Independence Bancshares Form 3 Independence Bancshares / Adam Gabriel Hurwich ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

OMB APPROVAL

OMB Number:	3235-0104
Estimated average burden
hours per response:	0.5

1. Name and Address of Reporting Person^*

Hurwich Adam Gabriel

(Last) (First) (Middle)

C/O FIRST SECURITY GROUP, INC.

531 BROAD STREET

(Street)

CHATTANOOGA TN 37402

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
05/14/2015

3. Issuer Name and Ticker or Trading Symbol
Independence Bancshares, Inc. [ IEBS ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
SERIES A CONVERTIBLE PREFERRED STOCK	05/14/2015	(1)	COMMON STOCK	2,150(2)	0.8	I(3)(4)	ULYSSES PARTNERS, L.P.
SERIES A CONVERTIBLE PREFERRED STOCK	05/14/2015	(1)	COMMON STOCK	300(2)	0.8	I(3)(5)	ULYSSES OFFSHORE FUND, LTD.

Explanation of Responses:

1. The Series A preferred stock has no expiration date.

2. The Series A preferred stock is convertible into Independence Bancshares, Inc. common stock at a price of $0.80 per share, thus, each share of Preferred Stock would convert into 1,250 shares of Common Stock.

3. Mr. Hurwich is employed by Ulysses Management LLC, the investment manager of Ulysses Partners, L.P. and Ulysses Offshore Fund, Ltd. Mr. Hurwich does not have any dispositive or voting power over the securities of the Issuer held by Ulysses Partners, L.P. or Ulysses Offshore Fund, Ltd. Mr. Hurwich disclaims any beneficial ownership of the securities reported, except to the extent of his pecuniary interest therein. The filing of this Form 4 shall not be deemed an admission that Mr. Hurwich is, for purposes of Section 16 of the Securities Exchange Act of 1934 or otherwise, the beneficial owner of any securities reported.

4. These shares are owned directly by Ulysses Partners, L.P.

5. These shares are owned directly by Ulysses Offshore Fund, Ltd.

	/S/ ADAM GABRIEL HURWICH BY NELSON MULLINS LAW FIRM WITH POWER OF ATTORNEY	05/20/2015
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.