5.1. HRSR 10-04-2004 - Laserfiche WebLink

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Section 5 Recipients Failing to Fulfill Obligations • (Do not complete this section if you completed it on another MBAF submitted to DEED.) 33. During the period January 1,2003 through December 31,2003,did your organization have any recipients who failed to report as required by Minn.Stat.§116J.993 and§116J.994? (Mark one.) • Yes(Indicate the name of each recipient failing to report and the value of subsidy or financial assistance awarded to that recipient. Attach additional pages if necessary.) • No Name of recipient Type of subsidy or assistance(See Questions 24 and 25.) Value of subsidy or assistance 34. Did your organization have any recipients who failed to achieve any goals or fulfill any other obligations under an agreement signed on or after August 1, 1999,that were required to be fulfilled by the time of this report?(Mark one.) • Yes(Complete the remainder of this section.) • No(Stop here and submit form to DEED.) 35.-39. Provide the following information for each recipient failing to fulfill goals or any other terms of an agreement that were to be attained by the time of reporting. (Attach additional pages if necessary.) 35. Information on recipient and agreement: Name of recipient in default Type of subsidy or assistance Initial value of subsidy or assistance Street address of recipient City/ZIP code of recipient Outstanding value of • subsidy or assistance 36. Reason(s)for default(Mark all that apply.): • •recipient ceased operation • •recipient relocated to a different community • •recipient was unable to fill vacant positions • other(Specify reason.) 37. To date,has the recipient fulfilled its repayment obligation?(Mark one.) • •Yes • No,recipient has begun to repay the assistance. • No,recipient has not begun to repay the assistance. 38. Has the agreement been amended to extend the recipient's deadline for fulfilling its obligations?(Mark one.) • •Yes • No 39. Describe the steps being taken to bring recipient into compliance or recoup the subsidy: Return your completed MBAF(s)by April 1,2004,to: Minnesota Business Assistance Form Minnesota Department of Employment and Economic Development-AEO 500 Metro Square, 121 East 7th Place St.Paul,MN 55101-2146 Or fax to: (651)215-3841 • Minnesota Business Assistance Form(1/14/04) Page 4 of 4 Dept.of Employment &Economic Development