0001493152-18-013899.txt : 20180928 0001493152-18-013899.hdr.sgml : 20180928 20180928171401 ACCESSION NUMBER: 0001493152-18-013899 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180111 FILED AS OF DATE: 20180928 DATE AS OF CHANGE: 20180928 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TAGLICH MICHAEL N CENTRAL INDEX KEY: 0001024533 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-31671 FILM NUMBER: 181094924 MAIL ADDRESS: STREET 1: TAGLICH BROTHERS INC STREET 2: 1370 AVENUE OF THE AMERICAS --31ST FLOOR CITY: NEW YORK STATE: NY ZIP: 6317254791 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: INTELLINETICS, INC. CENTRAL INDEX KEY: 0001081745 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 870613716 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2190 DIVIDEND DRIVE CITY: COLUMBUS STATE: OH ZIP: 43228 BUSINESS PHONE: 6143888909 MAIL ADDRESS: STREET 1: 2190 DIVIDEND DRIVE CITY: COLUMBUS STATE: OH ZIP: 43228 FORMER COMPANY: FORMER CONFORMED NAME: GLOBALWISE INVESTMENTS INC DATE OF NAME CHANGE: 20000928 4 1 ownership.xml X0306 4 2018-01-11 0 0001081745 INTELLINETICS, INC. INXL 0001024533 TAGLICH MICHAEL N 790 NEW YORK AVE HUNTINGTON NY 11743 0 0 1 0 Warrant 0.25 2018-01-11 4 J 0 210000 A 2018-01-11 2022-11-30 Common stock 210000 3177516 D Convertible Note 0.13 2018-09-26 4 P 0 200000 200000 A 2018-09-26 Common stock 1538461 4715977 D Placement 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. N/A /s/ Michael N. Taglich 2018-09-28