SEC Form 4 · accession 0001493152-18-013903
INTELLINETICS, INC. · INLX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Robert Taglich
10% Owner
Period of report
Jan 11, 2018
Accepted (ET)
Sep 28, 2018 · 5:16 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WarrantF1 | $0.25 | Jan 11, 2018 | J | 210,000 | A | Jan 1, 2018 | Nov 30, 2022 | Common stock | 210,000 | 1,796,305 | D |
| Convertible NoteF2 | $0.13 | Sep 26, 2018 | P | — | A | Sep 26, 2018 | — | Common stock | 1,538,461 | 3,334,766 | D |
Explanation of responses
- F1Placement Agent Warrants were issued at a rate of 10% of the shares sold by Taglich Brothers, Inc. on behalf of the company, as part of a private placement of convertible debt conducted by the Company in November 2017.
- F2N/A