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FR Y-6 OMB Number 7100-0297 Approval expires September 30, 2018 Page 1or2
Board of Governors of the Federal Reserve System
Annual Report of Holding Companies-FRY-
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 This report form is to be filed by all top-tier bank holding compaHolding Company Act (12 U.S.C. § 1844 (c)(1)(A)); Section 8(a) 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. does not meet the requirements of and is not treated as a qualify§§ 248(a)(1), 602, and 611a); Section 211 .13(c) of Regulation K 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' instructions for more detail of who must file.) The Federal Loan Act. Return to the appropriate Federal Reserve Bank the 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 chairman of the board must sign the report.
I, Matt Ricker Name of the Holding Company Director and Official
Board Member TIUe 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.
With 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 amJ. individual consent to public release of all details in the report concerning that individual.
~~ Signature of Holding Company Director and Official
02/22/2016 Date or Signature
For holding companies aSlJ. registered with the SEC-Indicate status of Annual Report to Shareholders:
0 is included with the FR Y-6 report 0 will be sent under separate cover lEJ is not prepared
For Federal Reserve Bank Use Only
RSSD ID 1000(:) Oo o'J C.I.
Date of Report (top-tier holding company's fiscal year-end):
December 31, 2015 Month I Day I Year
N/A Reporter's Legal Entity Identifier (LEI) (20-Characier LEI Code)
Reporter's Name, Street, and Mailing Address Volunteer State Bancshares, Inc Legal Tiiie of Holding Company
101 Highway 52 W est (Malling Address or the Holding Company) Street I P.O Box
Portland TN 37148 City State Zip Code
\J/C\ Physical Location (if different from mailing address)
Person to whom questions about this report should be directed: David Wolfe CFO Name nue 615-323-1003 Area Code I Phone Number I Extension
615-323-1355 Area Code I FAX Number
[email protected] E-mail Address
tJ /<>.. Address (URL) for the Holding Company's web page
Does the reporter request confidential treatment for any portion of this submission?
0 Yes Please identify the report items to which this request applies:
O In accordance with the Instructions on pages GEN-2 and 3, a letter justifying the request is being provided.
O The Information for which confidential treatment is sought is being submitted separately labeled "Confidential."
[gj No
Public repo<ting burden ror this lnrormauon collectlon Is estimated 10 vary rrom 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 esumate or any other aspect or this collection or lnformoUon, including suggestions for reducing this burden to· Secretary, Board or Govemors or the Federal Reserve System, 20th end C Streets, NW, \11/ashlnglon, DC 20551 . and to the Office of Management and Budget, Paperwork Reduction Project (7100-0297), \11/ashington, DC 20503.
12/2015
FR Y-e Page 2 or2
For Use By Tiered Holding Companies Top-tiered holding companies must list the names, mailing address, and physical locations of each of their subsidiary holding companies below.
Physical Location (ii dltrerent rrom malling address) Physical Location (if differenl rrom rMlling address)
Legal TiUe of Subsidiary Holding Company
(Malling Address or the Subsidiary Holding Company) Slreet IP 0 . Box
City State Zip Code
Physical Location (If d1neren1 from rMthng address)
Legal TiUe or Subsidiary Holding Company
(Malling Address or the Subsidiary Holding Company) Slreet I P O Box
City State Zip Code
Physteal Locabon (if d1neren1 rrom mailing address)
Legal TiUe or Subsidiary Holding Company
(Mailing Address of the Subsidiary Holding Company) Street I P.O. Box
City State Zip Code
Physical Location (if ditrerent from malling address)
Legal Tide of Subsidiary Holding Company
(Miiiing Address of the Subsidiary Holding Company) Sveet I P O Box
City State Zip Code
Physical Location (Ir different from malling address)
Legal Tide of Subsidiary Holding Company
(MaHing Address of the Subsidiary Holding Company) Street I P 0 Box
City State Zip Code
Physical Locabon (If dlfferenl from ma11tng addreu)
Legal Tille ot Subsidiary Holding Company
(Mailing Addreu or the Subsidiary Holding Company) S1reet I P 0 Box
City State Zip Code
Physlcal Locabon (if d1trerent from malling address)
Legal TiUe or Subsidiary Holding Company
(Malling Address or the Subsidiary Holding Company) Streel I P 0 Box
City State Zip Code
Legal Tide ol Subsidiary Holding Company
(Mailing Address or the Subsidiary Holding Company) Street IP0 . Box
City State Zip Code
1212012
VOLU TEER STATE BA C HARE , I C. DECEMBER 31 , 2015
ANNUAL REPORT ON FORM FRY-6
ITEM I a: Form 10-K filed with the Securities and Exchange Commission
The bani. ho lding company is not registered with the ecurities and Exchange Commission; therefore this section is not applicable.
