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Page 1: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust
Page 2: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust
Page 3: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust
Page 4: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust
Page 5: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust
Page 6: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust
Page 7: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust
Page 8: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust
Page 9: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust

Fo

rm F

R Y

-6

Firs

t Wes

tern

Mor

tgag

e C

orpo

ratio

n

Fisc

al Y

ear

End

ing

Sept

embe

r 30

, 201

7 R

epor

t Ite

m 3

: Se

curi

ties H

olde

rs

(1)(

a,b,

c) a

nd (2

)(a,

b,c)

20

17=

Item

3 -

Prin

Sha

reho

lder

s = F

WM

C re

vise

d fo

rmat

Cur

rent

Sha

reho

lder

s w

ith o

wne

rshi

p, c

ontr

ol o

r hol

ding

s of

5%

or m

ore

with

pow

er to

vot

e as

of f

isca

l yea

r end

ing

9/30

/201

7

Shar

ehol

ders

not

list

ed in

(3)(1

)(a) t

hrou

gh (3

)(1)(c

) th

at h

ad o

wne

rshi

p, c

ontr

ol o

r hol

ding

s of

5%

or

mor

e w

ith p

ower

to v

ote

durin

g th

e fis

cal y

ear

endi

ng 9

/30/

2017

(1)(a

) N

ames

& A

ddre

ss

(City

, Sta

te, C

ount

ry)

(1)(b

) C

ount

ry o

f C

itize

nshi

p or

In

corp

orat

ion

(1)(c

) N

umbe

r and

Pe

rcen

tage

of E

ach

Cla

ss o

f Vot

ing

Secu

ritie

s

(2)(a

) N

ames

& A

ddre

ss

(City

, Sta

te, C

ount

ry)

(2)(b

) C

ount

ry o

f C

itize

nshi

p or

In

corp

orat

ion

(2)(c

) N

umbe

r and

Pe

rcen

tage

of E

ach

Cla

ss o

f Vot

ing

Secu

ritie

s

Jam

es S

. DuB

ose

(For

t Wor

th, T

X / U

SA)

Tr

uste

e fo

r:

The

DuB

ose

Irrev

ocab

le A

sset

Tru

st o

f 199

8 fb

o An

na A

dam

s D

uBos

e

The

DuB

ose

Irrev

ocab

le A

sset

Tru

st o

f 199

8 fb

o Ja

mie

Ada

ms

DuB

ose

Ja

mes

E. D

ubos

e Irr

evoc

able

Tru

st

G

MD

K-C

hris

toph

er J

ames

Key

land

Tru

st

G

MD

K-Ka

thry

n Jo

y Ke

ylan

d Tr

ust

U

SA

64

,337

– 5

.43%

N

one

Chr

isto

pher

J. K

eyla

nd

(Aus

tin, T

X / U

SA)

Tr

uste

e fo

r:

GM

DK

Trus

t FBO

Chr

isto

pher

J. K

eyla

nd

U

SA

17

1,83

6.5

– 14

.50%

1

N

one

Kath

ryn

J. R

ober

ts

(Asp

en, C

O/ U

SA)

Tr

uste

e fo

r:

GM

DK

Trus

t FBO

Kat

hyrn

J. R

ober

ts

U

SA

17

1,83

6.5

– 14

.50%

2

N

one

Jam

es E

. DuB

ose

(F

ort W

orth

, TX

/ USA

)

Trus

tee

for:

Th

e An

na A

dam

s D

uBos

e Irr

evoc

able

Ass

et T

rust

Anna

Ada

ms

DuB

ose

Irrev

ocab

le In

terv

ivos

Tru

st

Th

e C

hris

toph

er J

ames

Key

land

Irre

voca

ble

Asse

t Tru

st

[con

tinue

d on

nex

t pag

e]

U

SA

77

3,13

8 –

65.2

6%3

N

one

1 I

nclu

des

3,17

8 (0

.27%

) hel

d as

sol

e an

d se

para

te p

rope

rty.

2 I

nclu

des

3,17

8 (0

.27%

) hel

d as

sol

e an

d se

para

te p

rope

rty.

3 I

nclu

des

7,13

4 (0

.60%

) hel

d as

indi

vidu

al a

nd 7

,659

(0.6

5%) h

eld

in s

pous

e’s

nam

e; b

oth

held

as

com

mun

ity p

rope

rty.

