0001503249-15-000017.txt : 20150518 0001503249-15-000017.hdr.sgml : 20150518 20150518113540 ACCESSION NUMBER: 0001503249-15-000017 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150514 FILED AS OF DATE: 20150518 DATE AS OF CHANGE: 20150518 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 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: 15872292 MAIL ADDRESS: STREET 1: 500 E. WASHINGTON ST. CITY: GREENVILLE STATE: SC ZIP: 29601 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2015-05-14 0 0001311828 Independence Bancshares, Inc. IEBS 0001351587 Hipp H Neel JR 500 E. WASHINGTON ST. GREENVILLE SC 29601 1 0 0 0 COMMON STOCK 31500 D COMMON STOCK 8000 I BY SELF AS TRUSTEE FOR H. NEEL HIPP, JR 1987 FAMILY TRUST COMMON STOCK 5000 I BY SELF AS TRUSTEE FOR HERMAN N. HIPP TRUST FBO MARY LADSON HIPP HADDOW COMMON STOCK 5000 I BY SELF AS TRUSTEE FOR HERMAN N. HIPP TRUST FBO WILLIAM F. HIPP COMMON STOCK 5000 I BY SELF AS TRUSTEE FOR HERMAN N. HIPP TRUST FBO EDWARD F. HIPP COMMON STOCK 5000 I BY SELF AS TRUSTEE FOR HERMAN N. HIPP TRUST FBO JANE GAGE HIPP CAULDER COMMON STOCK 1000 I BY SELF AS TRUSTEE FOR JANE GAGE HIPP CAULDER 1990 FAMILY TRUST COMMON STOCK 5000 I BY SELF AS TRUSTEE FOR JFH AND HNH LP #1 COMMON STOCK 125000 I H. NEEL HIPP, JR. REVOCABLE TRUST COMMON STOCK 133000 I AS TRUSTEE FOR THE H. NEEL HIPP 1987 FAMILY TRUST STOCK OPTION (RIGHT TO BUY) 0.65 2015-05-14 4 A 0 20000 0 A 2015-05-14 2025-05-14 COMMON STOCK 20000 20000 D Shared investment and voting power. /S/ H. NEEL HIPP, JR. BY NELSON MULLINS LAW FIRM WITH POWER OF ATTORNEY 2015-05-18