SEC Form 4 · accession 0001144204-16-089022
INTELLINETICS, INC. · INLX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Matthew L Chretien
Officer — Chief Executive Officer · Director
Period of report
Dec 31, 2015
Accepted (ET)
Mar 21, 2016 · 6:04 am EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001081745
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Dec 31, 2015 | C | 22,705 | $12,715.00 | A | 919,033 | D | |
| Common StockF1 | Jan 2, 2016 | A | 8,333 | — | A | 927,366 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible NoteF2,F3 | — | Dec 31, 2015 | C | — | D | — | — | Common stock | 22,705 | 500,000 | D |
| WarrantF2 | $0.65 | Dec 31, 2015 | C | 10,595 | A | Dec 31, 2015 | Dec 30, 2020 | Common stock | 10,595 | 510,595 | D |
| OptionF1,F4 | $0.90 | Jan 1, 2016 | A | 100,000 | A | — | Dec 31, 2025 | Common stock | 100,000 | 610,595 | D |
Explanation of responses
- F1Granted in exchange for director or officer services to the Company, in accordance with the 2015 Intellinetics Inc. Equity Incentive Plan.
- F2Convertible notes were converted into equity and warrants as part of a note exchange offering. Each outstanding convertible note was converted into common stock at its conversion price, and each noteholder exercising notes also received warrants to purchase common stock in an amount equal to 50% of the total principal and interested converted, divided by 0.6.
- F3N/A
- F425% of the options vest annually, beginning on January 1, 2016.