0001311828-18-000007.txt : 20180125
0001311828-18-000007.hdr.sgml : 20180125
20180125165608
ACCESSION NUMBER: 0001311828-18-000007
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: Hurwich Adam Gabriel
CENTRAL INDEX KEY: 0001579463
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-51907
FILM NUMBER: 18548880
BUSINESS ADDRESS:
BUSINESS PHONE: (423) 266-2000
MAIL ADDRESS:
STREET 1: C/O FIRST SECURITY GROUP, INC.
STREET 2: 531 BROAD STREET
CITY: CHATTANOOGA
STATE: TN
ZIP: 37402
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
0001579463
Hurwich Adam Gabriel
C/O FIRST SECURITY GROUP, INC.
531 BROAD STREET
CHATTANOOGA
TN
37402
1
0
0
0
Series A Preferred Stock
1000
2018-01-17
4
J
0
300
1000
D
Common Stock
375000
2150
I
By Ulysses Offshore Fund, Ltd.
Series A Preferred Stock
1000
2018-01-17
4
J
0
2150
1000
D
Common Stock
2687500
0
I
By Ulysses Partners, 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. 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/Adam G. Hurwich
2018-01-25