Loan Forgiveness Loan Forgiveness General Information Company Name Starting Balance BIWEEKLY BUDGET SALARY/WAGES Biweekly Salary/Wages Budget Biweekly Prorated Salary Reduction Biweekly Total Salary/Wages Health Insurance Biweekly Health Insurance Premiums Biweekly Life Insurance Biweekly Total Health Insurance Payroll Taxes & Retirement Biweekly State Taxes Biweekly Retirement (401k, Roth IRA) Biweekly Federal Taxes Biweekly Total Payroll Taxes & Retirement Utilities/Rent Biweekly Rent Biweekly Utilities Biweekly Total Rent/Utilities Biweekly Loan Budget Summary Biweekly Total Payroll Costs Biweekly Total Non Payroll Costs Week 1 & 2 Biweekly Loan Budget Summary Starting Balance Budget Actual Difference Total Payroll Costs Budget Actual Difference Total Non Payroll Costs Budget Actual Difference PROJECTED BALANCE Budget Actual Difference SALARY/WAGES Wages Budget Actual Difference Prorated Salary Reduction Budget Actual Difference TOTAL Salary/Wages Budget Actual Difference HEALTH INSURANCE Health Insurance Premiums Budget Actual Difference Life Insurance Budget Actual Difference TOTAL Health Insurance Budget Actual Difference PAYROLL TAXES & RETIREMENT State Taxes Budget Actual Difference Retirement (401k, Roth IRA) Budget Actual Difference Federal Taxes Budget Actual Difference TOTAL Payroll Taxes & Retirement Budget Actual Difference UTILITIES/RENT Rent Budget Actual Difference Utilities Budget Actual Difference TOTAL Utilities/Rent Budget Actual Difference Week 3 & 4 Biweekly Loan Budget Summary Starting Balance Budget Actual Difference Total Payroll Costs Budget Actual Difference Total Non Payroll Costs Budget Actual Difference PROJECTED BALANCE Budget Actual Difference SALARY/WAGES Wages Budget Actual Difference Prorated Salary Reduction Budget Actual Difference TOTAL Salary/Wages Budget Actual Difference HEALTH INSURANCE Health Insurance Premiums Budget Actual Difference Life Insurance Budget Actual Difference TOTAL Health Insurance Budget Actual Difference PAYROLL TAXES & RETIREMENT State Taxes Budget Actual Difference Retirement (401k, Roth IRA) Budget Actual Difference Federal Taxes Budget Actual Difference TOTAL Payroll Taxes & Retirement Budget Actual Difference UTILITIES/RENT Rent Budget Actual Difference Utilities Budget Actual Difference TOTAL Utilities/Rent Budget Actual Difference Week 5 & 6 Biweekly Loan Budget Summary Starting Balance Budget Actual Difference Total Payroll Costs Budget Actual Difference Total Non Payroll Costs Budget Actual Difference PROJECTED BALANCE Budget Actual Difference SALARY/WAGES Wages Budget Actual Difference Prorated Salary Reduction Budget Actual Difference TOTAL Salary/Wages Budget Actual Difference HEALTH INSURANCE Health Insurance Premiums Budget Actual Difference Life Insurance Budget Actual Difference TOTAL Health Insurance Budget Actual Difference PAYROLL TAXES & RETIREMENT State Taxes Budget Actual Difference Retirement (401k, Roth IRA) Budget Actual Difference Federal Taxes Budget Actual Difference TOTAL Payroll Taxes & Retirement Budget Actual Difference UTILITIES/RENT Rent Budget Actual Difference Utilities Budget Actual Difference TOTAL Utilities/Rent Budget Actual Difference Summary Calculation Date of enactment Type of entity as indicated on your PPP loan application. Did you have employees as of the beginning of the day 2/15/2020?* Yes No Did you have employees at any point in 2019? Yes No Enter your 2019 net income from 2019 Schedule C line 31 Date of loan origination Ending date of covered period Loan principal amount Did you refinance an EIDL loan in to your PPP loan? Yes No Did you have any salary reductions since 2/15/2020? If you are unsure click 'Yes' Yes No Did you have any layoffs since end of the day 2/15/202? If you are unsure click 'Yes' Yes No Forgivable Costs Payroll Cost Percent (%) Non Payroll Expenses Percent (%) EIDL grant advance refinanced into PPP loan Potential Loan Forgiveness Amount Reduction #1 (not used) Reduction #2 (# of employees) Reduction #3 (Salaries & Wages) Reduction Reversal (Re-Hires) Total Forgivable Costs Costs in excess of Loan** TOTAL LOAN FORGIVENESS Accrued interest during covered period @ 1%/365 * #days * principal Total loan balance at 6-15-2020 prior to forgiveness Less forgiven portion of the loan TOTAL LOAN BALANCE AT 6-15-2020 Submit
