CDFI Program and NMTC Program Annual Report

---

Overview

PRA Burden Statement 1559-0027
NMTC Report ILR

---

Sheet 1: PRA Burden Statement 1559-0027

Community Development Financial Institutions Program
CDFI Program Awardee and NMTC Allocatee Annual Report
OMB Approval Number 1559-0027

PAPERWORK REDUCTION ACT NOTICE
Public reporting burden for this collection of information is estimated to average 60 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this collection is 1559-0027. Send comments regarding this burden estimate or any other aspect of this collection of information to the Department of Treasury, CDFI Fund, 1500 Pennsylvania Avenue NW, Washington, DC 20220.

---

Sheet 2: NMTC Report ILR

Generated By:
Organization	Test Organization
ILR Certified	Checked				Report width must fit in a page when printed
Fiscal Year	2018
Certified Date	6/27/2019
Section I: Organization Information
A. Basic Information
Organization's Type
Organization Structure
Year of Organization’s Incorporation
Financial Activities Start Date
Street Address
City
State
Zip
Website Address (if available)
1. Name of Person Responsible for Completing the ILR	First Last
2. Telephone Number of Person Responsible (including Extension if applicable)	(000) 000-0000
3. Email Address of Person Responsible	name@place.com
B. Organizational Structure/Affiliation
4. Is the Organization a "Faith-Based" Organization?	No
5. Did any QLICIs Made During the Reporting Period Finance or Provide Services to any Religious Institution(s) or Faith-based Organization(s)?	No
6. Has or Does the Organization Intend to Use Any Other Tax Credit Programs in Conjunction With Its NMTC Program Strategy?
Historic Tax Credit
Empowerment Zone, Enterprise Community, or Renewal Community Tax Credits
Other Federal Tax Credit Program
State Tax Credit Program
Local Tax Credit Program
Name of Other Federal Tax Credit Program
Name of Other State Tax Credit Program
C. Geographies Financed During the Reporting Period
7. Which of the Following Geographic Areas were Financed by the Allocatee's QEI Proceeds During the Reporting Period?
Hot Zones; Rural Areas; Major Urban Area; Minor Urban Area
D. Human Resources Dedicated to the Allocatee's NMTC Program
8. FTEs Dedicated to Lending/Investing	1.58
9. FTEs Dedicated to FCOS	0
10. FTEs Dedicated to Administration and Other Activities	1.78
11. Total FTEs	3.36
12. Consultant/Contractor FTEs	0.75
Section II: Financial Position
A. Lending/Investing Pool
13. QEI Investment Capital Table
Type
Total QALICB Loans and Investments from QEIs
Total QALICB Loans and Investments from RQIs
Grand Total
14. Non-QEI Investment Capital Table
15. Investment Capital Summary Table	Percentage of Total Capital	Weighted Average Interest Rate of Debt	Weighted Average Term (months) for Debt
Type of Capital	0%	Not Applicable	Not Applicable
Equity from QEIs	0%
Grand Total			$0.00
15. Off-Balance Sheet Resources Committed to the Organization for NMTC- Related Lending/Investing
B. Additional Funds Leveraged by the Organization
16. Additional Funds the Organization Was Able to Attract Because of Its QEIs			1250000
C. QLICI Commitments
17. Total Financing Committed for QLICIs (Except FCOS) at Reporting Period End			0
D. Reporting Period Summary Financial Information
19. Non-QEI Contributions Table
Section III: Loan Purchases
20. Loan Purchase Table
21. Sector Breakouts for All Loans Purchased
	Real Estate (# of loans)	0
Real Estate (Amount paid)	Non-Real Estate (# of loans)	0
Non-Real Estate (Amount paid)	Other/Unknown (# of loans)	0
Other/Unknown (Amount paid)	Total Number of Loans Purchased	0
Total Amount Paid			Not Applicable
22. Requirement to reinvest percentage of proceeds in QLICIs
Section IV: Financial Counseling and Other Services (FCOS)
23. QEIs Used for FCOS Table
FCOS Provided Using QEI Funds
24. Entrepreneurs and Businesses Receiving Group-Based Training
Number of Clients	0
Number of Hours	0
25. Entrepreneurs and Businesses Receiving One-on-One Technical Assistance
Number of Clients	0
Number of Hours	0
26. Amount of Non-QEIs Used for FCOS, If Any
FCOS Provided Using Non-QEI Funds
27. Entrepreneurs and Businesses Receiving Group-Based Training
Number of Clients	0
Number of Hours	0
28. Entrepreneurs and Businesses Receiving One-on-One Technical Assistance
Number of Clients	0
Number of Hours	0
Section V: Better Rates & Terms
28. Allocatee's Comparable for Determining Better Rates and Terms	Lenders
30. Allocatees Comparables Comments
Section VI: Impacts
30. Lending/Investing with Other CDEs
31. Lending/Investing with Certified CDFIs
Section VII: Compliance with Other Creditor and Investment Agencies
32. At the end of the CDE’s fiscal year, was the CDE and any subsidiaries in full compliance with all terms and conditions of any creditor loan or other investment agreements	YES
