SEC Form 4 · accession 0001503249-15-000017
Independence Bancshares, Inc. · IEBS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
H Neel Hipp Jr.
Director
Period of report
May 14, 2015
Accepted (ET)
May 18, 2015 · 11:35 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 | — | — | — | 31,500 | D | ||
| COMMON STOCKF1 | holding | — | — | — | 8,000 | I | BY SELF AS TRUSTEE FOR H. NEEL HIPP, JR 1987 FAMILY TRUST | |
| COMMON STOCKF1 | holding | — | — | — | 5,000 | I | BY SELF AS TRUSTEE FOR HERMAN N. HIPP TRUST FBO MARY LADSON HIPP HADDOW | |
| COMMON STOCKF1 | holding | — | — | — | 5,000 | I | BY SELF AS TRUSTEE FOR HERMAN N. HIPP TRUST FBO WILLIAM F. HIPP | |
| COMMON STOCKF1 | holding | — | — | — | 5,000 | I | BY SELF AS TRUSTEE FOR HERMAN N. HIPP TRUST FBO EDWARD F. HIPP | |
| COMMON STOCKF1 | holding | — | — | — | 5,000 | I | BY SELF AS TRUSTEE FOR HERMAN N. HIPP TRUST FBO JANE GAGE HIPP CAULDER | |
| COMMON STOCKF1 | holding | — | — | — | 1,000 | I | BY SELF AS TRUSTEE FOR JANE GAGE HIPP CAULDER 1990 FAMILY TRUST | |
| COMMON STOCKF1 | holding | — | — | — | 5,000 | I | BY SELF AS TRUSTEE FOR JFH AND HNH LP #1 | |
| COMMON STOCKF1 | holding | — | — | — | 125,000 | I | H. NEEL HIPP, JR. REVOCABLE TRUST | |
| COMMON STOCKF1 | holding | — | — | — | 133,000 | I | AS TRUSTEE FOR THE H. NEEL HIPP 1987 FAMILY TRUST |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| STOCK OPTION (RIGHT TO BUY) | $0.65 | May 14, 2015 | A | 20,000 | A | May 14, 2015 | May 14, 2025 | COMMON STOCK | 20,000 | 20,000 | D |
Explanation of responses
- F1Shared investment and voting power.