SEC Form 4 · accession 0001144204-15-048232
INTELLINETICS, INC. · INLX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert Taglich
10% Owner
Period of report
Aug 7, 2015
Accepted (ET)
Aug 11, 2015 · 5:56 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,F3 | — | Aug 7, 2015 | J | — | D | Jun 25, 2015 | — | See Footnote 1 | — | 1,677,323 | D |
| Convertible NoteF1,F3 | — | Aug 7, 2015 | J | — | D | Jun 25, 2015 | — | See Footnote 1 | — | 1,677,323 | D |
| Convertible NoteF1,F3 | — | Aug 7, 2015 | J | — | D | Jun 25, 2015 | — | See Footnote 1 | — | 1,677,323 | D |
| Convertible NoteF1,F3 | — | Aug 7, 2015 | J | — | D | Jun 25, 2015 | — | See Footnote 1 | — | 1,677,323 | D |
| Convertible NoteF3 | $0.60 | Aug 7, 2015 | J | — | A | Aug 7, 2015 | — | common stock | 33,333 | 1,700,656 | D |
| Convertible NoteF3 | $0.57 | Aug 7, 2015 | J | — | A | Aug 7, 2015 | — | common stock | 17,543 | 1,718,199 | D |
| Convertible NoteF3 | $0.57 | Aug 7, 2015 | J | — | A | Aug 7, 2015 | — | common stock | 87,719 | 1,805,918 | D |
| Convertible NoteF3 | $0.57 | Aug 7, 2015 | J | — | A | Aug 7, 2015 | — | common stock | 43,859 | 1,849,777 | 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.
- F2The convertible notes disposed of in Box 5 were replaced with amended convertible notes, which are disclosed here as acquired in Box 5.
- F3N/A