J
Pro Forma cash Flows
1/1/2014 to
12l31l2014
In thousands of$
Cash In Flows
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2015
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2016
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Post
2016
Pro
Forma
Total
-
!;omments
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Private Capital Draws (Paid In)
SBA Leverage/Loan Draws
Idle Interest & Other Income
Loan & Investment Income/Proceeds (Schedule A)
Cash Out Flows
Expenses
Management Fees
SBA Interest, Leverage Fees, & Annual Charges
Other Expenses
I..,'"''''''''""''
Investments (Follow-Ons) (Schedule B)
~-------------~--~
LP Distributions
B
READ
Return of LP Capital
Total to LPs
SBA Distributions
SBA Leverage Redemptions
If Participating, Other SBA Distributions
Total SBA Distributions
Cash Out
Net Cash Flow
Ending Balances
~----~---~---~--~-~----L-----------__.J
12/31/2013
RegCap
-
-
-
-
-
Leverageable Capital
-
-
-
-
-
-
-
SBA LevBalance
Cash & Cash Equivalents
Unfunded Private Commitments
Unfunded SBA Commitments
SBA Form 468.2 (02/14) Previous edition obsolete .
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Operating Plan Supplement Page 1
SBA Form 468 Operating Plan Update Supplement: Wind-up Plan for Specified SBICs
OMB Approval No. 3245-0063
Schedule A- SBIC Forecast Anticipated Income/Proceeds
Expiration Date mm/dd/vvvvl
As of: I
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SBIC Name
-]
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license Numbe!L
Antici ated Exit Proceeds
~i
liquidations Only
Actual Cum.
:; ~
.. c
>-
Portfolio Company Name
Timing of likely Exit Income/Proceeds
Cost of
468 Reported
Invest.
Val
Ant. Exit
Type
Thru end of
Minimum
Maximum
likely
Current Year
2015
2016
Post2016
Total Estimated
Source of
Est. Exit
Cash Receipts
Future Recoveries
FMV
Year
inOL
Date Concluded
Comments:
-,
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I$
I$
I$
Comments:
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Comments:
-----
ITOTALS
I$
SBA Form 468.2 {02/14) Previous edition obsolete.
$
$
$
$
$
$
$
I$
--- --::J
Operating Plan Supplement Page 2
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SBA Form 468 Operating Plan Update Supplement: Wind-up Plan for Specified SBICs
OMB Approval No. 3245-0063
Schedule B- Anticipated Follow-on Investments for Wind-up Plan
Expiration Date mm/dd/YYYYI
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Asof j
SBIC Name
L
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License Number!
An :icipated Follow-on Investments
Company Name
Timing of SBIC Follow-On
Investment
Small Business
SBIC's Pro-Rata
Type
Total Round Size
Investment
SBIC Follow-on
Participation
Thru end of
Current Year
2015
2016
Post 2016
Comments
-
-
Totals
SBA Form 468.2 (02/14) Previous edition obsolete.
1
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Operating Plan Supplement Page 3
| File Type | application/pdf |
| File Modified | 2015-02-25 |
| File Created | 2014-03-25 |