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1839252
Board of Governors of the Federal Reserve System
FRY-6 0MB Number 7100--0297 Approval expires September 30, 2018 Page 1 of 2
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 sections 113, 165,312, 618, and 809 of the Dodd-Frank Act (12 U.S.C.
This report form is to be filed by all top-tier bank holding companies, top-tier savings and loan holding companies, and U.S. intermediate holding companies organized under U.S. law, and by any foreign banking organization that does not meet the requirements of and is not treated as a qualifying foreign banking organization under Section 211.23 of Regulation K (1 2 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 sponsor, and an organization (or a person) is not required to respond to, an information collection unless it displays a currently valid 0MB control number.
§§ 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 ESOP/ESOT formed as a corporation or is an LLC, see the General Instructions for the authorized individual who must sign the report. 1. David Schultz
Name of the Holding Company Director and Official
President litle 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 prepared in conformance with the instructions issued by the Federal Reserve System and are true and correct to the best of my knowledge and belief.
Wtth respect to information regarding individuals contained in this 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 fil1si. individual consent to public release of all
_g_etails in the rep concemin that individual. · .. ; _,{)
Date of Signature
For holding companies n.Qf. registered with the SEC-Indicate status of Annual Report to Shareholders:
~ is included with the FR Y-6 report D will be sent under separate cover D is not prepared
For Federal Reserve Bank Use Only
RSSDID C.I.
Date of Report (top-tier holding company's fiscal year-end):
December 31, 2016 Month / Day/ Year
None Reporter's Legal Entity Identifier (LEI ) (20-Character LEI Code)
Reporter's Name, Street, and Mailing Address
Bonduel Bancorp Inc. Legal litle of Holding Company
130 N Cecil SUPO Box 68 (Mailing Address of the Holding Company) Street / P.O. Box
Bonduel WI City State
Physical Location (if different from mailing address)
54107 Zip Code
Person to whom questions about this report should be directed: David Schultz President Name
715-758-2141 Area Code I Phone Number / Extension
715-758-2823 Area Code / FAX Number
[email protected] E-mail Address
litle
Address (URL) for the Holding Company's web page
O=No Is confidential treatment requested for any portion of this report submission? . .. . ... ... .... . . ... .. . . .. . .. .. ~
In accordance with the General Instructions for this report (check only one),
1. a letter justifying this request is being provided along with the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . .. D
2. a letter justifying this request has been provided separately . . .. . . ... . . ... .. . . .. ... .. .... .. .... ..... .. . . . ...... .... ... .. D
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 estimated to vary from 1.3 to 101 hours per response, with an average of 5.50 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 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, Paperworil Reduction Project (7100--0297). Washington, DC 20503.
1212016
Bonduel Bancorp Inc. 130 N Cecil St/PO Box 68
Bonduel WI 54107 Incorporated in the State of Wiscosnin
Form FR Y-6 Fiscal Year Ending December 31 , 2016
Incorporated in Wisconsin Bonduel Bancorp, Inc.
Bonduel, WI LEI= none
100%
IJncorporated in Wisconsin I Bonduel State Bank
Bonduel, WI LEI= none
100%
Incorporated in Nevada Bonduel Investment Corporation
Las Vegas, NV LEl=none
ftnutu:: A hst of bAnchet. foe your deposrtOfY lmtltuuon Neut STA ..... IA /I• ._.1o1, lllji,~torviMfitutionls~dbyliiUfti.out... "'" Nie. QR't~ ol Nl..
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RfCOftcliftk>n and Ytrifadon st,e> 1.. 1n I.he Dau Action c~umn or e.ch tw.nch row, enter Of'H! Of mCMe of the- a<uons specified be4ow
2 tf required, enter tM d1te m th« EffKtfve Date cCMumn
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,_Jcii.. tf a tnnch listed wH IOld Of clowd. ent·ernr In tM Data Action coiumn and ~wleot dosuredlte In IM Etfectivt01te cotumn
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..._: If a repo,t"Able br.nch 1, miu.inc. tnsert a row, ~ the btar,ch data, and enter..._. In the Data Action ro4umn and the openmc Of acqu1sihon d•tc In the Effectfve Oa1e column
tf pfln11nt 1h11 hst. you may nHd to Ml,u,t 'tOl.if pqt setup .n MS bee! Trv usina landscape onenhlhon, pa,e i.uhnc, and/or le:sal 11zed pape,
Submb.slon Prqgdure When you are hni~. s.end • uwd copy to your FR8 contact Sn the deu1led tnRf\lCl1on1on 1his ,ue for fflCM'e 1nform•Oon
If y0u are e,,,m11hn1 thlS to your FRB con1Kt. put 'fOUf fflt1tu11on name, otv and 1t1te In the IObjed line of !he e-m11I
Notr To s.atisfv the FR V· lO re.portin& requirements 'fOU mUit al,,o wbm1t f'R Y-10 Oomeshc: 8'anc:h xh,e,dulH for Heh bunch wllh • Oat. Adlon or~
The FR Y-10 repof1 maybe s.ubmitted 1n I hMdcopy format or VY the FR Y-lOOnllne appllcabon http1J/ylOonl1ne: .fecteBlreSttt"e ICY
• FOK: UNINUM, Office Humber. and ID_RSSO columns are fOf reference only VenfiaiUon of the:H v11uei II not tequ1red
Dau Action Effecdn Date &ranch Se.tvke T e ut.,Name Street Addrns
OK Full ServKe Head Office 35646 BONDUEL STAT( BANK 130 NORrn CECIL STRlfT
Coun Coun FOfC UNINUM• Office Number• He.Ml Offlc.e
SHA.WA.NO UNITED STAID 7168 0 BONOUElSTATtBANIC
Hud Offlu ID RSso• Comments
3S646
SECURITIES HOLDERS
Report Items 3: securities holders
Form FR Y-6 Bonduel Bancorp, Inc.
Bonduel, WI 54107 Fiscal Year Ending 12/31/2016
Current securities holders with ownership, control or holdings of 5% or more with Securities holders not listed in 3(1 )(a) through 3(1 )© that had ownership
nower to vote as of fiscal year endinq 12/31/2016 control or holdinas of 5%or more with power to vote during fiscal year 12/31/2011
(1 )(a) Name, city, state ,country (1 )(b) country of (1)©#and % of (2)(a) Name, city, state,country {2)(b) coutnry of (2)© # and % of each
citizenship each class securities citizenship class securities
David Clark USA 5000 shares-6.1009% NONE
Shawano WI 54166 common stock
REPORT ITEM 4: INSIDERS
NAME, ADDRESS,
CITY & SATE
James Bleick
Zachow WI 54182
Robert Wendt Jr.
Bonduel WI 54107
Allen O Kohn
Krakow WI 54137
David D Schultz
Bonduel WI 54107
Richard Kucksdorf
Bonduel WI 54107
PRINCIPAL
OCCUPATION
IF OTHER THAN WITH
BANK HOLDING CO
Graf Creamery
NIA
Farmer
CEO
N/A
Form FR Y-6
December 31 , 2016
TITLE & POSITION TITLE&POSITION TITLE&POSITION PERCENT AGE % VOTING NAME OF
BANK HOLD CO W/SUBSIDIARIES WITH OTHER VOTE SHARES SHARE IN OTHER
Director/Chairman Director
Director Director
Director Director
Director/President CEO/Secretary
Director Director
BUSINESSES BANK HOLD CO SUBSIDIARY COMPANY
President 2.1719
N/A 0.5124
Owner 0.0488
N/A 0.1586
N/A 0.0671
None
None
None
None
None
IF 25%0R MORE VOTE
None
None
None
None
None