Form RD 1951-4 RD 1951-4 Report of IRP/RDLF Lending Activity

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FORM APPROVED

REPORT OF IRP/RDLF LENDING ACTIVITY
(Intermediary Relending Program- Rural Development Loan Fund)

Form RD 1951-4
(Rev. 12-04)

OMB NO. 0570-0015
EXP. MM/DD/YYYY

Name of Organization

IRP/RDLF Fund Number::

Address:

Telephone No.:

Contact Person:

Date

Report Period

Date Intermediary IRP/RDLF
Loan was approved:

Tax I.D. No:
TO DATE

REPORT PERIOD
LOANS
1.

Amount of IRP/RDLF Loan

$

$

2.

Principal of loans disbursed

3.

Principal of loans received

$
$

$
$

4.

Net Lending (line 2 minus 3)

$

0.00

$

0.00

END OF PERIOD

AVAILABLE ASSETS
5.

Total Assets (less furniture & equipment)

6.

Loans Outstanding

$
$

7.

Loan Loss Reserve (After 3 yrs., 6% required)

$

8.

Funds Available for Relending (line 5 minus line 6 and 7)

$

0.00

9.

Percent of Assets Available for Relending (Line 8 divided by Line 5)

%

0.00

BALANCE SHEET
ASSETS
1. Cash (minus Loan Loss Reserve)
2. Loan Loss Reserve
3. Loans Outstanding
4. Interest-Bearing Deposits
5. Other Assets (specify)

Fixed Assets (furniture and fixtures)

6. TOTAL ASSETS

$
$
$
$
$
$
$
$

0.00

LIABILITIES
7. Loan Payable to RBS

$
$

8. Accounts Payable
9. Other Liabilities

10. TOTAL LIABILITIES
11. FUND BALANCE (Assets minus Liabilities)

$
$
$
$
$

0.00
0.00

A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for
failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of
information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 0570-0015.
Public reporting for this collection of information is estimated to be approximately 4 hours per response, including the time for reviewing
instructions, searching existing data sources, gathering and maintaining the data needed, completing and reviewing the collection of
information.
All responses to this collection of information are voluntary. However, in order to obtain or retain a benefit, the information in this form is
required by 7 CFR 1951. Rural Development has no plans to publish information collected under the provisions of this program. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
Page 1Innovation Center, Regulations Management Division at
burden to: Information Collection Clearance Officer, Rural Development
ICRMTRequests@usda.gov

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Form RD 1951-4
(Rev. 12-04)

IRP/RDLF INCOME AND EXPENSE STATEMENT
Report Period 1/0/00
Prior
Fiscal Year

USDA Approved
Budget
1. IRP/RDLF INCOME (All Sources)

Reporting
Period

Program to
Date

$

$

$

$

a. Employee Salaries

$

$

$

$

b. Employee Fringe Benefits

$

$

$

$

c. IRP/ RDLF -related Travel

$

$

$

$
$

2. EXPENSES (IRP/RDLF Related Expenses)

d. Loan Processing/Closing Costs

$

$

$

e. Interest Paid RBS

$

$

$

$

f. Professional Services

$

$

$

$

g. Marketing

$

$

$

$

h. Staff Training

$

$

$

$

i. Equipment - Rental

$

$

$

$

- Acquisition

$

$

$

$

j. Bad Debt (Loan Losses)

$

$

$

$

k. Loan Loss Recovery (negative number)
1. Space (rent)

$

$

$

$

$

$

$

$

m. Audit

$

$

$

$

n. Indirect Costs
o. Other (Specify)

$

$

$

$

3. TOTAL EXPENSES (sum line 2.a. thru line 2.o)
4. NET IRP/RDLF INCOME (line 1 minus line 3)
5. EXPENSES as % of IRP/RDLF INCOME (line 3/line 1)

$

$

$

$

$

0.00 $

0.00 $

0.00 $

0.00

$

0.00 $

0.00 $

0.00 $

0.00

%

0 %

0%

0 %

0

6. If salaries & expenses are not charged against the IRP/RDLF fund, how are theses expenses paid ?
EXPLANATION:
7. What is the total program income that was used to cover administrative costs?
$
8 . Describe any encumbrances, liens, compensating balances, or assignments on any of the assets in the IRP/RDLF, including those
pursuant to any guarantees made.
Description:

CERTIFICATION OF AUTHORIZED REPRESENTATIVE: I certify that the above information and any attachments
thereto arc complete and accurate to the best of my knowledge and belief.

