0001144204-17-000686.txt : 20170104 0001144204-17-000686.hdr.sgml : 20170104 20170104213021 ACCESSION NUMBER: 0001144204-17-000686 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161230 FILED AS OF DATE: 20170104 DATE AS OF CHANGE: 20170104 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SCHROEDER ROBERT C CENTRAL INDEX KEY: 0001268331 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-31671 FILM NUMBER: 17508543 MAIL ADDRESS: STREET 1: TAGLICH BROTHERS, INC. STREET 2: 405 LEXINGTON AVE, 51ST FLOOR CITY: NEW YORK STATE: NY ZIP: 10174 4 1 v456273_form4.xml FORM 4 X0306 4 2016-12-30 0 0001081745 INTELLINETICS, INC. INLX 0001268331 SCHROEDER ROBERT C 2190 DIVIDEND DR. COLUMBUS OH 43228 1 0 0 0 Convertible Note 2016-12-30 4 J 0 25000 25000 D 2016-11-30 Common stock 279020 D Convertible Note 0.65 2016-12-30 4 J 0 25000 25000 A 2016-12-30 Common stock 38461 317481 D Convertible Note is convertible into any equity securities next issued by the Company to investors on the same terms as sold to other investors. N/A Transaction Code J: The filer exchanged with the issuer an existing convertible note for a different convertible note with different terms. /s/ Robert C. Schroeder 2017-01-04