Form FR H-(b)11 FR H-(b)11 Savings Association Holding Company Report

FR H-(b)11
OMB Number 7100-0334
Approval expires December 31, 2019
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Board of Governors of the Federal Reserve System

Savings Association Holding Company Report—FR H-(b)11

This Report is required by law: Section 10(b)(2) of the Home
Owners' Loan Act (12 U.S.C. § 1467a(b)(2)); and Sections 238.4
and 238.5 of Regulation LL (12 C.F.R. §§ 238.4, 238.5).

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.

This form is to be filed by all savings and loan holding companies.

Certification
The undersigned principal executive or principal financial officer of the Savings and Loan Holding Company making this
Savings Association Holding Company Report (FR H-(b)11)
acknowledges and certifies that the information contained
herein, including forms or exhibits, has been carefully
reviewed, and that such information is true, correct, and
complete.

Indicate if this report is an Annual or Current Report and provide
the appropriate report date.

Annual Report
For the Fiscal Year Ended:
Month / Day / Year

Current Report
For the Quarter Ended:

Printed Name of Officer Signing on Behalf of the
Savings and Loan Holding Company

Month / Day / Year

Title

For the Event on:
Month / Day / Year

Attest:
Signature of Officer

Date of Signature

Savings and Loan Holding Company Information:

Person to whom questions about this report should be directed:

Savings and Loan Holding Company Name

Name

Executive Office Street

Area Code / Phone Number

City

State

Zip Code

Title

Area Code / FAX Number

E-mail Address of Contact

Savings and loan holding companies must maintain in their files a manually signed and attested printout of the data submitted.
Public reporting burden for this information collection is estimated to average 2 hours per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, formatting the information, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other
aspect of this information collection, 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 (7100–0334), Washington, DC 20503.

12/2016

FR H-(b)11
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For Use by Multi-tier Savings and Loan Holding Companies
Multi-tier holding companies that are filing a combined report, must provide the savings and loan holding company names and
addresses for each additional savings and loan holding company included in the combined report. In addition, each savings and loan
holding company should execute a separate certification. (If the savings and loan holding company has more than one lower tier, use
additional pages as needed.)

Savings and Loan Holding Company Included in the Combined Report
Legal Name of Savings and Loan Holding Company

Street Mailing Address

City

State

Zip Code

Certification
The undersigned principal executive or principal financial officer of the Savings and Loan Holding Company combined in this
Savings Association Holding Company Report (FR H-(b)11) acknowledges and certifies that the information contained herein,
including forms or exhibits, has been carefully reviewed, and that such information is true, correct, and complete.
Attest:
Printed Name of Officer Signing on Behalf of the
Savings and Loan Holding Company

Title

Signature of Officer

Date of Signature

Savings and loan holding companies must maintain in their files a manually signed and attested printout of the data submitted.
09/2013