0001311828-18-000003.txt : 20180125
0001311828-18-000003.hdr.sgml : 20180125
20180125153751
ACCESSION NUMBER: 0001311828-18-000003
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: Hipp H Neel JR
CENTRAL INDEX KEY: 0001351587
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-51907
FILM NUMBER: 18548172
MAIL ADDRESS:
STREET 1: 500 E. WASHINGTON ST.
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.
IEBS
0001351587
Hipp H Neel JR
500 E. WASHINGTON ST.
GREENVILLE
SC
29601
1
0
0
0
Common Stock
2018-01-23
4
D
0
201500
0.125
D
0
D
Options
0.01
2018-01-23
4
J
0
20000
0
D
2025-05-14
Common Stock
20000
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 (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.
/s/H. Neel Hipp, Jr.
2018-01-25