ITEM I b: Annual Report to hareholders
The annual report to shareholders is included. ITEM 2: Organization Chart
VOLUNTEER TATE BANC ll ARE , IN . (LEI - N/A) PORTLA 0, TE NE EE (Incorporated in the tale of Tennes ee)
( I) BANK UB IDIARY
VOLUNTEER TATE BANK ( Incorporated in the State of Tennessee) I 00% Common toe!. Owned by o lunteer State Bancshares, Inc., IOI Highway 52 West, Portland. Tennessee 37148
(2) B IDIARIE OF BANK (Bank ubs incorporated in the late ofTennessee)
G uaranty Trus t Company, a mortgage- banking subsidiary owned 100% by Volunteer State Bank. P 0 Box 12 18, 3 16 Robert Rose Blvd. Murfreesboro. Tennessee 37129 (LEI A)
Middle Tennessee Insurance Agency, Inc., a general insurance agency, owned 100% by Volunteer tale Bank. Operations began in July 2003, I 0 I Highway 52 West. Portland. Tennessee 37 148. (LEI NIA)
(3) NONBANK B IDIARY
VOLUNTEElt FINANCIAL GRO P, INC. (Incorporated in the Lite ofTennessee) (LEl-N/A) I 00% of Common Stock owned by Volunteer State Bancshares, Inc., I 01 1lighway 52 West, Portland Tennessee 37 148 (Currently inactive)
VOL NTEER TATE BANC llARE T R ST II {Incorporated in the tale of Oelaware){LEl-N/A) I 00% o r Common tock owned by Volunteer tate Bancshares, Inc., I 0 I I lighway 52 West, Portland Tennessee 37 148
The infonnation required by ITEM 2 Part (4 to 9) and the supplementa l information are Not Applicable.
ITEM 3: hareholders
I : The fo llowing is a list of shareholders o r record that di rectly or indirectly O\.Vll, control or hold with power to vote five percent (5° o) or more o r the common stock of Bl IC"
(a) Larry Collins Portland, Tennessee 37 148 - United tates o r America
1
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..... 11< 11< TN TN TN TN TN TN
TN
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17141 SUMID l"'"6 SUMND 17066 SUMNER non SUM.ND. l107S SUM>ICA non SUMHDI J7141 OOl£JmO!t 37172 ltO&ElllTSON
l71U SUMN!ll
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UNfTEO STATES 254621 S VOLUNfUR STAT[ I ANl n•u2
UNITTDSTATU l0t716 9 'JOlUNTUJl<TATE IAHl n•m
_.._A.. oflnnclm....... - ......... l/OWOITUl<T•T'I &AllCSKAOES. INC. (1-J)oll'O«T\AHD, TN n.•ta.,easofUJJlf)Oll OlitA ret.ct.lnb'rMllofttt.1...n~ •ndprOCBMd~ Ol/fJ1/l016.
!twrc!!lttlonand Ytttnct1ktn St!M
J In the Ditta Actii>n cok.mn of tach bta~ row, .rlllf ON or more of the trd.lons spedl\ed ~
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...... To WlSfv the fl1'·10 Nportire ,......_youmuu Mo~ rR Y·10DometUc tf.ndtSdttduies fot Heh bnnm.-ft t o.m AcUonof ~.0ot.t. Datte. Dr 4dd
Thi JR'f· lO repon m..,._ tubrnittedln a Ntdcopf fornMI Of* the FR Y·lO~tptliaiUon · ~fV10cdne..fl'de:tU~
• FOW:: UNlNUM, Oftke N.-nber, and l>_lltSSD<.olumM 111 f04 refetitnea onty_Veiiftcaidon of ttwM...-.lua .. not required. ,,__
Larry Joe Collins 22 13.92%
2. (a), {b), and (c) Not Applicable
ITEM 4: Directors and Officers
The following is a list of Directors and Officers and their positions held with BHC and subsidiaries and princ iple occupation ifnot with BHC:
(I ) I. Larry Collins Portland, Tennessee 37 148, United States o f America
Mailing address: Portland, Tennessee 37 148
2. Owner Collins Construction Company, a sole proprietorship.
3(a). Chairman o f the Board, Director and Chaim1an o f the Executive Committee. Volunteer State Bancshares, Inc.
