0000905716-13-000003.txt : 20130102
0000905716-13-000003.hdr.sgml : 20130101
20130102145906
ACCESSION NUMBER: 0000905716-13-000003
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20121230
FILED AS OF DATE: 20130102
DATE AS OF CHANGE: 20130102
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Elliott Jennifer Aplin
CENTRAL INDEX KEY: 0001527982
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-00147
FILM NUMBER: 13501525
MAIL ADDRESS:
STREET 1: 1178 BELLINGHAM DR.
CITY: OCEANSIDE
STATE: CA
ZIP: 92057
FORMER NAME:
FORMER CONFORMED NAME: Elliot Jennifer Aplin
DATE OF NAME CHANGE: 20110815
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: HICKOK INC
CENTRAL INDEX KEY: 0000047307
STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823]
IRS NUMBER: 340288470
STATE OF INCORPORATION: OH
FISCAL YEAR END: 0930
BUSINESS ADDRESS:
STREET 1: 10514 DUPONT AVE
CITY: CLEVELAND
STATE: OH
ZIP: 44108
BUSINESS PHONE: 2165418060
MAIL ADDRESS:
STREET 1: 10514 DUPONT AVE
CITY: CLEVELAND
STATE: OH
ZIP: 44108
FORMER COMPANY:
FORMER CONFORMED NAME: HICKOK ELECTRICAL INSTRUMENT CO
DATE OF NAME CHANGE: 19920703
4
1
primary_doc.xml
PRIMARY DOCUMENT
X0306
4
2012-12-30
0
0000047307
HICKOK INC
HICKA
0001527982
Elliott Jennifer Aplin
1178 BELLINGHAM DR.
OCEANSIDE
CA
92057
1
0
1
0
Class A Common Stock, no par value.
2012-12-30
2012-12-30
4
M
0
112752
1.85
A
127411
I
By Trust
Convertible Promissory Note
1.85
2012-12-30
2012-12-30
4
M
0
112752
A
2011-12-30
2012-12-30
Class A Common Stock
112752
0
I
By Trust
1. On December 30, 2011, Hickok Incorporated (the "Company") entered into a Convertible Loan Agreement (the "Convertible Loan Agreement") with the Aplin Family Trust (the "Aplin Trust") among others. Under the Convertible Loan Agreement, the Company issued a convertible note to the Aplin Trust in the principal amount of $208,591.20 ( the "Note"). The Convertible Loan Agreement provided that the Note may be converted by the Aplin Trust at any time, in whole or in part, into Class A Common Shares of the Company ("Conversion Shares") at a conversion price of $1.85 per share. The Aplin Note may not be converted into more than 112,752 Conversion Shares.
/s/Jennifer A. Elliott
2013-01-02