0001311828-18-000004.txt : 20180125
0001311828-18-000004.hdr.sgml : 20180125
20180125162522
ACCESSION NUMBER: 0001311828-18-000004
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180123
FILED AS OF DATE: 20180125
DATE AS OF CHANGE: 20180125
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: STOCK KEITH
CENTRAL INDEX KEY: 0001241317
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-51907
FILM NUMBER: 18548530
MAIL ADDRESS:
STREET 1: 1819 A WEST ST
CITY: ANNAPOLIS
STATE: MD
ZIP: 21401
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Independence Bancshares, Inc.
CENTRAL INDEX KEY: 0001311828
STANDARD INDUSTRIAL CLASSIFICATION: NATIONAL COMMERCIAL BANKS [6021]
IRS NUMBER: 201734180
STATE OF INCORPORATION: SC
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 500 E. WASHINGTON STREET
STREET 2: P.O. BOX 1776
CITY: GREENVILLE
STATE: SC
ZIP: 29602
BUSINESS PHONE: 864-672-1776
MAIL ADDRESS:
STREET 1: 500 E. WASHINGTON STREET
STREET 2: P.O. BOX 1776
CITY: GREENVILLE
STATE: SC
ZIP: 29602
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2018-01-23
0
0001311828
Independence Bancshares, Inc.
IEBS
0001241317
STOCK KEITH
1819 A WEST ST
ANNAPOLIS
MD
21401
1
0
0
0
Common Stock
2018-01-23
4
D
0
125000
0.125
D
0
I
By First Financial Partners Fund II, L.P.
Options
0.01
2018-01-23
4
D
0
20000
0
D
2025-05-14
Common Stock
20000
0
D
Series A Preferred Stock
1000
2018-01-23
4
J
0
100
1000
D
Common Stock
125000
0
I
By First Financial Partners Fund II, L.P.
Disposed of pursuant to that certain Agreement and Plan of Merger dated as of September 25, 2017, between First Reliance Bancshares, Inc. (First Reliance), FR Merger Subsidiary, Inc. (Merger Sub), and Independence Bancshares, Inc. (Independence), pursuant to which Independence was merged with and into First Reliance (the Merger). At the effective time of the Merger, each share of Independence common stock was converted into the right to receive $0.125 in cash.
On May 14, 2015, the reporting person was granted an option to purchase 20,000 shares of common stock at $0.65 per share. The option immediately vested for all of the shares. Prior to the effective time of the Merger, all holders of options granted by Independence surrendered their rights under the options for a cash payment of $0.01 per share of common stock underlying the options.
Immediately prior to the effective time of the merger, each share of Independence Series A Preferred Stock was redeemed for its stated per share redemption price by the payment of cash in the amount of $1,000.
Not Applicable
/s/Keith Stock
2018-01-25