FRY-6
Board of Governors of the Federal Reserve Syste
OMS Number 7100-0297
Approval expires December 31, 2015
Page 1 of2
COPY
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)); Section 8(a)
This report form is to be filed by all top-tier bank holding compa­
nies and top-tier savings and loan holding companies organized
of the International Banking Act (12 U.S.C. § 3106(a)); Sections
under U.S. law, and by any foreign banking organization that
11(a)(1), 25 and 25A of the Federal Reserve Act (12 U.S.C.
§§ 248(a)(1), 602, and 611a); Section 211.13(c) of Regulation K
does not meet the requirements of and is not treated as a qualify­
ing foreign banking organization under Section 211.23 of
(12 C.F.R. § 211.13(c)); and Section 225.5(b) of Regulation Y (12
Regulation K (12 C.F.R. § 211.23). (See page one of the general
C.F.R. § 225.5(b)) and section 10(c)(2)(H) of the Home Owners'
Loan Act. Return to the appropriate F ederal Reserve Bank the
instructions for more detail of who must file.) The Federal
Reserve may not conduct or sponsor, and an organization (or a
original and the number of copies specified.
person) is not required to respond to, an information collection
unless it displays a currently valid OMS control number.
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 chair­
Date of Report (top-tier holding company's fiscal year-end):
December 31, 2014
Month
I
Day
I Year
N/A
man of the board must sign the report.
Reporter's Legal Entity ldentlfler (LEI) (20-Character LEI Code}
1, M. Gary Jacobs
Reporter's Name, Street, and Mailing Address
Name of the Holding Company Director and Official
Mackinaw Valley Financial Services, I n c .
Vc
i e-President
Legal Title of Holding Company
Title of the Holding Company Director and Official
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
P 0 Box 290
(Mailing Address of the Holding Company) Street I P.O. Box
Mackinaw
IL
City
State
61755
-------
Zip Code
knowledge and belief.
101 E Fast Ave Mackinaw IL 61755
With respect to information regarding individuals contained in this
P hysical Location (if different from mailing address)
report, the Reporter certifies that it has the authority to provide this
information to the Federal Reserve. 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 Reserve 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.F.R. Part 261,
that the Reporter
filKi..
individual consent to public release of all
details in the report concerning that individual.
J:
Person to whom questions about this report should be directed:
M. Gary Jacobs
Vice-President
Name
Title
309-359-3961
Area Code I Phone Number
I Extension
309-359-8136
Area Code I FAX Number
gjacobs@fsb1.com
E-mail Address
lead bankwww.fsb1.com
Address (URL} for the Holding Company's web page
For holding companies not registered with the SEC­
Indicate status of Annual Report to Shareholders:
0
0
k8l
is included with the FR Y-6 report
Does the reporter request confidential treatment for any portion of this
submission?
D Yes
Please identify the report items to which this request applies:
will be sent under separate cover
is not prepared
D In accordance with the instructions on pages GEN-2
and 3, a letter justifying the request Is being provided.
For Federal Reserve Bank Use Only
RSSD ID
C.I.
I£// 7 j_-:J,.1
------
D The information for which confidential treatment is sought
is being submitted separately labeled "Confidential."
[8J No
Public reporting burden for this information collection is estimated to vary from 1.3 to 101 hours per response, with an average of 5.25 hours per response, Including time to gather and
maintain data in the required form and to review instructions and complete the information collection. Send comments regarding this burden estimate or any ot er 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.
1012014
Mackinaw Valley Financial Services, Inc. Organization_al Chart
2014
Mackinaw Valley Financial Services, Inc. is 100% owner of First Security Bank and General
Partner of Mackinaw Partners, L.P.
All entities are incorporated in the State of Illinois
Results: A list of branches for your depos.itory institution: FIRST SECURITY BANK (ID_RSSD: 416339).
This depository institution is held by MACKINAW VALLEY FINANCIAl SERVICES, INC. (1417539) of MACKINAW, IL
The data are as of 12/31/2014. Data reflects Information that was received and processed through 01/07/2015.
