SEC Form 4 · accession 0001493152-17-013704
INTELLINETICS, INC. · INLX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Michael N Taglich
10% Owner
Period of report
Sep 21, 2017
Accepted (ET)
Nov 21, 2017 · 9:47 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 | $0.30 | Sep 21, 2017 | P | — | A | Sep 21, 2017 | — | Common stock | 257,733 | 1,892,516 | D |
| WarrantF2 | $0.30 | Sep 21, 2017 | P | 75,000 | A | Sep 21, 2017 | Sep 22, 2022 | Common stock | 75,000 | 1,967,516 | D |
| Convertible NoteF1 | $0.30 | Nov 17, 2017 | P | — | A | Nov 17, 2017 | — | Common stock | 1,000,000 | 2,967,516 | D |
Explanation of responses
- F1N/A
- F2Warrants were issued in connection with Mr. Taglich's purchase of the $77,320 convertible note disclosed above.