0001144204-13-018536.txt : 20130329
0001144204-13-018536.hdr.sgml : 20130329
20130329084704
ACCESSION NUMBER: 0001144204-13-018536
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130328
FILED AS OF DATE: 20130329
DATE AS OF CHANGE: 20130329
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Murtlow Ann D.
CENTRAL INDEX KEY: 0001568465
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35750
FILM NUMBER: 13726237
MAIL ADDRESS:
STREET 1: 8888 KEYSTONE CROSSING, SUITE 1700
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46240
FORMER NAME:
FORMER CONFORMED NAME: Murtlow Ann S.
DATE OF NAME CHANGE: 20130201
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: First Internet Bancorp
CENTRAL INDEX KEY: 0001562463
STANDARD INDUSTRIAL CLASSIFICATION: SAVINGS INSTITUTIONS, NOT FEDERALLY CHARTERED [6036]
IRS NUMBER: 203489991
STATE OF INCORPORATION: IN
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 8888 KEYSTONE CROSSING
STREET 2: SUITE 1700
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46240
BUSINESS PHONE: 317-532-7900
MAIL ADDRESS:
STREET 1: 8888 KEYSTONE CROSSING
STREET 2: SUITE 1700
CITY: INDIANAPOLIS
STATE: IN
ZIP: 46240
4
1
v339850_4.xml
OWNERSHIP DOCUMENT
X0306
4
2013-03-28
0
0001562463
First Internet Bancorp
INBK
0001568465
Murtlow Ann D.
8888 KEYSTONE CROSSING, SUITE 1700
INDIANAPOLIS
IN
46240
1
0
0
0
Common Stock
2013-03-28
4
P
0
385
25.5843
A
385
D
/s/ Kay E. Whitaker, Attorney-in-Fact for Ann D. Murtlow
2013-03-29