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