SEC Form 4 · accession 0001503249-15-000015
Independence Bancshares, Inc. · IEBS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Alvin Hageman
Director
Period of report
May 14, 2015
Accepted (ET)
May 18, 2015 · 11:09 am EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001311828
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| COMMON STOCK | holding | — | — | — | 490,250 | D | ||
| COMMON STOCK | holding | — | — | — | 900,000 | I | BY BAIRD HAGEMAN & CO. SERIES I, LLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| STOCK OPTON (RIGHT TO BUY) | $0.65 | May 14, 2015 | A | 37,500 | A | May 14, 2015 | May 14, 2025 | COMMON STOCK | 37,500 | 37,500 | D |
| SERIES A CONVERTIBLE PREFERRED STOCKF1,F2 | $0.80 | May 14, 2015 | P | 125 | A | May 14, 2015 | — | COMMON STOCK | 125 | 125 | D |
Explanation of responses
- F1The Series A preferred stock is convertible into Independence Bancshares, Inc. common stock at a price per share of $0.80 per share, thus, each share of Preferred Stock would convert into 1,250 shares of Common Stock.
- F2The Series A preferred stock has no expiration date.