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