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["CREDIT UNION PROFILE CHANGES EFFECTIVE SEPTEMBER 2009"]

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["INSTRUCTIONS FOR REPORTING REQUIREMENTS"]
[]
["This form has been divided into sections based on the categories in the online credit union profile.  All credit unions must complete all sections if this is your first time filing this form with the National Credit Union Administration.  Therefore, all credit unions receiving this form for September 30, 2009 Call Report cycle, must complete the entire form, as applicable and return it to the contact identified on the enclosed instructional letter. "]
[]
["For Call Report cycles after September 30, 2009:  Credit unions that have submitted this information previously are only required to complete the areas that have changed since the last time they filed.  If there are no changes to the area, please check the box titled \"No changes\"."]
[]
["All credit unions filing this form manually, must sign the certification page on page 1."]

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["CERTIFICATION"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
[]
["I understand each operating insured credit union must update their credit union profile within 30 days of any changes and certify its accuracy every 180 days in accordance with NCUA Rules and Regulations.  I hereby certify to the best of my knowledge and belief the information in the profile has been updated and is accurate.  I make this certification pursuant to sections 106, 120, and 204 of the Federal Credit Union Act (12 U.S.C. 1756, 1766, and 1784)."]
[]
[]
["Last Name:","_________________________",null,null,"First Name: _________________",null,null,"Date:___________"]
["Please Print ","Certified Correct By"]
[]
[]
["Full Name","________________________________________________"]
[" ","Certified Correct By (Signature)"]
[]
[]
["Last Name:","_________________________",null,null,"First Name: _________________",null,null,"Date:___________"]
["Please Print ","Prepared By"]
[]
[]
["Full Name","________________________________________________"]
[" ","Prepared By (Signature)"]

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["CONTACTS (1)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my contacts since the last time I completed this form   "]
[]
["The Contacts section of the profile includes all of the Officials, Disaster Recovery Contacts, Emergency Contacts, Profile and 5300 Call Report contacts.  Mandatory fields are identified with an asterisk (*).  Please reference the directions for a list of all required contacts and roles the credit union must report."]
[]
[]
["A.  *Job Title:  Manager/CEO      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["B.  *Job Title:  Chairperson      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["C.   *Job Title:  Vice Chairperson      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]

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["CONTACTS (2)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my contacts since the last time I completed this form   "]
[]
[]
[]
["D.  *Job Title:  Secretary      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["E.  *Job Title:  Treasurer      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["F.  *Job Title:  Board Member      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]

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["CONTACTS (3)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my contacts since the last time I completed this form   "]
[]
["If the credit union has additional Board Members, please continue on a copy of this form."]
[]
[]
["G.  *Job Title:  Board Member      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["H.  *Job Title:  Board Member      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["I.  *Job Title:  Board Member      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]

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["CONTACTS (4)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my contacts since the last time I completed this form   "]
[]
[]
[]
["J.  *Job Title:  Credit Committee Chairperson      *CU Employment: ____________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["K.  *Job Title:  Credit Committee Member      *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["L.  *Job Title:  Credit Committee Member      *CU Employment: _____________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]

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["CONTACTS (5)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my contacts since the last time I completed this form   "]
[]
[]
[]
["M.  *Job Title:  Supervisory Committee Chairperson  *CU Employment:_________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["N.  *Job Title:  Supervisory Committee Member   *CU Employment: ___________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["O.  *Job Title:  Supervisory Committee Member   *CU Employment: __________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["*Home Address: _______________________________________________ *Country:_______________"]
[]
["*Home City:___________________________ *State:______*Zip Code: ___________ "]
[]
["*Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]