Reconciliation and Ver!fiation Steps
1. In the Dita Action column of each branch row, l!nter one or more of the actions specified below.
2. If required, enter the date in the Effective Date column.
Actions
O)(: If the branch information is correct, enter 'OK' in the 0<1ta Action column.
Chance : If the branch Information is incorrect or Incomplete, revise the data, enter 'Change' in the Data Action column and the date when this lnformatlon first became valid in the Effective Date column.
Close: 1f a branch listed was sold or dosed, enter 'Close' in the Dan Action column and the sale or closure date ln the Effective Date column.
Delete: If a branch listed was never owned by this depository Institution, enter 'Delete' In the Data Action column.
Add: If a reportabl!! branch is missing, insert a row, add the branch data, and enter 'Add' In the Data Action column and the opening or acquisition date in the Effective Date column.
lf printing this list, you may need to adjust your page setup In MS Excel. Try using landscape orientation, page scaling, and/or legal sized paper.
Submission Procedure
When you are finb;hed, send a saved copy to your FRB contact. See the detalled Instructions on this site for more information.
If you are e-mailing this to your FRB contact, put your institution namt', city and state in the subject line of the e-mail.
Note:
To satisfy the FR Y-10 re po rtin1 requirements, you must also submit FR Y-10 Domestic Branch Sc.hedulM for each branch with a Data Action of Change, Close, Delete, or Add.
The FR Y-10 report may be submitted in a har dco pv format or vla the FR Y-10 Online application - https://y10onl!ne.federalres�e.gov.
•
FDIC UNINUM, Office Number, and ID_RSSD columns are for reference only. Verification of these values ts not required.
D•ta Action
Eftectfve Date
Branch Service Tvpe
Branch to_RSSD•
Po oulu N ame
St reet Address
EAST FAST AVENUE
OK
Full Service lHead Office)
416339 FIRST SECURITY BANK
101
OK
Full Service
698537 116 EAST EXCHANGE ST OFFICE
116 EAST EXCHANGE STREET
EAST FIRST STRE£T
OK
Full Seniice
3309900 DEER CREEK BANKING CENTER
201
OK
Full Service
3303382 HERITAGE LAKE BANKING CENTER
2 BRADFORD DRIVE
c;ty
Sblte Zip Code
MACK I NA W
IL
61755 TAZEWELL UNITED STATES
DANVER S
IL
61732 MCLE AN
UNITED STATES
DEER CREEK
IL
61733 TAZEWELL
MACKINAW
IL
61755 TAZEWELL
County
Countrv
FDIC UNINUM•
Office Numbfl•
Head Office
Head Office to Rsso•
2368
0 FIRST SECURITY BANK
416339
17102
3 FIRST SECURITY BANK
416339
UNITED STATES
429641
2 FIRST SECURITY BANK
416339
UNITED STAID
42B149
1 FIRST SECURl1Y BANK
416339
Comments
FR Y-6
MACKINAW VALLEY FINANCIAL SERVICES, INC
MACKINAW ILLINOIS
Fiscal Year Ending December 31, 2014
Report Item 3: Securities Holders
Current Securities Holders with ownership, control or holdings of 5%
or more with power to vote as of fiscal year ending 12-31-2014
(1)(a)
(1)(b)
Name & Address (City,
State, Country)
Country of
Citizenship or
Incorporation
Donald Harrell Mackinaw USA
(1)(c)
Number and
Percentage of Each
Class of Voting
Securities
6,500 Shares/7.68%
ILUSA
Mary Ann Harrell
USA
Mackinaw IL USA
Samuel Hovey Mackinaw
USA
6, 100
Shares/7.21%
!LUSA
Mary Hovey Mackinaw
USA
IL USA
Dorothy McGrath Mackinaw USA
6,300 Shares/7.44%
IL USA
Estate of Alvin Schmidgall
USA
14,012 Shares/16.56%
USA
12,688 Shares/14.99%
Mackinaw IL USA
Charles E Weishaupt
Mackinaw IL USA
Mary Jane Weishaupt
USA
Mackinaw IL USA
•'
Dorothy White Mackinaw
USA
10,000 Shares/11.82%
USA
4,407 Shares/5.21 %
IL USA
John Trimble
Mackinaw IL USA
Donna Trimble
Mackinaw IL USA
USA
Securities Holders not listed in 3(1)(a) through (3)(1)(c) that had
ownership, control or holdings of 5% or more with power to vote
during the fiscal year ending 12-31-2014
(2)(a)
(2){b)
Name & Address
(City, State, Country)
Country of
Citizenship or
Incorporation
(2){c)
Number and
Percentage of Each
Class of Voting
Securities
FRY·6
MACKINAW VALLEY FINANCIAL SERVICES, INC.
