Statement of Changes in Beneficial Ownership (4)
November 26 2021 - 4:50PM
Edgar (US Regulatory)
FORM 4
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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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OMB APPROVAL
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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
*
Furfaro Vincent J. |
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) SVP StrategicCorp. Dev. & CISO |
(Last)
(First)
(Middle)
96 CUMMINGS POINT ROAD |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/23/2021 |
(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 | 11/23/2021 | | M | | 6000 | A | $19.95 | 6000 | D | |
Common Stock | 11/23/2021 | | F(1) | | 3183 | D | $56.69 | 2817 | 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) | $19.95 | 11/23/2021 | | M | | | 6000 | (2) | 12/1/2021 | Common Stock | 6000 | $0 | 0 | D | |
Explanation of Responses: |
(1) | Represents a "net exercise"of stock option. The reporting person received 2,817 shares of common stock on net exercise option to purchase 6,000 shares of common stock. The Comapny withheld 3,183 shares of common stock underlying the option for payment of the exercise price and applicable taxes, based on the closing stock price on November 23, 2021 of $56.69. |
(2) | Fully vested as of the date hereof. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Furfaro Vincent J. 96 CUMMINGS POINT ROAD STAMFORD, CT 06902 | X |
| SVP StrategicCorp. Dev. & CISO |
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Signatures
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/s/Vincent J. Furfaro | | 11/26/2021 |
**Signature of Reporting Person | Date |
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