SEC Form 4 · accession 0001144204-17-000688
INTELLINETICS, INC. · INLX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert Taglich
10% Owner
Period of report
Dec 30, 2016
Accepted (ET)
Jan 4, 2017 · 9:30 pm EST
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 | — | Dec 30, 2016 | J | — | D | Nov 30, 2016 | — | Common stock | — | 1,099,726 | D |
| Convertible NoteF2 | $0.65 | Dec 30, 2016 | J | — | A | Dec 30, 2016 | — | Common stock | 153,846 | 1,253,572 | D |
Explanation of responses
- F1Convertible Note is convertible into any equity securities next issued by the Company to investors on the same terms as sold to other investors.
- F2N/A
Remarks
Transaction Code J: The filer exchanged with the issuer an existing convertible note for a different convertible note with different terms.