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