0001503249-15-000025.txt : 20150714 0001503249-15-000025.hdr.sgml : 20150714 20150714095523 ACCESSION NUMBER: 0001503249-15-000025 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130327 FILED AS OF DATE: 20150714 DATE AS OF CHANGE: 20150714 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WILLUMSTAD ROBERT B CENTRAL INDEX KEY: 0001225708 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-51907 FILM NUMBER: 15986621 MAIL ADDRESS: STREET 1: CITIGROUP INC/CORP LAW DEPT STREET 2: 425 PARK AVE 2ND FL CITY: NEW YORK STATE: NY ZIP: 10043 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2013-03-27 0 0001311828 Independence Bancshares, Inc. IEBS 0001225708 WILLUMSTAD ROBERT B C/O INDEPENDENCE BANCSHARES INC. 500 EAST WASHINGTON ST GREENVILLE SC 29601 1 1 0 0 CHAIRMAN COMMON STOCK 1250000 D STOCK OPTION (RIGHT TO BUY) 0.8 2014-08-22 4 A 0 543750 0 A 2023-03-27 COMMON STOCK 543750 725000 D STOCK OPTION (RIGHT TO BUY) 0.8 2023-03-27 COMMON STOCK 181250 725000 D ON MARCH 27, 2013, THE REPORTING PERSON WAS GRANTED AN OPTION TO PURCHASE 725,000 SHARES OF COMMON STOCK AT $0.80 PER SHARE. THE OPTION IMMEDIATELY VESTED FOR 181,250 SHARES, OR 25% OF THE SHARES. THE OPTION FOR THE REMAINING 543,750 SHARES, OR 75% OF THE SHARES, WAS TO VEST RATABLY EVERY SIX MONTHS, BEGINNING JUNE 30, 2013, PROVIDED THAT AT EACH SUCH VESTING DATE, A CERTAIN PERFORMANCE CONDITION WITH RESPECT TO THE ISSUER HAD BEEN SATISFIED. IF THIS PERFORMANCE CONDITION WAS NOT SATISFIED PRIOR TO THE APPLICABLE VESTING DATE, THEN NO SHARES WOULD VEST ON SUCH VESTING DATE, AND THEN UPON THE DATE THAT THE PERFORMANCE CONDITION WAS SATISFIED, ALL SHARES THAT WOULD HAVE OTHERWISE VESTED WOULD IMMEDIATELY VEST. THE PERFORMANCE CONDITION WAS SATISFIED ON AUGUST 22, 2014, AT WHICH POINT THE OPTION IMMEDIATELY VESTED WITH RESPECT TO 271,875 SHARES. /s/ Robert B. Willumstad by Nelson Mullins Riley & Scarborough LLP with Power of Attorney 2015-07-13