SEC Form 4 · accession 0001213758-16-000002
AMERICAN INDEPENDENCE CORP · AMIC
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
James G Tatum
Director
Period of report
Aug 31, 2016
Accepted (ET)
Sep 1, 2016 · 5:01 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000097196
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Aug 31, 2016 | J | 5,000 | — | D | 0 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Option (Right to Buy)F2 | $10.80 | Aug 31, 2016 | J | 6,667 | D | — | May 15, 2024 | Common Stock | 6,667 | 0 | D |
Explanation of responses
- F1Disposed of pursuant to the merger of the Issuer with and into AMIC Holdings, Inc. (the "Merger") in exchange for $24.74 per share.
- F2This option was canceled in connection with the Merger; in consideration thereof, the Reporting Person received the right to receive $24.74 per share of Common Stock underlying the option, less the exercise price of the option.