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["CONTACTS (6)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my contacts since the last time I completed this form   "]
[]
["This page is reserved so the credit union can report the name of their Chief Information Officer, Internal Auditor, Chief Financial Officer, and/or any of their employees or volunteers not already reported in the Contacts section of this form.  This page is OPTIONAL.  If you need additional lines, please continue on a copy of this form."]
[]
[]
["P.  *Job Title: ___________________     *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["Home Address: _______________________________________________ Country:_______________"]
[]
["Home City:_____________________________________ State:______Zip Code: ___________ "]
[]
["Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["Q.  *Job Title: ___________________   *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["Home Address: _______________________________________________ Country:_______________"]
[]
["Home City:___________________________________ State:______Zip Code: ___________ "]
[]
["Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]
[]
[]
["R.  *Job Title: ___________________     *CU Employment: ______________________ "]
[]
["*Salutation:_____*First Name:________________Middle Initital:_____  *Last Name:___________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Role(s) - See Instructions: _____________________________________________ "]
[]
[]
["Home Address: _______________________________________________ Country:_______________"]
[]
["Home City:__________________________________ State:______Zip Code: ___________ "]
[]
["Home Phone: ___________________  Fax:____________________ Cell Phone:_________________"]
[]
[]
["Work Address: _______________________________________________  Country:__________________"]
[]
["Work City:_______________________________ State:_______ Zip Code: ____________ "]
[]
["Work Phone: ________________  Extension:  _____  Fax:______________ Cell Phone:______________"]

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["CONTACTS (7)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my contacts since the last time I completed this form   "]
[]
["The credit union must identify the following contacts.  These individuals may be Officials, volunteers, or employees of the credit union.  This information will not be released to the public.  Mandatory fields are identified with an asterisk (*).  Please refer to the instructions for additional guidance."]
[]
[]
["A. *Role: Call Report Contact   *Job Title: __________________*CU Employment:_____________________"]
[]
["*Salutation:______*First Name:_________________Middle Initital:____  *Last Name:__________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Work Phone: ________________________ Extension:___________"]
[]
[]
[]
["B. *Role: Profile Information Contact   *Job Title: ______________*CU Employment:____________________"]
[]
["*Salutation:______*First Name:_________________Middle Initital:____  *Last Name:__________________"]
[]
["Work Email:________________________________Home Email:______________________________"]
[]
["*Work Phone: ________________________ Extension:___________"]
[]
[]
[]
["C. *Role: Primary Patriot Act Contact   *Job Title: ______________*CU Employment:___________________"]
[]
["*Salutation:______*First Name:_________________Middle Initital:____  *Last Name:__________________"]
[]
["*Work Email:________________________________ *Fax Number:____________________________"]
[]
["*Work Phone: ________________________ Extension:___________"]
[]
[]
["D.  *Role: Secondary Patriot Act Contact   *Job Title: ______________*CU Employment:_________________"]
[]
["*Salutation:______*First Name:_________________Middle Initital:____  *Last Name:__________________"]
[]
["*Work Email:________________________________ *Fax Number:____________________________"]
[]
["*Work Phone: ________________________ Extension:___________"]
[]
[]
["E. *Role: Primary Emergency Contact   *Job Title: ________________*CU Employment:__________________"]
[]
["*Salutation:______*First Name:_________________Middle Initital:____  *Last Name:__________________"]
[]
["*Work or Home Email:_______________________________ Cell Phone:___________________________"]
[]
["*Work or Home Phone (please identify): ________________________ Extension:___________"]
[]
[]
["F.  *Role: Secondary Emergency Contact   *Job Title: ______________*CU Employment:_________________"]
[]
["*Salutation:______*First Name:_________________Middle Initital:____  *Last Name:__________________"]
[]
["*Work or Home Email:_______________________________ Cell Phone:___________________________"]
[]
["*Work or Home Phone (please identify): ________________________ Extension:___________"]

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["SITES (1)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my sites since the last time I completed this form   "]
[]
["The Sites section of the profile includes all locations the credit union operates from, shared service centers, the Disaster Recovery location, Vital Records Center, Hot site, and location of records.  Mandatory fields are identified with an asterisk (*).  Please reference the instructions for additional guidance."]
[]
[]
["A.  Identify the Main Office information in this section.  Mandatory fields are identified with an asterisk."]
[]
["*Site Type: Corporate Office  *Site Name: _________________    *Site Function(s):__________________"]
[]
["*Is Main Office: Yes  *Hours of Operation: _________________  *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["*Mailing Address: _______________________________________________ *Country:_______________"]
[]
["*Mailing City:______________________________ *State:________*Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["B.  Identify the Disaster Recovery Location information in this section.  "]
[]
["*Site Type: ____________  *Site Name: _________________   *Site Function(s):  Disaster Recovery Location"]
[]
["*Is Main Office: No   Hours of Operation: _________________   *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["C.  Identify the Vital Records Center information in this section.  (Required by Rules and Regs Part 749)"]
[]
["*Site Type: _______________  *Site Name: _________________   *Site Function(s):  Vital Records Center"]
[]
["*Is Main Office: No   Hours of Operation: _________________   *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["D.  Identify the hot site for the credit union, if applicable."]
["*Site Type: ______________________  *Site Name: _________________   *Site Function(s):  Hot Site"]
[]
["*Is Main Office: No   Hours of Operation: ________________   *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]

