Form FR XX-1 FR XX-1 Financial Company (as defined) Report of Consolidated Li

FR XX-1
OMB Number 7100-0363
Approval expires November 30, 2017
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DRAFT
Board of Governors of the Federal Reserve System

Financial Company (as defined) Report of Consolidated
Liabilities—FR XX-1
Report at the close of business as of the last calendar day in December
This report is required by law: Section 14 of the Bank Holding
Company Act (12 U.S.C. § 1852).
The Financial Company (as defined) Report of Consolidated
Liabilities is to be prepared in accordance with the instructions

NOTE: The Financial Company (as defined) Report of Consolidated
Liabilities must be signed and attested by the chief financial officer
(CFO) of the reporting holding company (or by the individual performing this equivalent function).

provided by the Federal Reserve System. The Federal Reserve
may not conduct or sponsor, and an organization (or a person) is
not required to respond to, a collection of information unless it
displays a currently valid OMB control number.

Date of Report:
Month / Day / Year (FCCL 9999)

I, the undersigned CFO (or equivalent) of the financial company,
attest that the FR XX-1 report listed on this page 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.

Printed Name of Officer (FCCL C490)

Legal Name of Financial Company (RSSD 9017)

Title of Officer (FCCL C491)

(Mailing Address of the Financial Company) Street / PO Box (RSSD 9110)

Signature of Officer

City (RSSD 9130)

State (RSSD 9200)

Zip Code (RSSD 9220)

Date of Signature (MM/DD/YYYY) (FCCL J196)

Person to whom questions about this report should be directed:

Name / Title (FCCL 8901)

Area Code / Phone Number (FCCL 8902)

Area Code / FAX Number (FCCL 9116)

E-mail Address of Contact (FCCL 4086)

Public reporting burden for this information collection is estimated to be 2 hours per response, including time to gather and maintain data in the required form and to review instructions and
complete the information collection. Comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing the burden, may be sent
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 (7100-0363), Washington, DC 20503.

12/2014

FR XX-1
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DRAFT
Financial Company (as defined) Report of Consolidated Liabilities

A financial company is (1) a top-tier company that controls an insured depository institution, as defined in section 3(c)(2) of the Federal
Deposit Insurance Act, but does not file the Consolidated Financial Statements for Holding Companies (FR Y-9C), the Parent Company
Only Financial Statements for Small Holding Companies (FR Y-9SP), Parent Company Only Financial Statements for Large Holding
Companies (FR Y-9LP), the Capital and Asset Report for Foreign Banking Organizations (FR Y-7Q), or consolidated total liabilities on the
Quarterly Savings and Loan Holding Company Report (FR 2320), or (2) a nonbank financial company supervised by the Board that does
not file the Consolidated Financial Statements for Holding Companies (FR Y-9C). (see instructions).
Dollar Amounts in Thousands FCCL

Bil

Mil

Thou

1. Total consolidated liabilities of the financial company1................................................................... 2948

1.

1. A financial company that is incorporated or organized in a country other than the United States must report the combined liabilities of its U.S.
operations, as discussed in the instructions to this form.

12/2014