Fillable Printable Bank Dividend Request Template

Bank Dividend Request Template

Kentucky Department of Financial Institutions

2016 Dividend Request Form

Dividend Amount: 2016 YTD Operating Income

Dividend request as of: As of: Budget Actual Variance

Detail the Specific Uses of Funds:

Net Interest Income

Noninterest Income

Noninterest Expense

Loan Loss Provision

Net Income

2016 Ratios Actual Projected

Current YTD Prior Year Prior Year YTD 2016

Net Profits Retained Earnings Retained Earnings ROAA

As of: 12/31/2015 12/31/2014

Tier-1 Leverage Capital

Maximum Payable Dividend Per KRS 286.3-350* $0 Total Risk Based Capital

Fiscal Year-end Projections Net Interest Margin

2016 2017 2018

Projected Net Income Asset Growth

Projected ROAA ALLL to Total Loans

Quarterly Net Income (Include projections for future periods)

1st Qtr 2016

2nd Qtr 2016

3rd Qtr 2016

4th Qtr 2016

*286.3-350 When dividends may be declared.

(1) The board of directors of any bank or trust company organized under the laws

of this state may declare a dividend of so much of the net profits as they deem

expedient. The net profits shall be computed by deducting all expenses,

losses, and interest and taxes accrued or due from the bank.

(2) The approval of the commissioner shall be required if the total of all dividends

declared by such institution in any calendar year shall exceed the total of its net

profits of that year combined with its retained net profits of the preceding two

(2) years, less any required transfers to surplus or a fund for the retirement of

preferred stock or debt.