{"sheet":"Sites (2)-10","index":12,"n_rows":74,"n_cols":7,"rows_kept":74,"cut":false,"hidden":false,"merged":[[28,0,28,8],[42,0,42,8],[45,0,45,8],[59,0,59,8],[61,0,61,8],[25,0,25,8],[0,0,0,8],[5,0,5,8],[6,0,6,8],[7,0,7,8],[11,0,11,8]],"flags":["formulas_cached_only"]}
["SITES (2)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my sites since the last time I completed this form   "]
[]
["Record on this page all the branch locations the credit union may have.  A Shared Service Center may be considered a branch location.  Please identify Shared Service Centers under the \"Site Function\" field.  Mandatory fields are identified with an asterisk (*).  Please reference the instructions for additional guidance.  If you have more than 4 branch locations, please continue on page 11 or a copy of this form."]
[]
[]
["E.  Identify branch location information in this section.  Mandatory fields are identified with an asterisk."]
[]
["*Site Type: Branch Office  *Site Name: _________________    *Site Function(s):__________________"]
[]
["*Is Main Office: No  *Hours of Operation: _________________  *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["F.  Identify branch location information in this section.  Mandatory fields are identified with an asterisk."]
[]
["*Site Type: Branch Office  *Site Name: _________________    *Site Function(s):__________________"]
[]
["*Is Main Office: No  *Hours of Operation: _________________  *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["G.  Identify branch location information in this section.  Mandatory fields are identified with an asterisk."]
[]
["*Site Type: Branch Office  *Site Name: _________________    *Site Function(s):__________________"]
[]
["*Is Main Office: No  *Hours of Operation: _________________  *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["H.  Identify branch location information in this section.  Mandatory fields are identified with an asterisk."]
["*Site Type: Branch Office  *Site Name: _________________    *Site Function(s):__________________"]
[]
["*Is Main Office: No  *Hours of Operation: _________________  *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]

{"sheet":"Sites (3)-11","index":13,"n_rows":75,"n_cols":7,"rows_kept":75,"cut":false,"hidden":false,"merged":[[28,0,28,8],[42,0,42,8],[45,0,45,8],[59,0,59,8],[62,0,62,8],[25,0,25,8],[0,0,0,8],[5,0,5,8],[6,0,6,8],[7,0,7,8],[11,0,11,8]],"flags":["formulas_cached_only"]}
["SITES (3)"]
[]
["Credit Union Name:  ",null,"________________________________________________",null,null,null,"Charter Number: _________"]
[]
["There have been no changes to my sites since the last time I completed this form   "]
[]
["Record on this page all locations where the credit union maintains its records.  Sections K and L are provided for the credit union to report vacant land, future office locations, planned evaculation site, ATM or other locations.  Reporting of ATM locations is optional.  Mandatory fields are identified with an asterisk (*).  Please reference the instructions for additional guidance.  "]
[]
[]
["I.  Identify the site where the credit union maintains its records.  "]
[]
["*Site Type: _______________  *Site Name: _________________    *Site Function:  Location of Records"]
[]
["*Is Main Office: _____  *Hours of Operation: ________________  *Operational Status: ________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["J.  Identify an additional site where the credit union maintains its records.  "]
[]
["*Site Type: _______________  *Site Name: _________________    *Site Function:  Location of Records"]
[]
["*Is Main Office: _____  *Hours of Operation: ________________  *Operational Status: ________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["K.  Credit unions may identify any additional sites they may have in this section.  See instructions."]
[]
["*Site Type: _______________  *Site Name: _________________    *Site Function(s):__________________"]
[]
["*Is Main Office: No  *Hours of Operation: _________________  *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]
[]
[]
["L.  Credit unions may identify any additional sites they may have in this section.  See instructions."]
[]
["*Site Type: _______________  *Site Name: _________________    *Site Function(s):__________________"]
[]
["*Is Main Office: No  *Hours of Operation: _________________  *Operational Status: __________________ "]
[]
["*Phone:____________________ Extension:________  Fax:_____________________"]
[]
["Mailing Address: _______________________________________________ Country:_______________"]
[]
["Mailing City:______________________________ State:________  Zip Code: ___________ "]
[]
["*Physical Address: ___________________________________________  *Country:__________________"]
[]
["*Physical City:_______________________________ *State:________  *Zip Code: ____________ "]