Page 10: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust

Fo

rm F

R Y

-6

Firs

t Wes

tern

Mor

tgag

e C

orpo

ratio

n

Fisc

al Y

ear

End

ing

Sept

embe

r 30

, 201

7 R

epor

t Ite

m 3

: Se

curi

ties H

olde

rs

(1)(

a,b,

c) a

nd (2

)(a,

b,c)

20

17=

Item

3 -

Prin

Sha

reho

lder

s = F

WM

C re

vise

d fo

rmat

Cur

rent

Sha

reho

lder

s w

ith o

wne

rshi

p, c

ontr

ol o

r hol

ding

s of

5%

or m

ore

with

pow

er to

vot

e as

of f

isca

l yea

r end

ing

9/30

/201

7

Shar

ehol

ders

not

list

ed in

(3)(1

)(a) t

hrou

gh (3

)(1)(c

) th

at h

ad o

wne

rshi

p, c

ontr

ol o

r hol

ding

s of

5%

or

mor

e w

ith p

ower

to v

ote

durin

g th

e fis

cal y

ear

endi

ng 9

/30/

2017

(1)(a

) N

ames

& A

ddre

ss

(City

, Sta

te, C

ount

ry)

(1)(b

) C

ount

ry o

f C

itize

nshi

p or

In

corp

orat

ion

(1)(c

) N

umbe

r and

Pe

rcen

tage

of E

ach

Cla

ss o

f Vot

ing

Secu

ritie

s

(2)(a

) N

ames

& A

ddre

ss

(City

, Sta

te, C

ount

ry)

(2)(b

) C

ount

ry o

f C

itize

nshi

p or

In

corp

orat

ion

(2)(c

) N

umbe

r and

Pe

rcen

tage

of E

ach

Cla

ss o

f Vot

ing

Secu

ritie

s

[con

tinue

d fro

m p

age

1]

Jam

es E

. DuB

ose

(F

ort W

orth

, TX

/ USA

)

Trus

tee

for:

Th

e FW

MC

Con

trol T

rust

The

GM

DK

Irrev

ocab

le A

sset

Tru

st fb

o C

hris

toph

er K

eyla

nd

Th

e G

MD

K Irr

evoc

able

Ass

et T

rust

fbo

Kath

ryn

Rob

erts

The

Jam

ie A

dam

s D

uBos

e Irr

evoc

able

Ass

et T

rust

Jam

ie A

dam

s D

uBos

e Irr

evoc

able

Inte

rviv

os T

rust

The

JED

Irre

voca

ble

Asse

t Tru

st

Th

e JE

D T

rust

JLD

/GM

DK

Irrev

ocab

le A

sset

Tru

st fb

o C

hris

toph

er J

. Key

land

JLD

/GM

DK

Irrev

ocab

le A

sset

Tru

st fb

o Ka

thry

n J.

Rob

erts

The

JLD

/JED

Irre

voca

ble

Asse

t Tru

st

JL

D-A

nna

Adam

s D

uBos

e Tr

ust

JL

D-C

hris

toph

er J

. Key

land

Des

cend

ant T

rust

#3

JL

D-C

hris

toph

er J

ames

Key

land

Des

cend

ant T

rust

#1

JL

D-C

hris

toph

er J

ames

Key

land

Tru

st

JL

D-J

ames

E. D

uBos

e Tr

ust

JL

D-J

amie

Ada

ms

DuB

ose

Trus

t

JLD

-Kat

hryn

J. R

ober

ts D

esce

ndan

t Tru

st #

4

JLD

-Kat

hryn

Joy

Key

land

Des

cend

ant T

rust

#2

JL

D-K

athr

yn J

oy K

eyla

nd T

rust

JLD

-Vic

toria

Ann

Ada

ms

Trus

t

The

JSD

/GM

DK

Irrev

ocab

le A

sset

Tru

st

Th

e JS

D/J

ED Ir

revo

cabl

e As

set T

rust

JSD

-Ann

a Ad

ams

DuB

ose

Trus

t

JSD

-Chr

isto

pher

J. K

eyla

nd D

esce

ndan

t Tru

st #

3

JSD

-Chr

isto

pher

Jam

es K

eyla

nd D

esce

ndan

t Tru

st #

1

JSD

-Chr

isto

pher

Jam

es K

eyla

nd T

rust

JSD

-Jam

es E

. DuB

ose

Trus

t

[c

ontin

ued

on n

ext p

age]

