Statement of Changes in Beneficial Ownership (4)
January 20 2021 - 04:10PM
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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APPROVAL
OMB Number: 3235-0287
Estimated average burden
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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 * BECKER
DAVID B |
2. Issuer Name and Ticker or Trading
Symbol First Internet Bancorp [ INBK ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chairman, President and CEO |
(Last)
(First)
(Middle)
11201 USA PARKWAY |
3. Date of Earliest Transaction (MM/DD/YYYY)
1/18/2021
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(Street)
FISHERS, IN 46037
(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
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1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
1/18/2021 |
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A |
|
8351 (1) |
A |
$0 |
352196 (2) |
D |
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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 |
Explanation of
Responses: |
(1) |
Represents grant of RSUs
under the First Internet Bancorp 2013 Equity Incentive Plan. The
RSUs are scheduled to vest in substantially equal annual
installments on December 31, 2021, December 31, 2022,and December
31, 2023. |
(2) |
Includes 423 shares acquired
on January 15, 2020 pursuant to the First Internet Bancorp Dividend
Reinvestment and Stock Purchase Plan, 9 restricted stock units
acquired on January 15, 2021 pursuant to the terms of outstanding
restricted stock units as a result of the payment of cash dividends
paid on our common stock and 104 shares acquired on January 5, 2021
pursuant to the First Internet Bancorp Employee Stock Purchase
Plan. |
Reporting
Owners
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Reporting Owner Name / Address |
Relationships
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Director |
10% Owner |
Officer |
Other |
BECKER DAVID B
11201 USA PARKWAY
FISHERS, IN 46037 |
X |
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Chairman, President and CEO |
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Signatures
|
/s/ Kenneth J. Lovik, Attorney-in-Fact for David
B. Becker (power of attorney previously filed) |
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1/20/2021 |
**Signature of
Reporting Person |
Date |