{"sheet":"IST(1)-12","index":14,"n_rows":66,"n_cols":8,"rows_kept":66,"cut":false,"hidden":false,"merged":[[5,0,5,8],[0,0,0,9]],"flags":["formulas_cached_only"]}
["INFORMATION SYSTEMS AND TECHNOLOGY (IS&T) (1)"]
[]
["Credit Union Name:_______________________________________",{"$nulls":5},"Charter Number: _________"]
[]
["There have been no changes to my IS&T information since the last time I completed this form   "]
[]
[]
[{"$nulls":4},"Yes","No"]
["1.  Does the credit union have a website?"]
[]
[null,"a.  If yes, what is the website address "]
[]
[null,"b.  If yes, is the website hosted internally?"]
[null,"            1 = yes    2 = no"]
[]
[null,"c.  If yes, please indicate the type of website (select only one)?"]
[null,"            1 = Informational   2 = Interactive    3 = Transactional"]
[]
[null,"d.  If the credit union has a transactional website, please provide"]
[null,"the name of the primary vendor used to deliver such services"]
[]
["2.  If the credit union does not have a website and plans to add one in the future,"]
[null,"a.  Please provide a date"]
[]
[null,"b.  Please identify the type of website"]
[null,"            1 = Informational   2 = Interactive    3 = Transactional"]
[]
[{"$nulls":6},"Yes","No"]
["3.  Does the credit union have Internet access? "]
[null," "]
["4.  Does the credit union have an internal wireless network?"]
[null," "]
["5.  If the credit union has an organizational email address, please provide it."]
[null," "]
["6.  Indicate in the box at the right the number of the statement below which best describes the system the credit "]
[null,"union uses to maintain its share and loan records."]
[null,"1 = Manual System       ",null,"2 = Vendor Supplied In-House System"]
[null,"3 = Vendor On-Line Service Bureau",null,null,"4 = CU Developed In-House System",null,null,"    5 = Other"]
[null," "]
["7.  Indicate the name of the primary share and loan information processing vendor"]
[null," "]
["8.  How do your members access/perform electronic financial services (select all that apply):"]
[null,"a.  Home Banking via Internet Website"]
[null,"b.  Audio Response/Phone Based"]
[null,"c.  Automatic Teller Machine (ATM)"]
[null,"d.  Mobile Banking"]
[null,"e.  Kiosk"]
[null,"f.  Other"]
[null," "]
["9.  What services do you offer electronically (select all that apply):"]
[null,"a.  Member Application",null,null,null,"  j.  Download Account History"]
[null,"b.  New Loan",null,null,null,"  k.  Electronic Cash"]
[null,"c.  Account Balance Inquiry",null,null,null,"  l.  Account Aggregation"]
[null,"d.  Share Draft Orders",null,null,null,"  m.  Internet Access Services"]
[null,"e.  New Share Account",null,null,null,"  n.  e-Statements"]
[null,"f.  Loan Payments",null,null,null,"  o.  External Account Transfers"]
[null,"g.  View Account History",null,null,null,"  p.  Electronic Signature"]
[null,"h.  Internal Share Account Transfers",null,null,null,"      Authentication/Certification"]
[null,"i.  Bill Payment",null,null,null,"  q.  Other (please specify)"]
[]
[null," "]
["10.  What systems does the credit union use to process electronic payments (select all that apply)?"]
[null,"a.  Fedline Advantage"]
[null,"b.  Corporate Credit Union"]
[null,"c.  Correspondent Bank"]
[null,"d.  Other (please specify)"]