By:

Date:

Name and Position:

Page 2

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Form RD 1951-4
(Rev. 12-04)

ULTIMATE RECIPIENT INFORMATION
Recipient Name:

Recipient Tax ID#:

Applicant Type:
Indian Tribe
Profit-making Corporation
Proprietorship
Public Body

Partnership
Trust
Other
Non-Profit Corporation

Facility Location

Street Address

Borrower's Address:
(if different)

City:
State:

Zip Code

County:

Project Information
Job Saved
Jobs Created

I

NAICS Code

Third Party Document
Approved

F

RECIPIENT LOAN IN FORMATION:
Loan Amount:
$
Loan Balance:
$
Term:( Months)
Interest Rate:
%

Closing Date:
Status:

Ahead
Current
Delinquent
Loss/Charged Off
Paid in Full

Interest Rate Type

Fixed

Variable

Suspend/Deferred
Terms Renegotiated:

I
Pay-Off Date:

Recipient Loan Funded by:

F

Initial USDA Loan Funds and approved by RD

Agency Contribution:

$

Advance Date (ACH):
Intermediary Contributions:

$

Modifications to Amortization:

Revolving Funds

T)l IP Payment
Delayed
Other

Balloon Payment
Interest Only Payment:

Collateral Information:
Personal Guarantees

Equipment
Real Estate

Other
3rd p
Position
Other

1st Position

Lien Position:

2nd Position

I

Other Description
Supplemental Funding Amounts:
State/Local
Bank Loans

$

$

Federal Funds
Other

$

$

Source of USDA Funding For This Loan

PAYMENT INFORMATION
Annually

Payment Frequency:

Other

Monthly
Number of Payments:
Due (since inception)
# Made on Time

Other Description

Made Late (30 days past due or less)
Made Late (more than 30 days)

Comments:

For Official Use
Only
Race Information

Black/African American
American Indian/Alaskan Native
Asian
Native Hawaiian or Other Pacific Islander

Verified
Jobs Created

Veteran
~
'IHispanic
p
orLLatino

Ethnicity

Not Hispanic or Latino

S,
x
Sex:

Jobs Saved

Male
Female
Public Body

Total

Page 3

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Form RD 1951-4
(Rev, 12-04)

RECIPIENT LOAN INFORMATION

ULTIMATE RECIPIENT INFORMATION
Jobs
Saved

Recipient Name

Jobs
Created

Date
Verified

Original
Loan Amount

Supplemental Funding
Private
Equity
Other
Funding
Injection
Funding

Current
Balance

PAYMENT INFORMATION
**
Loan
Status

Use Only
Loan Loss
Amount

Loan Loss
Recovery

Loan Status Codes:
C - Current
S - Suspended/Dererred
D - Delinquent
P - Paid-Out
DD-Default
L-Loss

Page 4

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# Due

# Made
on time

#>
30 days

#<
30 days

Race

Ethnicity

Sex

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Form RD 1951-4
(Rev., 4-03)

PART I- PORTFOLIO STATUS
Status of Loans.

Current Principal
Balance

Orig. Loan Amount

#Loans

1. Total Loans Made:

-$

2. Fully Repaid

-$

3. Current

$

4. Delinquent (>30 days)

$

5. Default

$

6. Total Active Loans (Add lines 3, 4, and 5)

$

7. Total Written Off

-$
-$
-$
0.00

0

-$

0.00

-$

$

PART II: PORTFOLIO SUMMARY
Provide information below on Active Loans and Total Loans closed to date.

A. Summary of Loan Activities:

Total Loans

Active Loans
1. # IRP/RDLF Loans
2. Total $$ Loaned:

$

$

a. Private

$

$

b. Other

$

$

c. Equity Injection

$

$

d. Total Leveraged $$ (a+b+c)

$

0.00

$

0.00

$

0.00

$

0.00

3. Non-IRP/RDLF Leveraged

4. Total Project Leverage (2 + 3d)
5. Private Sector Jobs:
a. Created
b. Saved

0

c. Total jobs (a + b)

0

For Official Use Only
B. Summary of Demographics:

Provide information below on each borrower regarding race and ethnicity.
Total Loans

1. # of IRP/ RDLF Loans to Borrowers per Race:
a. White
b. Black/African American
c. American Indian/Alaskan Native
d. Asian
c. Native Hawaiian/Other Pacific Islander
2. # of IRP/RDLF Loans to Borrowers per Ethnicity:
a. Hispanic or Latino
b. Not-Hispanic or Latino
3. # of IRP/RDLF Loans to Borrowers per Sex:
a. Male
b. Female

Page 5

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