Page 11: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust

Fo

rm F

R Y

-6

Firs

t Wes

tern

Mor

tgag

e C

orpo

ratio

n

Fisc

al Y

ear

End

ing

Sept

embe

r 30

, 201

7 R

epor

t Ite

m 3

: Se

curi

ties H

olde

rs

(1)(

a,b,

c) a

nd (2

)(a,

b,c)

20

17=

Item

3 -

Prin

Sha

reho

lder

s = F

WM

C re

vise

d fo

rmat

Cur

rent

Sha

reho

lder

s w

ith o

wne

rshi

p, c

ontr

ol o

r hol

ding

s of

5%

or m

ore

with

pow

er to

vot

e as

of f

isca

l yea

r end

ing

9/30

/201

7

Shar

ehol

ders

not

list

ed in

(3)(1

)(a) t

hrou

gh (3

)(1)(c

) th

at h

ad o

wne

rshi

p, c

ontr

ol o

r hol

ding

s of

5%

or

mor

e w

ith p

ower

to v

ote

durin

g th

e fis

cal y

ear

endi

ng 9

/30/

2017

(1)(a

) N

ames

& A

ddre

ss

(City

, Sta

te, C

ount

ry)

(1)(b

) C

ount

ry o

f C

itize

nshi

p or

In

corp

orat

ion

(1)(c

) N

umbe

r and

Pe

rcen

tage

of E

ach

Cla

ss o

f Vot

ing

Secu

ritie

s

(2)(a

) N

ames

& A

ddre

ss

(City

, Sta

te, C

ount

ry)

(2)(b

) C

ount

ry o

f C

itize

nshi

p or

In

corp

orat

ion

(2)(c

) N

umbe

r and

Pe

rcen

tage

of E

ach

Cla

ss o

f Vot

ing

Secu

ritie

s

[con

tinue

d fro

m p

age

2]

Jam

es E

. DuB

ose

(F

ort W

orth

, TX

/ USA

)

Trus

tee

for:

JS

D-J

amie

Ada

ms

DuB

ose

Trus

t

JSD

-Kat

hryn

J. R

ober

ts D

esce

ndan

t Tru

st #

4

JSD

-Kat

hryn

Joy

Key

land

Des

cend

ant T

rust

#2

JS

D-K

athr

yn J

oy K

eyla

nd T

rust

JSD

-Vic

toria

Ann

Ada

ms

Trus

t

The

Kath

ryn

Joy

Keyl

and

Irrev

ocab

le A

sset

Tru

st

[E

nd o

f Tru

stee

list

ing

for J

ames

E. D

uBos

e]

The

com

pany

has

onl

y on

e cl

ass o

f sto

ck:

Com

mon

.

Page 12: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust

2017

= Ite

m 4

- FW

MC

= re

vise

d fo

rmat

Fi

rst W

este

rn M

ortg

age

Cor

pora

tion

Fo

rm F

R Y

-6

Fo

rt W

orth

, TX

Fi

scal

Yea

r E

ndin

g Se

ptem

ber

30, 2

017

Rep

ort I

tem

4:

Insi

ders

(1

), (2

), (3

)(a,

b,c)

and

(4)(

a,b,

c)

(1)

Nam

es &

Add

ress

(C

ity, S

tate

, Cou

ntry

)

(2)

Prin

cipa

l O

ccup

atio

n if

othe

r tha

n w

ith B

ank

Hol

ding

C

ompa

ny

(3)(a

) Ti

tle &

Po

sitio

n W

ith B

ank

Hol

ding

C

ompa

ny

(3)(b

) Ti

tle &

Pos

ition

w

ith S

ubsi

diar

ies

(incl

ude

nam

es

of s

ubsi

diar

ies)

(3)(c

) Ti

tle &

Pos

ition

with

Oth

er

Bus

ines

ses

(incl

ude

nam

es

of o

ther

bus

ines

ses)

(4)(a

) Pe

rcen

tage

of

Vot

ing

Shar

es in

B

ank

Hol

ding

C

ompa

ny

(4)(b

) Pe

rcen

tage

of

Vot

ing

Shar

es in

Su

bsid

iarie

s (in

clud

e na

mes

of

subs

idia

ries)

(4)(c

) Li

st n

ames

of o

ther

co

mpa

nies

(inc

lude

s pa

rtne

rshi

ps) i

f 25%

or

mor

e of

vot

ing

secu

ritie

s ar

e he

ld

(Lis

t nam

es o

f com

pani

es

and

per

cent

age

of v

otin

g se

curit

ies

held

)

