Exhibit A by United States of America — United States v. Breckenridge (Dkt. 49, S.D. W. Va.)

Summary

Exhibit A to a filing in United States v. Malik Breckenridge, Criminal No. 2:22-cr-00084, in the U.S. District Court for the Southern District of West Virginia, filed October 27, 2022 as Doc. 49. It contains two Small Business Administration Certified Statements of Account on SBA Form 596 B, from the Loan Accounting Branch, dated October 14, 2022 and October 18, 2022. Each lists the lender as Fountainhead SBF LLC and has lines for principal, principal forgiveness, interest, PPP processing fee and total indebtedness. They are signed by lead accountants Gabriella Maes and Patrick Henning.

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IN THE UNITED STATES DISTRICT COURT 
FOR THE SOUTHERN DISTRICT OF WEST VIRGINIA 
CHARLESTON 
 
UNITED STATES OF AMERICA 
 
 
v. 
 
 
 
 
 
 
 
      CRIMINAL NO. 2:22-cr-00084 
 
 
MALIK BRECKENRIDGE   
 
 
 
 
 
EXHIBIT A 
Case 2:22-cr-00084     Document 49     Filed 10/27/22     Page 1 of 3 PageID #: 133

As of
$
$
$
$
$
$
$
$
$
      
  
SBA FORM 596 B (8-81)
 
Principal Forgiveness 
Add: Interest Forgiveness
Add: PPP Processing Fee
Certified to be a true and accurate statement of the balances as reported by the lender and reflected 
by the official accounting records of the Small Business Administration 
7/31/2021
Interest Paid Through
5/14/2021
2,500.00
October 14, 2022
Total Amount Disbursed by SBA to Lender:
Total Amount Disbursed by Lender to Borrower:
2608 5th Ave Charleston WV 25387
Malik Breck                               
Less: Principal Payments
Less: Principal Forgiveness
Lender Principal Balance
Loan Number: 
Lender Name:
Borrower Name:  
7956568905
Borrower Address:  
Loan
Fountainhead SBF LLC                       
Loan Accounting Branch
Program Accounting Division
Office of Performance, Planning, and the Chief Financial Officer
SMALL BUSINESS ADMINISTRATION
CERTIFIED STATEMENT OF ACCOUNT
10/14/2022
Gabriella Maes, Lead Accountant
Authorized Signature and Title
Date 
Denver, CO  80259
20,833.00
50.93
Total Indebtedness
20,833.00
20,833.00
0.00
23,383.93
23,383.93
Last 1502 Report Date
SBA Charges Outstanding
Case 2:22-cr-00084     Document 49     Filed 10/27/22     Page 2 of 3 PageID #: 134

As of
$
$
$
$
$
$
$
$
$
      
  
SBA FORM 596 B (8-81)
 
Principal Forgiveness 
Add: Interest Forgiveness
Add: PPP Processing Fee
Certified to be a true and accurate statement of the balances as reported by the lender and reflected 
by the official accounting records of the Small Business Administration 
7/31/2021
Interest Paid Through
4/23/2021
2,500.00
October 18, 2022
Total Amount Disbursed by SBA to Lender:
Total Amount Disbursed by Lender to Borrower:
2608 5th Ave Charleston WV 25387
Malik Breck                               
Less: Principal Payments
Less: Principal Forgiveness
Lender Principal Balance
Loan Number: 
Lender Name:
Borrower Name:  
2569758802
Borrower Address:  
Loan
Fountainhead SBF LLC                       
Loan Accounting Branch
Program Accounting Division
Office of Performance, Planning, and the Chief Financial Officer
SMALL BUSINESS ADMINISTRATION
CERTIFIED STATEMENT OF ACCOUNT
10/18/2022
Patrick Henning, Lead Accountant
Authorized Signature and Title
Date 
Denver, CO  80259
20,833.00
63.08
Total Indebtedness
20,833.00
0.00
20,833.00
0.00
23,396.08
23,396.08
Last 1502 Report Date
SBA Charges Outstanding
Case 2:22-cr-00084     Document 49     Filed 10/27/22     Page 3 of 3 PageID #: 135

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