Statement of Changes in Beneficial Ownership (4)
08 December 2021 - 9:26AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
HERBERT TERESA A |
2. Issuer Name and Ticker or Trading Symbol
INDEPENDENCE HOLDING CO
[
IHC
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
President |
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(Last)
(First)
(Middle)
96 CUMMINGS POINT ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/5/2021 |
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(Street)
STAMFORD, CT 06902
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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| Common Stock | 12/5/2021 | | M | | 27500 | A | $27.65 | 113615 | D | |
| Common Stock | 12/5/2021 | | F(1) | | 17839 | D | $56.63 | 95776 | D | |
| Common Stock | 12/5/2021 | | M | | 31534 | A | $37.38 | 127310 | D | |
| Common Stock | 12/5/2021 | | F(3) | | 24176 | D | $56.63 | 103134 | D | |
| Common Stock | 12/5/2021 | | M | | 11000 | A | $27.65 | 114134 | D | |
| Common Stock | 12/5/2021 | | D | | 11000 | D | $56.63 | 103134 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 7. Title and Amount of Securities Underlying Derivative Security
(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) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Employee Stock Option (Right to Buy) | $27.65 | 12/5/2021 | | M | | | 27500 | (2) | 11/16/2022 | Common Stock | 27500 | $0 | 0 | D | |
| Employee Stock Option (Right to Buy) | $37.38 | 12/5/2021 | | M | | | 31534 | (2) | 7/4/2022 | Common Stock | 31534 | $0 | 0 | D | |
| Stock Appreciation Right | $27.65 | 12/5/2021 | | M | | | 11000 | (2) | 11/16/2022 | Common Stock | 11000 | $0 | 0 | D | |
| Explanation of Responses: |
| (1) | Represents a "net exercise"of stock option. The reporting person received 9,661 shares of common stock on net exercise option to purchase 27,500 shares of common stock. The Comapny withheld 17,839 shares of common stock underlying the option for payment of the exercise price and applicable taxes, based on the closing stock price on December 3, 2021 of $56.63. |
| (2) | Vests in three equal annual installments beginning on the one-year anniversary of the grant date. |
| (3) | Represents a "net exercise" of stock option. The reporting person received 7,358 shares of common stock on net exercise option to purchase 31,534 shares of common stock. The Company withheld 24,176 shares of common stock underlying the option for payment of the exercise price and applicable taxes based on the closing stock price onDecember 3, 2021 of $56.63. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
HERBERT TERESA A
96 CUMMINGS POINT ROAD
STAMFORD, CT 06902 | X |
| President |
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Signatures
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| /s/Teresa A. Herbert | | 12/7/2021 |
| **Signature of Reporting Person | Date |
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