M.ACK.INAW ILUNOiS
Fiscal Year Ending December 31,
(2)
(1)
(3)(a)
2014
(4)(a)
(3) (c)
(3)(b)
(4)(c)
(4)(b)
List names of other
companies
(includes
partnerships) if 25%
or more of voting
securities are held
Percentage of
Title & Position
Principal
Title & Position
Title & Position
with Other
Percentage of
with Subsidiaries
Businesses
Voting Securities in Subsidiaries
Names & Address
Occupation if other with Bank
{City, State,
than with Bank
Holding
(include names of (include names of
Country)
Holding Company
Company
subsidiaries)
other businesses)
(List names of
Voting Securities companies and
percentage of
in Bank Holding
(include names
voting securities
Company
of subsidiaries)
held)
Richard Grunert
Mackinaw IL USA
Retired Grocer
Secretary
Secretary (FSB)
NIA
3.72%
NIA
NIA
Donald Harrell
Retired
Dlrcector
Director (FSB)
NIA
7.68%
NIA
NIA
NIA
NIA
NIA
N/A
Held Jointly
NIA
NIA
Atitorney
Director/President
Director/Chairman
Owner, McGrath Law
0.00%
Office PC Mackinaw IL
NIA
N/A
(FSB)
Farmer
Director
Director (FSB)
NIA
14.99%
N/A
NIA
Retired
NIA
NIA
NIA
Held JoinUy
NIA
N/A
Mackinaw IL USA
Mary Ann Harrell
Mackinaw IL USA
Mark McGrath
Mackinaw IL USA
Charles E Weishaupt
Mackinaw IL USA
Mary Jane Weishaupt
Mackinaw IL USA
Pag·e
2
Report item 4:
Insiders
FR Y-6
John Trimble
Trucking Company
Director
Mackinaw IL USA
Donna Trimble
Director/Vice-
President Ken Trimble
Chairman (FSB)
Trucking Co Mackinaw
5.21%
NIA
Ken Trimble Trucking
Inc. 25%
NIA
NIA
NIA
NIA
Held Jointly
NIA
NIA
NIA
DlrectorNP
President/CEO (FSB)
NIA
0.62%
NIA
NIA
Retired
NIA
NIA
NIA
11.82%
NIA
NIA
NIA
NIA
NIA
NIA
16.56%
NIA
NIA
Consultant
Director
Director (FSB)
Partner, Health Care
2.77%
NIA
Heatlh Care Futures
Mackinaw IL USA
M. Gary Jaccbs
Mackinaw IL USA
Dorothy White
Mackinaw IL USA
Estate of Alvin
Schmidgall Mackinaw ii
USA
Edward J. McGrath
Inverness IL USA
Diane J. McGrath
Inverness IL USA
Louise Weishaupt
Mackinaw, IL USA
LP_ 28%
Futures LP., Itasca IL
NIA
NIA
NIA
NIA
Held Jointly
NIA
NIA
Farmer
Director
Director (FSB)
NIA
0_32%
NIA
NIA