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