{"sheet":"IST(2)-13","index":15,"n_rows":57,"n_cols":9,"rows_kept":57,"cut":false,"hidden":false,"merged":[[40,0,40,9],[43,0,43,8],[5,0,5,8],[28,1,28,8],[0,0,0,9]],"flags":["formulas_cached_only"]}
["IS&T (2) and DATA PROCESSING CONVERSION "]
[]
["Credit Union Name: _______________________________ ",{"$nulls":5},"Charter Number: _________"]
[]
["There have been no changes to my IS&T information since the last time I completed this form   "]
[]
[]
["11.  If the credit union is an Originating Depository Financial Institution, what type of ACH transactions are"]
[null,"originated by the credit union (check all that apply):"]
[]
[null,"a.  Consumer Transactions",null,null,null,"  e.  TEL Based Transactions"]
[null,"b.  Business Transactions",null,null,null,"  f.  International Transactions"]
[null,"c.  Payrolls",null,null,null,"  g.  Other (please specify)"]
[null,"d.  WEB Based Transactions"]
[]
["12.  If the credit union performs wire transfers, where does the credit union wire funds (check all that apply):"]
[]
[null,"a.  Domestically"]
[null,"b.  Internationally"]
[]
["13.  Which processes can a member use to initiate a wire transfer from the credit union (check all that apply):"]
[]
[null,"a.  Email",null,null,null,"d.  Telephone"]
[null,"b.  Fax",null,null,null,"e.  In Person"]
[null,"c.  Internet Banking",null,null,null,"f.  Other (please specify)"]
[]
["14.  Statement of Compliance- Minimum Security Devices and Procedures"]
[]
[null,"I hereby certify to the best of my knowledge and belief that this credit union has developed and administers a security program that equals or exceeds the standards prescribed by Section 748.0 of the NCUA Rules and Regulations; that such security program has been reduced to writing, approved by this credit union's Board of Directors, and have provided for the installation, maintenance, and operation of security devices, if appropriate, in each of the credit union's offices."]
[]
[null,"Name of Person Certifying Compliance:_________________________________________"]
[]
["15.  If the credit union has undergone a Data Processing Conversion, please provide the following information:"]
[]
[null,"a.  Date of Conversion"]
[]
[null,"b.  Data Processor Converted to"]
[]
[]
[]
["DISASTER RECOVERY INFORMATION"]
[]
["There have been no changes to my Disaster Recovery information since the last time I completed this form   "]
[]
[]
["1.  In the event of a disaster, will the credit union communicate ",{"$nulls":6},"Yes","No"]
[null,"with members through a website?"]
[]
["2.  Please check the resources or services you have available and would be willing to share with other credit unions"]
[null,"during the time of an emergency if you did not need them. (Check all that apply)"]
[]
[null,"a.  Cash Non-Member Share Drafts",null,null,null,"  d.  Mobile Branch"]
[null,"b.  Generator",null,null,null,"  e.  Office Space"]
[null,"c.  IT Support",null,null,null,"  f.  Staff/Management Services"]
[]
["3.  If the credit union completed a disaster recovery test since the last time you reported, please provide the date: "]
[" "]

{"sheet":"Reg-14","index":16,"n_rows":26,"n_cols":9,"rows_kept":26,"cut":false,"hidden":false,"merged":[[0,0,0,10],[4,0,4,9]],"flags":["formulas_cached_only"]}
["REGULATORY INFORMATION"]
[]
["Credit Union Name: _____________________________________ ",{"$nulls":7},"Charter Number: _________"]
[]
[]
[]
["1.  Please provide the date of the most recent annual meeting held by the credit union."]
[]
["2.  Please provide the date of the most recent financial statement audit."]
[]
["3.  Indicate in the box the number of the description below that best characterizes the "]
[" ","last audit performed of the credit union's records."]
[]
[null,"1 =  Financial statement audit performed by state licensed persons"]
[null,"2 = Balance sheet audit performed by state licensed persons"]
[null,"3 = Examinations of internal controls over call reporting performed by state licensed persons"]
[null,"4 = Supervisory Committee audit performed by state licensed persons"]
[null,"5 = Supervisory Committee audit performed by other external auditors"]
[null,"6 = Supervisory Committee audit performed by the supervisory committee or designated staff"]
[]
["4.  Please provide the effective date of the most recent Supervisory Committee verification"]
[null,"of member's accounts"]
[]
["5.  Indicate in the box the number of the description below that best characterizes who "]
[null,"completed the verification of member's accounts"]
[null,"1 = Supervisory Committee            2= Third Party"]

