SEC Form 4 · accession 0001144204-15-043159
INTELLINETICS, INC. · INLX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert Taglich
10% Owner
Period of report
May 20, 2015
Accepted (ET)
Jul 17, 2015 · 5:51 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001081745
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible NoteF1,F2,F3 | — | May 20, 2015 | P | — | A | Jun 25, 2015 | — | See Footnote | — | 1,667,323 | D |
| Convertible NoteF1,F2,F3 | — | Jun 3, 2015 | P | — | A | Jun 25, 2015 | — | See Footnote | — | 1,667,323 | D |
| Convertible NoteF1,F2,F3 | — | Jun 17, 2015 | P | — | A | Jun 25, 2015 | — | See Footnote | — | 1,667,323 | D |
| Convertible NoteF1,F2,F3 | — | Jul 15, 2015 | P | — | A | Jul 15, 2015 | — | See Footnote | — | 1,667,323 | D |
Explanation of responses
- F1The convertible notes are convertible into any financial instrument next issued by the Company to investors, at a 20% discount from the price of such instrument.
- F2N/A
- F3The underlying securities could be any financial instrument next issued by the Company to investors, including debt, equity, or derivatives.