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