{"sheet":"CUSO-15","index":17,"n_rows":35,"n_cols":11,"rows_kept":35,"cut":false,"hidden":false,"merged":[[0,0,0,10],[2,0,2,10],[4,1,4,2],[4,5,4,7]],"flags":["formulas_cached_only"]}
["CREDIT UNION SERVICE ORGANIZATION (CUSO)"]
[]
[" List all CUSOs the credit union uses (regardless of whether the credit union has a financial interest) and all the services provided by the CUSO.  If the crdit union has a loan, an investmnet, a \"controlling financial interest\", the \" ability tp exert significant influence, or own a smaller portion of the CUSO, please provide the value of the investment in the CUSO, amount loaned to the CUSO, and the Aggregate Cash Outlay in the CUSO, as applicable.  See the instructions for additonal instructions.  If the credit union needs additional space, please continue on a copy of this form."]
[]
["Tax ID","Full/Legal Name of CUSO",null,"City","State","        See Note Below                  *                 **            ***",null,null,"Investment in CUSO","Loan to CUSO","Aggregate Cash Outlay"]
{"$rows_empty":16}
["* Is the CUSO wholly owned by the credit union?  1 = Yes, 2 = No"]
[]
["** Indicate in the box the letter(s) which describe the service(s) provided by the CUSO:"]
[null,"a.  Checking and Currency Services",null,null,"h.  Insurance brokerage or agency",null,null,null,"o.  Travel agency services"]
[null,"b.  Clerical, professional and management services",null,null,"i.  Fixed asset services",null,null,null,"p.  Trust and trust-related services"]
[null,"c.  Shared credit union branch operations",null,null,"j.  Loan support services",null,null,null,"q.  Real estate brokerage services"]
[null,"d.  Consumer mortgage origination",null,null,"k. Leasing",null,null,null,"r.  CUSO investments in non-CUSO service providers"]
[null,"e.  Electronic transaction services",null,null,"l.  Securities brokerage services",null,null,null,"s.  Other (please identify)"]
[null,"f.  Financial counseling services",null,null,"m.  Business loan origination"]
[null,"g.  Record retention, security & disaster recovery",null,null,"n.  Student loan origination"]
[]
[]
["*** How is the investment in the CUSO accounted for on the credit union's financial statements?"]
[null,"1 = Consolidation         2 = equity method            3 = cost method"]

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["CREDIT UNION PROGRAMS AND MEMBER SERVICES"]
[]
["Credit Union Name: _____________________________________ ",{"$nulls":7},"Charter Number: _________"]
[]
[]
[]
["Credit Union Programs - Place an \"x\" in the box next to all the programs the credit union offers (Check all that apply)"]
[]
[null,"a.  Mortgage Processing",{"$nulls":4},"e.  Investment Pilot Program"]
[null,"b.  Approved Mortage Seller",{"$nulls":4},"f.  Investments not authorized by the FCU"]
[null,"c.  Borrowing Repurchase Agreements",{"$nulls":4},"    Act (State Credit Union Only)"]
[null,"d.  Brokered Deposits (all deposits ",{"$nulls":4},"g.  Deposits and Shares Meeting 703.10(a)"]
[null,"    acquired through a third party)",{"$nulls":4},"h.  Brokered Certificates of Deposit"]
[]
["Member Service and Product Offerings - Place an \"x\" in the box next to all the products offered (Check all that apply)"]
[]
[null,"Transactional",{"$nulls":4},"Credit"]
[null,"a.  ATM/Debit Card Program",{"$nulls":4},"a.  Business Loans"]
[null,"b.  Check Cashing",{"$nulls":4},"b.  Credit Builder"]
[null,"c.  International Remittances",{"$nulls":4},"c.  Debt Cancellation/Suspension"]
[null,"d.  Low-cost wire transfers",{"$nulls":4},"d.  Direct Financing Leases"]
[null,"e.  Money orders",{"$nulls":4},"e.  Indirect Business Loans"]
[null,"f.  No surcharge ATMs",{"$nulls":4},"f.  Indirect Consumer Loans"]
[{"$nulls":6},"g.  Indirect Mortgage Loans"]
[null,"Depository",{"$nulls":4},"h.  Interest Only or Pymt Option 1st"]
[null,"a.  Business Share Accounts",{"$nulls":4},"      Mortgage Loans"]
[null,"b.  Health Savings Accounts",{"$nulls":4},"i.  Micro Business Loans"]
[null,"c.  Individual Development Accounts",{"$nulls":4},"j.  Micro Consumer Loans"]
[null,"d.  No Cost Share Drafts",{"$nulls":4},"k.  Overdraft Lines of Credit"]
[null,"e.  Share Certificates with low minimum",{"$nulls":4},"l.  Overdraft Protection/ Courtesy Pay"]
[null,"     balance requirements",{"$nulls":4},"m.  Participation Loans"]
[{"$nulls":6},"n.  Pay Day Loans"]
[null,"Other Member Services",{"$nulls":4},"o.  Real Estate Loans"]
[null,"a.  Bilingual Services",{"$nulls":4},"p.  Refund Anticipation Loans"]
[null,"b.  Insurance/Investment Sales",{"$nulls":4},"q.  Risk Based Loans"]
[null,"c.  No Cost Bill Payer",{"$nulls":4},"r.  Share Secured Credit Cards"]
[null,"d.  No Cost Tax Preparation Services"]
[null,"e.  Student Scholarship"]
[]
[null,"Financial Education"]
[null,"a.  Financial Eductions"]
[null,"b.  Financial Counseling"]
[null,"c.  Financial Literacy Workshops"]
[null,"d.  First Time Homebuyer Program"]
[null,"e.  In School Branches"]

