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Report Of Changes In Organizational Structure FR Y-10 - Official Federal Forms
| Report Of Changes In Organizational Structure Form. This is a national form and can be used in Applications Structure Change Federal Reserve System . |
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FR Y-10 OMB Number 7100-0297 Approval expires December 31, 2015 Page 1 of 9 Board of Governors of the Federal Reserve System Report of Changes in Organizational Structure--FR Y-10 This report is required by law: Sections 4(k) and 5(c)(1)(A) of the Bank Holding Company Act (12 U.S.C. §§ 1843(k), 1844(c)(1) (A)); Section 8(a) of the International Banking Act (12 U.S.C. § 3106(a)); Sections 11(a)(1), 25(7) and 25A of the Federal Reserve Act (12 U.S.C. §§ 248(a)(1), 321, 601, 611a and 615); Section 211.13(c) of Regulation K (12 C.F.R. § 211.13(c)); Sections 225.5(b) and 225.87 of Regulation Y (12 C.F.R. §§ 225.5(b) and 225.87); and Section 10(c)(2)(H) of the Home Owners' Loan Act (12 U.S.C. 1461 et seq.). Reporter's Name, Street, and Mailing Address Legal Name Date of Report: (Month / Day / Year) Physical Street Address Reporter's Mailing Address (if different from physical street address) City and County Mailing City State / Province, Country Zip / Postal Code Mailing State / Province, Country Zip / Postal Code Contact's Name and Mailing Address for this Report Name Title Contact's Mailing Address (if different from reporter's) Area Code / Phone Number / Extension Mailing City Area Code / FAX Number Mailing State / Province, Country Zip / Postal Code E-mail Address Authorized Official I, Printed Name Title , Does the reporter request confidential treatment for any portion of this submission? Yes Please identify the report schedule(s) and item(s) to which this request applies: am an authorized official of this company named above, and hereby declare that this report is true and complete to the best of my knowledge and belief. Signature of Authorized Official Date of Signature For Federal Reserve Bank Use Only RSSD ID In accordance with the instructions on page GEN-4, a letter justifying the request is being provided The information for which confidential treatment is sought is being submitted separately and labeled "Confidential." No Public reporting burden for the information collection is estimated to average 2.25 hours per response, including time to gather and maintain the data and complete the information collection. The Federal Reserve may not conduct or sponsor, and a person is not required to respond to any information collection unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Secretary, Board of Governors of the Federal Reserve System, 20th and C Streets, NW, Washington, DC 20551, and to the Office of Management and Budget, Paperwork Reduction Project (7100-0297), Washington, DC 20503. 12/2012 American LegalNet, Inc. www.FormsWorkFlow.com Banking Schedule Use this schedule to report information about a reporter that is a Banking Company, and about a reporter's directly or indirectly held interests in a Banking Company. 1.a. Event Type (check all that apply): Acquisition of a Going Concern De Novo Formation External Transfer Internal Transfer Other, please describe: For Federal Reserve Bank Use Only ID_RSSD_E1 (direct holder) ID_RSSD_E2 (reportable company) If applicable, former d/h FR Y-10 Page 2 of 9 Check box if correction (MM / DD / YYYY) 1.b. Date of Event: Change in Ownership Liquidation Change in Characteristics Change in Activity or Legal Authority No Longer Reportable Became Inactive Debts Previously Contracted Became Reportable Characteristics Section 2.a. Legal Name of Banking Company 2.b. If Name Change or Correction, Prior Legal Name of Banking Company 3.a. Current Street Address (Physical Location) City and County State / Province, Country, and Zip / Postal Code State or Country (if foreign) of Incorporation 3.b. If Relocation or Correction, Prior Street Address (Physical Location) If Relocation or Correction, Prior City and County If Relocation or Correction, Prior State / Province, Country, and Zip / Postal Code If Relocation or Correction, Prior State or Country (if foreign) of Incorporation 4. 6. Date Opened: (MM / DD / YYYY) 5. Fiscal Year End (FBOs and BHCs Only): (MM/DD) SEC Reporting Status: Not Applicable Subject to 13(a) or 15(d) of SEC Act of 1934 and Section 404 of SOX Act Subject to 13(a) or 15(d) of SEC Act of 1934, but not Section 404 of SOX Act Terminated or suspended reporting requirements under 13(a) or 15(d) of the SEC Act of 1934 8. Tax ID Number: 7. 9. 10. CUSIP Number: not required for FBOs U.S. State Chartered Savings Bank Limited Partnership Mutual Limited Liability Co./Corp. leading six digits only Banking Company Type: Business Organization Type: BHC FBO Other, please describe: U.S. Commercial Bank Corporation General Partnership Business Trust Sole Proprietorship Cooperative Limited Liability Partnership Limited Liability Limited Partnership Other, please describe: Yes 11. Is the banking company consolidated in the reporter's financial statements? (only reportable for foreign investments) No Ownership Section (report at direct holder level unless otherwise noted) 12. Direct Holder's Name and Location: Legal Name City, State/Province, Country 13.a. Percentage of a Class of Voting Shares: 13.b. Percentage of Nonvoting Equity: 13.c. Other Interest: % % 14. 15. 16. Control by Direct Holder: Control by Reporter: Yes Yes No No Yes No Former Direct Holder's Name and Location (if applicable): Legal Name of Former Direct Holder 13.d. If the reportable company is a type of partnership or limited liability company as indicated in Item 10 above, please indicate the appropriate ownership interest of the direct holder: General Partner/Managing Member Limited Partner/Non-Managing Member FRS Legal Authority Code NAICS Activity Code City, State / Province, Country Activity and Legal Authority Section (for list of FRS legal authority codes, see the Appendix of these instructions.) Activity Type Description of Activity 17.a. Primary Activity 17.b. Secondary Activity (FBOs and BHCs only) 17.c. Termination of Activity American LegalNet, Inc. www.FormsWorkFlow.com 12/2012 Savings and Loan Schedule Use this schedule to report information about a reporter that is a savings and loan holding company (SLHC), and about any reporter's (including a BHC's) directly or indirectly held interest in all SLHCs and savings associations. 1.a. Event Type (check all that apply): Acquisition of a Going Concern De Novo Formation External Transfer Internal Transfer Other, please describe: For Federal Reserve Bank U
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