0001311828-18-000001.txt : 20180125 0001311828-18-000001.hdr.sgml : 20180125 20180125151823 ACCESSION NUMBER: 0001311828-18-000001 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: Moore E Fred CENTRAL INDEX KEY: 0001358973 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51907 FILM NUMBER: 18548109 MAIL ADDRESS: STREET 1: 500 E WASHINGTON STREET CITY: GREENVILLE STATE: SC ZIP: 29601 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. IESB 0001358973 Moore E Fred 500 E WASHINGTON STREET GREENVILLE SC 29601 0 1 0 0 CHIEF CREDIT OFFICER Common Stock 2018-01-23 4 D 0 4125 0.125 D 0 D Options 0.01 2018-01-23 4 D 0 8885 0 D 2018-01-23 Common Stock 8885 0 D Options 0.01 2018-01-23 4 D 0 30000 0 D 2023-07-16 Common Stock 30000 0 D 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. 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 January 23, 2008, the reporting person was granted an option to purchase 8,885 shares of common stock at $10.50 per share. The option was to vest ratably 20% every 12 months. 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. On July 16, 2013, the reporting person was granted an option to purchase 30,000 shares of common stock at $0.80 per share. The option immediately vested for 3,000 shares, or 10% of the shares. The option for the remaining 27,000 shares, or 90% of the shares, was to vest ratably every 12 months provided that a performance condition with respect to Independence had been satisfied. 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. /s/E. Fred Moore 2018-01-25