SEC Form 4 · accession 0001503249-15-000018
Independence Bancshares, Inc. · IEBS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Keith Stock
Director
Period of report
May 14, 2015
Accepted (ET)
May 18, 2015 · 1:39 pm 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 STOCKF1,F2 | holding | — | — | — | 125,000 | I | BY FIRST FINANCIAL PARTNERS FUND II, LP |
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 |
| SERIES A CONVERTIBLE PREFERRED STOCKF3,F4 | $0.80 | May 14, 2015 | P | 100 | A | May 14, 2015 | — | COMMON STOCK | 100 | 100 | D |
Explanation of responses
- F1Mr. Stock is President and sole shareholder of First Financial Partners, Inc., which is the General Partner of FFP Affiliates II, LP, which is the General Partner of First Financial Partners Fund II, LP. Mr. Stock has dispositive voting power over the securities of the Issuer held by First Financial Partners Fund II, LP.
- F2These shares are owned directly by First Financial Partners Fund II, LP.
- F3The Series A preferred stock is convertible into Independence Bancshares, Inc. common stock at a price of $0.80 per share, thus, each share of Preferred Stock would convert into 1,250 shares of Common Stock.
- F4The Series A preferred stock has no expiration date.