____

The sum of RC items 1.b., Interest-bearing Balances; 2.a. and 2.b., Securities; 3.a., Federal Funds Sold; 3.b.,

Securities Purchased Under Agreements to Resell; 4.a. and 4.b., Total Loans and Lease Financing

Receivables; 5., Trading Assets; RC-F, item 4., Equity Securities That Do Not Have Readily Determinable

Fair Values; less the sum of RC-N items 1.a.through 9, Column C, Nonaccrual Loans, Lease Financing

Receivables, Debt Securities and Other Assets.Sum of self-examination items 1., 4., 5., 43., 44., 46., and 47.k.,

less 37., and 39.


4.
Equity Securities That Do Not Have Readily Determinable Fair Values
4. $_____________

RC-F item 4. Include Federal Reserve Bank stock, Federal Home Loan Bank stock and bankers bank stock.

5.
Assets Held in Trading Accounts
5. $_____________

RC item 5.

6.
Accrued Interest Receivable



6. $_____________
RC-F item 1. Includes accrued interest receivable on loans, leases, debt securities, and other interest-bearing assets.


7. OREO

7.
$_____________

RC item 7. Other Real Estate Owned.


8. Intangible
Assets
8.
$_____________

The sum of RC items 10.a., Goodwill, and 10.b., Other Intangible Assets.

9.
Disallowed Goodwill and Other Disallowed Intangibles

8.
$_____________

RC-R item 7.a.

10.
Disallowed Servicing Assets and Purchased Credit Card Relationships
10. $_____________

RC-R item 9.a.

11.
Disallowed Deferred Tax Assets



11. $_____________

RC-R item 9.b.

12. Total
Assets

12.
$_____________

Total assets, net of reserve for loan loses. RC item 12.

13. Total
Deposits


RC item 13.a. for banks filing FFIEC 041. The sum of RC items 13.a. and 13.b for banks filing FFIEC 031. 13.
$_____________

14. Interest-Bearing
Deposits
14.
$_____________

RC item 13.a.(2) for banks filing FFIEC 041. The sum of RC items 13.a.(2) and 13.b.(2) for banks filing
FFIEC
031.

15.
Total Time Deposits of $100M or more
15. $_____________

RC-E item M.2.c.

16.
Fully Insured Brokered Deposits Issued in Denominations of less than $100M

16. $_____________

RC-E item M. 1.c.(1).

17. Other
Interest-Bearing Liabilities

17. $_____________
The sum of RC items 14.a., Federal Funds Purchased; 14.b., Securities Sold Under Agreements to Repurchase;
15., Trading Liabilities; and 16., Other Borrowed Money.

18.
Other Borrowed Money
18. $_____________

RC item 16.

19.
Notes & Debentures Subordinated to Deposits
19. $_____________

RC item 19.

20.
Accumulated Other Comprehensive Income
20. $_____________

RC item 26.b
.
REPORT LOSSES WITH ( ).


21. Total
Equity
Capital

21.
$_____________

RC item 28. Perpetual Preferred Stock and Related Surplus, Common Stock, Surplus, Retained Earnings,

Accumulated Other Comprehensive Income (includes Net Unrealized Holding Gains/Losses on Available-

For-Sale Securities) and Other Equity Capital Components. INPUT REPORT
Income Statement

(REPORT ON AN ACCRUAL BASIS YEAR-TO-DATE INCOME AND EXPENSES
)

22.
Interest and Fee Income on Loans and Lease Financing Receivables
22. $_____________

The sum of RI items 1.a.(6) and 1.b. for banks filing FFIEC 041. The sum of RI items 1.a.(3) and

1.b for banks filing FFIEC 031.

23. Interest
and
Dividend
Income on Securities

23. $_____________

Sum of RI items 1.d.(1), 1.d.(2) and 1.d.(3).

24.
Total Interest Income



24. $_____________

RI item 1.h.

25.
Interest Expense not Deductible for Federal Income Tax Purposes
25. $_____________

RI Memorandum item M.1.

26.
Tax-Exempt Interest Earned on Securities, Loans and Leases


26. $_____________

The sum of RI Memoranda items M.3. and M.4.

27.
Interest Expense on Deposits


27.
$_____________

The Sum of RI items 2.a.(1) and 2.a.(2)a., b., and c.

28.
Interest Expense on Other Borrowed Funds


28. $_____________

The Sum of RI items 2.b., 2.c,. and 2.d.

29.
Total Interest Expense



29. $_____________

RI item 2.e.

30.
Provision for Loan and Lease Losses



30. $_____________

RI item 4 (year-to-date total).

