0001144204-13-047115.txt : 20130820
0001144204-13-047115.hdr.sgml : 20130820
20130820162956
ACCESSION NUMBER: 0001144204-13-047115
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130816
FILED AS OF DATE: 20130820
DATE AS OF CHANGE: 20130820
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
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: 131051056
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
4
1
v353390_4.xml
OWNERSHIP DOCUMENT
X0306
4
2013-08-16
0
0001562463
First Internet Bancorp
INBK
0001568465
Murtlow Ann D.
8888 KEYSTONE CROSSING, SUITE 1700
INDIANAPOLIS
IN
46240
1
0
0
0
Common Stock
2013-08-16
4
P
0
1000
30.00
A
2577
D
/s/ Kay E. Whitaker, Attorney-in-Fact for Ann D. Murtlow
2013-08-20