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["GRANTS AND PARTNERSHIPS"]
[]
["Credit Union Name: _____________________________________ ",{"$nulls":6},"Charter Number: _________"]
[]
[]
["This page is optional for credit unions and not required to be completed.  This information will not be released to the public."]
[]
[]
["Grant Information - Please provide information on any grants you have received since the last time you reported."]
[]
[null,"Grantor",{"$nulls":5},"Date Awarded","Amount"]
[null,"NCUA Technical Assistance Program"]
[null,"Community Development Financial Institutions Fund"]
[null,"Department of Health and Human Services"]
[null,"National Credit Union Foundation"]
[null,"New York State Credit Union Foundation"]
[null,"Massachusetts Credit Union League"]
[null,"CUNA"]
[null,"Association of Credit Union Leagues"]
[null,"US Department of Labor"]
[null,"National Federation of Community Development Credit Unions"]
[null,"US General Services Administration"]
[null,"US Department of Agriculture"]
[null,"Enterprise Grant Program"]
[null,"Other (please specify):"]
[null,"Other (please specify):"]
[null,"Other (please specify):"]
[]
["Partnership Information - Please provide information on any partnerships you have with other credit unions."]
[]
[null,"Name of Credit Union Partner",{"$nulls":5},"Service Type (**)","Relationship Type (***)"]
[]
[]
[]
[null," "]
[null," "]
[null," "]
[null,"  "]
[null," "]
[null,"  "]
[]
[null,"Service Types (**):"]
[null,"a.  ALM",null,null,"i.  Development of New Services",null,null,"q.  Operational resources"]
[null,"b.  Auditing",null,null,"j.  Disaster Recovery",null,null,"r.  Shared branching"]
[null,"c.  Back Office Operations",null,null,"k.  Financial Education",null,null,"s.  Shared employees"]
[null,"d.  Backup Operating Site",null,null,"l.  Grant writing",null,null,"t.  Share operating systems"]
[null,"e.  BSA Training",null,null,"m.  Loan Collections",null,null,"u.  Website assistance"]
[null,"f.  Compliance Review",null,null,"n.  Loan processing/underwriting",null,null,"v. Other (please specify)"]
[null,"g.  Computer Training",null,null,"o.  Marketing"]
[null,"h.  Data Processing",null,null,"p.  Mentoring"]
[]
[null,"Relationship Types (***)"]
[null,"a.  Catastrophic Act",null,null,null,"f.  Seller/Buyer of loan participations"]
[null,"b.  Disaster Recovery",null,null,null,"g.  Low or no-cost non-member deposits provider"]
[null,"c.  Formal Relationship (under contract)",null,null,null,"h.  Mentor/mentee"]
[null,"d.  Informal Relationship",null,null,null,"i.  Other (please specify)"]
[null,"e.  Free Services"]