31. Non-Interest
Income

31.
$_____________

RI item 5.m.

32. Non-Interest
Expense

32. $_____________

RI item 7.e. Exclude Provision for Loan Losses, Realized Gains (Losses) on Securities and Applicable


Income Taxes.

33.
Extraordinary Items and Other Adjustments, Net of Income Taxes
33. $_____________


RI item 11.

34. Net
Income

34. $_____________

Net income after extraordinary items and taxes. RI item 12.
OTHER DATA

35a.
Overdue Loans (30 days or more)



35.a. $____ _______

All loans past due 30 days or more. Include loans 90 days or more past due.

Sum of RC-N items 1.a. through 8. (8.b. for banks filing FFIEC 031), columns A, B and C. Deduct balance


of loans on nonaccrual that are less than 30 days overdue.

35b.
Number of Overdue Loans (30 days or more)






35.b.$____________

Number of loans 30 days or more past due.

36
Loans and Leases 90 Days or More Overdue and Still Accruing


36. $_____________

Sum of RC-N items 1.a. through 8. (8.b. for banks filing FFIEC 031), Column B.

37.
Nonaccrual Loans and
Leases
37.
$_____________

Sum of RC-N items 1.a. through 8. (8.b. for banks filing FFIEC 031), Column C.

38.
Debt Securities and Other Assets 90 Days or More Overdue and Still Accruing
38. $_____________

RC-N item 9., Column B.

39.
Nonaccrual Debt Securities and Other Assets



39. $_____________

RC-N item 9., Column C
.

40.
Federal Income Tax Rate (Estimated)
40. $_____________

41. Full-time
Equivalent
Employees



41.
$
_______ _____

RI Memoranda item M.5.

42.
Life Insurance Assets
42. $_____________

RC-F item 5.

43. Held-to-Maturity
Securities

43.
$_____________

RC item 2.a. Exclude Commercial Paper, BAs and CDs Purchased.

44. Available-For-Sale
Securities
44.
$_____________

RC item 2.b. Exclude Commercial Paper, BAs and CDs Purchased.

45. Debt
Securities
Maturing
in One Year or Less


45. $_____________

RC-B Item M.2.d.

46. Interest-Bearing
Balances
46. $_____________

RC item 1.b. INPUT REPORT


ASSETS REPRICEABLE WITHIN 1 YEAR

47.
a.
Fixed Rate Loans


47. a. $_____________


b.
Variable Rate Loans


b. $_____________


c.
U. S. Treasury Securities


c. $_____________


d.
Fixed Rate Agency Securities


d. $_____________


e.
Variable Rate Agency Securities


e. $_____________


f.
MBS & CMO Securities and Projected Principal Paydowns


f. $_____________


g.
Certificates of Deposit Due From Other Institutions


g. $_____________

h.
Municipal
Securities


h.
$_____________


i.
Fixed Rate Corporate Securities


i. $_____________


j.
Variable Rate Corporate Securities


j. $_____________


k.
Federal Funds Sold; Securities Purchased Under Agreement to
k. $_____________


Resell; FHLB Interest Bearing Deposits; Other Money Market Accounts

LIABILITIES REPRICEABLE WITHIN 1 YEAR

48.
a.
Other Savings


48. $_____________


b.
NOW and Super NOW Accounts


b. $_____________


c.
Money Market Deposit Accounts


c. $_____________


d.
Certificates of Deposit Less than $100M


d. $_____________


e.
Certificates of Deposit $100M and Over (include time open)


e. $_____________


f.
Federal Funds Purchased

f. $_____________


g.
Securities Sold Under Agreement to Repurchase
g. $_____________


h.
Federal Reserve Borrowings


h. $_____________


i.
Other Borrowings, Demand Notes, Trading Liabilities


i. $_____________


j.
Subordinated Debt and Limited-life Preferred Stock


j. $_____________

OTHER PERFORMANCE INDICATORS


49.
Provision for Loan Losses - current month increase


49. $_____________

50.
Loans Charged Off - current month


50 $_____________

51.
Loan Recoveries current month

51 $_____________

52.
Profit (Loss) From Sale of Securities (exclude unrealized gains
52. $_____________

or losses) - current month

53.
Dividends Declared current month
53. $_____________

54.
Capital Injections current month


54. $_____________

55.
Capital Adjustments Related to Prior Periods
55. $_____________


56. Agricultural
Loans:

a. Total of Loans Secured by Farmland (including farm


56. $_____________

residential and other improvements). RC-C item 1.b.

b. Total of Loans to Finance Agricultural Production

56.b.
$_____________

and Other Loans to Farmers. RC-C item 3.














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