0001493152-17-013703.txt : 20171121 0001493152-17-013703.hdr.sgml : 20171121 20171121214423 ACCESSION NUMBER: 0001493152-17-013703 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170921 FILED AS OF DATE: 20171121 DATE AS OF CHANGE: 20171121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TAGLICH ROBERT CENTRAL INDEX KEY: 0001353439 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-31671 FILM NUMBER: 171218269 MAIL ADDRESS: STREET 1: 700 NEW YORK AVENUE CITY: HUNTINGTON STATE: NY ZIP: 11743 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 form4.xml X0306 4 2017-09-21 0 0001081745 INTELLINETICS, INC. INLX 0001353439 TAGLICH ROBERT 275 MADISON AVENUE, #1618 NEW YORK NY 10016 0 0 1 0 Convertible Note 0.30 2017-09-21 4 P 0 77320 75000 A 2017-09-21 Common stock 257733 1511305 D Warrant 0.30 2017-09-21 4 P 0 75000 A 2017-09-21 2022-09-22 Common stock 75000 1586305 D Warrants were issued in connection with Mr. Taglich's purchase of the $77,320 convertible note disclosed above. /s/ Robert F. Taglich 2017-11-21