Ben

Dem

psey

, CPA

, CM

B Fo

rt W

orth

, TX,

USA

C

hief

Fin

anci

al

Offi

cer

VP, S

ecre

tary

, Tr

easu

rer

VP

, Sec

reta

ry &

Tre

asur

er

(C

olon

ial H

oldi

ng

C

ompa

ny)

Chi

ef F

inan

cial

Offi

cer

(C

olon

ial S

avin

gs F

A)

VP, S

ecre

tary

& T

reas

urer

(Inve

stor

s M

ortg

age

C

orp)

Se

nior

VP,

Tre

asur

er-

Con

trolle

r

(For

t Wor

th M

ortg

age

C

orpo

ratio

n)

Tr

easu

rer,

Und

erw

riter

C

olon

ial L

loyd

s Tr

easu

rer,

Dire

ctor

C

olon

ial L

ife In

sur-

a

nce

Co

of T

exas

Tr

easu

rer,

Dire

ctor

C

olon

ial M

ortg

age

In

sura

nce

Com

pany

Tr

easu

rer,

Dire

ctor

C

LIC

OT

Insu

ranc

e

Agen

cy, I

nc.

Trea

sure

r, D

irect

or –

Cas

ualty

Hol

ding

s, In

c.

N

one

N

one

N

one

Chr

isto

pher

J. K

eyla

nd,

Trus

tee

for G

MD

K Tr

ust

FBO

Chr

isto

pher

J. K

eyla

nd

Aust

in, T

X, U

SA

[Con

tinue

d on

nex

t pag

e]

So

und

Con

sulta

nt

Prin

cipa

l Sh

areh

olde

r

N

one

Pres

iden

t –

Ke

ylan

d So

und

C

orpo

ratio

n

14

.50%

N

one

CLI

CO

T In

sura

nce

Agen

cy

(25.

0%)

DuB

ose

& As

soc.

Insu

ranc

e Ag

ency

(25.

0%)

GD

K / J

ED L

LC (2

5%)

GD

K / J

ED R

eal E

stat

e Lt

d (2

5%)

JSD

/ JL

D L

LC (2

5%)

JSD

/ JL

D M

anag

emen

t LLC

(2

5%)

Page 13: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust

2017

= Ite

m 4

- FW

MC

= re

vise

d fo

rmat

Fi

rst W

este

rn M

ortg

age

Cor

pora

tion

Fo

rm F

R Y

-6

Fo

rt W

orth

, TX

Fi

scal

Yea

r E

ndin

g Se

ptem

ber

30, 2

017

Rep

ort I

tem

4:

Insi

ders

(1

), (2

), (3

)(a,

b,c)

and

(4)(

a,b,

c)

(1)

Nam

es &

Add

ress

(C

ity, S

tate

, Cou

ntry

)

(2)

Prin

cipa

l O

ccup

atio

n if

othe

r tha

n w

ith B

ank

Hol

ding

C

ompa

ny

(3)(a

) Ti

tle &

Po

sitio

n W

ith B

ank

Hol

ding

C

ompa

ny

(3)(b

) Ti

tle &

Pos

ition

w

ith S

ubsi

diar

ies

(incl

ude

nam

es

of s

ubsi

diar

ies)

(3)(c

) Ti

tle &

Pos

ition

with

Oth

er

Bus

ines

ses

(incl

ude

nam

es

of o

ther

bus

ines

ses)

(4)(a

) Pe

rcen

tage

of

Vot

ing

Shar

es in

B

ank

Hol

ding

C

ompa

ny

(4)(b

) Pe

rcen

tage

of

Vot

ing

Shar

es in

Su

bsid

iarie

s (in

clud

e na

mes

of

subs

idia

ries)

(4)(c

) Li

st n

ames

of o

ther

co

mpa

nies

(inc

lude

s pa

rtne

rshi

ps) i

f 25%

or

mor

e of

vot

ing

secu

ritie

s ar

e he

ld

(Lis

t nam

es o

f com

pani

es

and

per

cent

age

of v

otin

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ency

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GD

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ED R

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stat

e Lt

d (2

5%)

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LC (2

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anag

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t LLC

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GD

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agem

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LC

(45%

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te R

ober

ts D

esig

ns, L

LC

(100

%)

Page 14: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust

2017

= Ite

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%)

Page 15: First Western Mortgage Corp - Dallasfed.org/media/Documents...2017/09/30  · James E. Dubose Irrevocable Trust GMDK-Christopher James Keyland Trust GMDK-Kathryn Joy Keyland Trust

2017

= Ite

m 4

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ank

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ompa

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(3)(a

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