0001566092-18-000001.txt : 20180125
0001566092-18-000001.hdr.sgml : 20180125
20180125144659
ACCESSION NUMBER: 0001566092-18-000001
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: LONG MARTHA L.
CENTRAL INDEX KEY: 0001566092
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-51907
FILM NUMBER: 18547975
MAIL ADDRESS:
STREET 1: 500 EAST 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
0001566092
LONG MARTHA L.
500 EAST WASHINGTON ST
GREENVILLE
SC
29601
0
1
0
0
CHIEF FINANCIAL OFFICER
Common Stock
2018-01-23
4
D
0
62500
0.125
D
0
D
Options
0.01
2018-01-23
4
D
0
40000
0
D
2023-07-16
Common Stock
40000
7500
D
Options
0.01
2018-01-23
4
D
0
7500
0
D
2024-02-05
Common Stock
7500
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 July 16, 2013, the reporting person was granted an option to purchase 40,000 shares of common stock at $0.80 per share. The option immediately vested for 4,000 shares, or 10% of the shares. The option for the remaining 36,000 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.
On May 14, 2015, the reporting person was granted an option to purchase 30,000 shares of common stock at $1.59 per share. The option immediately vested for 7,500 of the shares, and the remaining 22,500 shares were forfeited when the performance vesting condition was not achieved. 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/Martha L. Long
2018-01-25