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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Lorch Nicole S. 11201 USA PARKWAY FISHERS, IN 46037 |
SVP, Retail Banking |
/s/ Kenneth J. Lovik, Attorney-in-Fact for Nicole S. Lorch (power of attorney previously filed) | 01/18/2017 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | Represents grant of restricted stock units ("RSUs") under the First Internet Bancorp 2013 Equity Incentive Plan. The RSUs are scheduled to vest in substantially equal annual installments on March 31, 2017, March 31, 2018, and March 31, 2019. |
(2) | Includes 77 shares acquired between April 20, 2016 and October 20, 2016 pursuant to the First Internet Bancorp Dividend Reinvestment and Stock Purchase Plan, 40 restricted stock units ("RSUs") acquired between April 15, 2016 and January 17, 2017 pursuant to the terms of outstanding RSUs as a result of the payment of cash dividends paid on our common stock and 79 shares acquired between May 4, 2016 and January 5, 2017 pursuant to the First Internet Bancorp Employee Stock Purchase Plan. |