FR
Y-6
OMB Number 7100-0297 Approval expires Seplember 30, 2018 Page 1of 2
Board of Governors of the Federal Reserve System
Annual Report of Holding Companies-FR Y-6
Report at the close of business as of the end of fiscal year This Report is required by law: Section 5(c)(1 )(A) of the Bank Holding Company Act (12 U.S.C. § 1844(c)(1 )(A)); sections 8(a) and 13(a) of the International Banking Act (12 U.S.C. §§ 3106(a) and 3108(a)), sections 11(a)(1), 25, and 25A of the Federal Reserve Act (12 U.S.C. §§ 248(a)(1), 602, and 611a); and sec tions 113, 165, 312, 618, and 809 of the Dodd-Frank Act (12 U.S.C §§ 5361, 5365, 5412, 1850a(c)(1), and 5468(b)(1)). Return to the appropriate Federal Reserve Bank the original and the number of copies specified
NOTE: The Annual Report of Holding Companies must be signed by one director of the top-tier holding company. This individual should also be a senior official of the top-tier holding company. In the event that the top-tier holding company does not have an individual who is a senior official and is also a director, the chairman of the board must sign the report. If the holding company is an ESOPIESOT formed as a corporation or is an LLC, see the General Instructions for the aulhorized individual who must sign the report.
This report form is to be filed by all top-tier bank holding compa nies, top-tier savings and loan holding companies, and U.S. inter mediate holding companies organized under U.S. law, and by any foreign banking organization that does not meet the require ments of and is not treated as a qualifying foreign banking orga nization under Section 211.23 of Regulation K (12 C.F.R. § 211.23). (See page one of the general instructions for more detail of who must file.) The Federal Reserve may not conduct or spon sor, and an organization (or a person) is not required to respond to, an Information collection unless it displays a currently valid OMB control number
Date of Report (top-tier holding company's fiscal year-end)
December 31, 2016 Month
I Day I Year
N/A Repor1er's Legal Entity ldenlifier (LEI) (20-Character LEI Code)
Reporter's Name, Street, and Mailing Address
1. Thomas J. Pampe ri n Name of 1he Holding Company Dlrec1or and Official
M.S.B. Bancorporation, Inc.
President
Legal Title or Holding Company
Tiiie or lhe Hol d i ng Company Director and Orticial
attest that the Annual Report of Holding Companies (including the supporting attachments) for this report date has been pre pared in conformance with the instructions issued by the Federal Reserve System and are true and correct to the best of my knowledge and belief With respect to information regarding individuals contained m this report, the Reporter certifies that 11 has the authority to provide this information to the Federal ReseNe. The Reporter also certifies that it has the authority, on behalf of each individual, to consent or object to public release of information regarding that individual The Federal ReseNe may assume, in the absence of a request for confidential treatment submitted in accordance with the Board's "Rules Regarding Availability of Information,· 12 C.FR Part 261, er amt individual consent to public release of all that th detail in the rep co'ceming that individual. l
s...
�lng Company Director and Orticial
230 Mavis Road ( Mailing Address or the Holding Company) Slreet IP 0 Box
Marion
WI
City
Stat e
Physical Location (if different
54950
-------
Zi p Code
from mailing address)
Person to whom questions about this report should be directed.
SVP-Administration Titl e
Susan Mares Name
715-754-2535 Area Code I Phone Number
I Extension
715-754-5905 Area Code I FAX Number
[email protected] E-mail Address
Signature or H
N/A
03/30/2017
Address (URL) for the Holding Company's web page
Date or S ignature
For holding companies aQl registered with the SECIndicate status of Annual Report to Shareholders:
!El
0 0
Is included with the FR Y-6 report will be sent under separate cover is not prepar ed
9 ld � 0::\ 4
For Federal Reserve Bank Use Only RSSD ID
C.I.
Is confidential treatment requested for any portion of this report submission?
�
.............................. �
In accordance with the General Instructions for this report (chock only o ne),
1. a letter justifying this request Is being provided along with the report .
.
.......................................
.
.
........ ...
2. a letter justifying this request has been provided separately ............................................ . . . . ........ . . . .
0 0
NOTE: Information for which confidential treatment Is being requested must be provided separately and labeled as "confidential."
Public reporting burden for this Information collection Is esUmated 10 vary from 1.3 to 101 hours per response, with an average of 5.50 hours per response, Including Ume lo gather and maintain data In the required rorm and lo review Instructions and complete th e Information collectlon. Send comments regarding this burden esllmate or any other aspect of this collection of
tnrormetion, Including suggestions for rodudn g this burden to; Secrelary, Boord of Governors or lhe Federal Reserve System. 20th and C Slreots, NW, Washlnglon, DC 20551, end to the
Office of Management and Budget, Paperwor1t Reducllo n Profec1 (7100-0297), Washington, OC 20503.
1212016
M.S.B. BANCORPORATION, INC. Marion, WI FRY-6 Fiscal Year Ending December 31, 2016
1 The BHC does prepare an annual report its shareholders. Enclosed are two copies of the annual report.
2 Organization Chart M.S.B. Bancorporation, lnc. • Marion, WI 54950 USA State of lncorooration: Wisconsin
1�-----
Owns I 00% of outstanding stock
Premier Community Bank• Marion, WI 54950
USA
State of Incorporation: Wisconsin Owns I 00% of outslanding stock MSB lnvestments, Inc.• Marion, WI 54950
USA
lndependent Financial Services, Inc.• DBA Premier Insurance Services Marion, Wl 54950 USA
State of Incorporation: Nevada
•ooes not have a LEI Code
2(b) Branch Verification Submitted via e-mail on 3/01/2017
State of Incorooration: Wisconsin
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When 'f°" are tlnfJhed, send• s.Yed copy to your rRB contact See the delllltd lnmuchon• on thrs Mt• for more 1t1fonn•hon H you are •rna•knc thl• to your fll.8 conlld, put yow Institution name, otv end •l•le In the wbte