(b). None
(c). None
4(a). 28 shares of Common Stock, 17.72%
(b). None
(c). Owner Collins Construction Company, a sole proprietorship, I 00%.
(2) I. Matt Ricker Portland, Tennessee 3 7 148. United States o f America
2. None
3(a) Director, Volunteer State Bancshares
(b). President & CEO Volunteer State Bank. President & CEO Middle Tennessee Insurance Agency, Director of Volunteer State Bank, Middle Tennessee Insurance Agency, and G uaranty Tnist Mongage Company.
(c). None
4(a). None
(b). None
(c). None
(3) I. Jeffrey David Collins
3
Mai ling address: Portland Tennessee
(b) Country or ci tizenship - United States of America
(c) Number ofshares and percentage of each class of voting securities owned, controlled or held with power to vote.
Larry Collins 28 17.72%
(a) Jaska Ann Russe ll Portland, Tennessee 37148 - United States of America
(b) Country or citizenship - United States o f America
(c) Number of shares and percentage of each c lass of voting securities owned, controlled or held with power to vote.
Jaska Ann Russell 22 13.92%
(a) Tammy Collins Portland, Tennessee 37 148 - United States of America
(b) Country or citizenship - United States ofAmerica
(c) Number ofshares and percentage of each class of voting securities owned, contro lled or held with power to vote.
Tammy Collins 22 13.92%
(a) Jeffrey David Collins Portland. Tennessee 37 148 - United Sta tes o r America
(b) Country or citizenship - United States o f America
(c) Number of shares and percentage of each class o f voting securities owned, contro lled or held with power to vote.
Jeffrey David Coll ins 22 13.92%
(a) Jonathan Ray Collins Portland, Tennessee 37 148 - United States of America
(b) Country or citizenship - United States of America
(c) Number o r shares and percentage or each class of voting securities owned, controlled or held with power to vote.
Jonathan Ray Collins 22 13.92%
(a) Larry Joe Collins, Jr. Portland, Tennessee 37 148 - United States of America
(b) Country or citizenship - United States of America
(c) Number ofshares and percentage of each class of voting securities owned, controlled or held with power to vote.
2
Portland, Tennessee 37 148, United States ofAmerica
2. Partner C & C Construction Company
3(a). Vice Chairman and Director, Volunteer State Bancshares, Inc.
(b). Chairman and Director, Volunteer State Bank, Director Guaranty Trust Company, Chairman and Director USA Title Company, Inc., and Director Middle Tennessee Insurance Agency, Inc.
{c). None
4(a). 22 shares of Common Stock, 13.92%
(b). None
(c). Partner C & C Construction Company, 50%
(4)1. Dave Wo lfe Portland, Tennessee 37148. United State of America
2. None
3(a) Chief Financial Officer, Volunteer State Bancshares. Inc.
(b) Chief Financial Officer & Chief Operations Omccr. Volunteer State Bank
(c). None
4(a). None
(b). None
(c). None
(5) I. Jaska Coll ins Russell Portland. Tennessee 37 148. United State o f America
2. Business Owner, Retail, Food Industry. Employment Services, and industrial warehouse develpoment
3. (a) Principal Shareholder
(b) Director, Volunteer State Bank
(c) None
4. (a) 22 shares ofcommon stock, 13.92%
4
(c) None
4. (a) 22 shares ofcommon stock, 13.92%
(b) None
(c) None
6
(b) one
(c) None
(6.) I . Jonathan Ray Collins Portland. Tennessee 37 148, United State of America
2. Co-Owner/Leaser of Industrial Warehouse develo pment
3. (a) Principal Shareholder
(b) one
(c) None
4. (a) 22 shares ofcommon stock, 13.92%
(b) None
(c) None
(7.) I . Larry Joe Coll ins Portland, Tennessee 37 148, United State o f America
2. Construction Company Owner
3. (a) Principal Shareholder
(b) one
(c) None
4. (a) 22 shares ofcommon stock. 13.92%
(b) None
(c) None
(8.) I . Tammy Collins Portland, Tennessee 37 148, United State o f America
2. None
3. (a) Principal Shareho lder
(b) None
5