Section VIII: Data Collection Systems
34. Loan Portfolio Software	Nortridge
35. Borrower Characteristics Software	Nortridge
36. Community Development Impact Software	IMPLAN
Other
Section IX: Credit Reporting Agencies Used
37. Credit Scores	YES
38. Reporting Agency	Equifax; Experian; TransUnion
Section X: ILR Feedback
Your Organization’s Success Story	NA
Section XI: IRS Compliance Questions
1. For each Qualified Equity Investment received during the fiscal year have you notified the investor that their investment qualifies for the New Markets Tax Credit?	No
2. At any time during the fiscal year did the total dollar amount of QEIs received exceed the amount of the NMTC allocation awarded by the CDFI Fund?	No
2a. If yes, what was the amount of QEIs received that exceeded the amount authorized in the Allocation Agreement?
3. During the fiscal year was there a recapture event, as described in 26 CFR #1.45D-1T(e)(2) that was not corrected in accordance with the IRS regulations?
3a. If yes, complete the following chart for each QEI subject to recapture.	Yes
4. For QLICIs made during the fiscal year, was each QLICI made within 12 months of originally receiving the QEI in accordance with the IRS regulations including allowable corrections?
4a. What was the aggregate dollar amount of QLICIs not made within the required timeframe?	No
4b. If not applicable, include explanation in Question 11 narrative box
5. Did you receive any principal repayments on a QLICI (equity or debt), for which these amounts were not reinvested that resulted in the organization failing the substantially-all requirement?	NA
5a. If yes, what was the aggregate dollar amount of QLICI repayments not reinvested within the required timeframe?
6. For any QLICIs that you made during the fiscal year to Qualified Active Low-Income Community Businesses, did the businesses qualify as QALICBs (per 26 CFR §1.45D-1T(d)(4)) at the time of the initial investment?	NA
6a. If NO, please describe below
7. Invested in or lent to other CDEs, did you ensure that these entities	NA
7a. Were in fact certified as CDEs by the CDFI Fund?	NA
7b. Invested the funds received into eligible QALICBs?	No
8. If you purchased loans from other CDEs, did those loans meet the loan purchasing criteria (per 26 CFR §1.45D-1T(d)(1)(ii))?
9. Did you establish reserves in accordance with 26 CFR §1.45D-1T(d)(3)?
9a. If yes, what was the aggregate amount of reserves established?
10. Did you use the direct tracing or safe harbor method for determining substantially all?
Name	Substantially All Methodology Used
NDS-00047345	Not Applicable
NDS-00047346	Direct Tracing
NDS-00047347	Not Applicable
NDS-00047348	Not Applicable
NDS-00047349	Not Applicable
11. Please use the narrative box below to provide any further information regarding your responses to Questions 1-10 of this IRS compliance survey.
Section XII: Survey Administration Questions
a. Do you give the CDFI Fund permission to release your Organization's identity when it releases your Organization's ILR data for this and previous reporting periods?			Yes
b. Do you give the CDFI Fund permission to release your Organization's identity when it releases your Organization's TLR data for this and previous reporting periods?			Yes
How many hours did it take to complete the ILR?			1
How many hours did it take to complete the TLR?			1
Certification
Prior to the CDFI Fund accepting the data submitted by a Recipient/Allocatee, the user must certify, on behalf of the organization, to the following:
1) The person(s) entering the data and making these certifications has been authorized, by the organization for which the data is input, to enter the data and make the certifications on its behalf.
2) Any information or data being provided to the CDFI Fund that is input in the Awards Management Information System (or other submission method) pursuant to the reporting requirements of the Assistance Agreement(s) or Allocation Agreement(s) (“Agreement(s)”) is true, accurate, and complete, and accurately represents the activities and/or performance of the organization for which the data is input.
3) The organization remains compliant with all applicable assurances and certifications, representations and warranties, and covenants and agreements as agreed upon in the Agreement(s) for which this data is being input or, alternatively, has notified the CDFI Fund of the organization’s inability to remain compliant with such provisions of the Agreement(s) through the submission of a Material Event notification (as described in the Agreement(s)) or other communication to the CDFI Fund.
I have reviewed the Certification Statement above and selected the appropriate checkbox to agree with the statement			Checked