0001144204-14-001300.txt : 20140108
0001144204-14-001300.hdr.sgml : 20140108
20140108215025
ACCESSION NUMBER: 0001144204-14-001300
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140106
FILED AS OF DATE: 20140108
DATE AS OF CHANGE: 20140108
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Alliqua, Inc.
CENTRAL INDEX KEY: 0001054274
STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841]
IRS NUMBER: 582349413
STATE OF INCORPORATION: FL
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2150 CABOT BOULEVARD WEST
CITY: LANGHORNE
STATE: PA
ZIP: 19047
BUSINESS PHONE: 215-702-8550
MAIL ADDRESS:
STREET 1: 2150 CABOT BOULEVARD WEST
CITY: LANGHORNE
STATE: PA
ZIP: 19047
FORMER COMPANY:
FORMER CONFORMED NAME: HEPALIFE TECHNOLOGIES INC
DATE OF NAME CHANGE: 20030529
FORMER COMPANY:
FORMER CONFORMED NAME: ZETA CORP
DATE OF NAME CHANGE: 20030219
FORMER COMPANY:
FORMER CONFORMED NAME: ZETA CORP /CA
DATE OF NAME CHANGE: 20000303
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ROSENBLUM RICHARD
CENTRAL INDEX KEY: 0001205074
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-29819
FILM NUMBER: 14517566
MAIL ADDRESS:
STREET 1: 19 HORIZON DRIVE
CITY: WAYNE
STATE: NJ
ZIP: 07470
4
1
v364991_4.xml
OWNERSHIP DOCUMENT
X0306
4
2014-01-06
0
0001054274
Alliqua, Inc.
ALQA
0001205074
ROSENBLUM RICHARD
C/O ALLIQUA, INC.
2150 CABOT BLVD. WEST, SUITE B
LANGHORNE
PA
19047
1
0
0
0
Common Stock
2014-01-06
4
A
0
194667
A
819307
D
Stock Option (right to buy)
8.75
2014-01-06
4
D
0
114286
D
2010-12-31
2015-12-09
Common Stock
114286
0
D
Stock Option (right to buy)
8.75
2014-01-06
4
D
0
38095
D
2011-03-01
2016-03-01
Common Stock
38095
0
D
Stock Option (right to buy)
9.19
2014-01-06
4
D
0
114286
D
2013-05-16
2022-05-16
Common Stock
114286
0
D
Stock Option (right to buy)
6.34
2014-01-06
4
D
0
11429
D
2013-05-16
2022-05-16
Common Stock
11429
0
D
On January 6, 2014, pursuant to an option cancellation and release agreement by and between the Issuer and Mr. Rosenblum (the "Rosenblum Cancellation Agreement"), the Issuer granted to Mr. Rosenblum 194,667 shares of common stock under the Alliqua, Inc. 2011 Long-Term Incentive Plan (the "2011 Incentive Plan") as consideration for the cancellation of certain nonqualified stock options previously granted to Mr. Rosenblum.
Includes, prior to the acquisitions reported on this Form 4, (a) 325,198 shares of common stock directly beneficially owned by Harborview Value Master Fund, L.P. ("Harborview Value Fund"), (b) 7,086 shares of common stock directly beneficially owned by Harborview Capital Management, LLC ("Harborview Management"), (c) 278,247 shares of common stock directly beneficially owned by Mr. Rosenblum and (d) 14,109 shares of common stock owned by The Corbran, LLC, an entity controlled by Mr. Rosenblum. Harborview Advisors, LLC ("Harborview Advisors") is the general partner of, and may be deemed to beneficially own securities owned by, Harborview Value Fund. Mr. Rosenblum is a managing member of, and may be deemed to beneficially own securities owned by, each of Harborview Advisors and Harborview Management.
Except as otherwise indicated, all share amounts and prices reported in this Form 4 reflect a 1-for-43.75 reverse stock split of the common stock of the Issuer that occurred on November 18, 2013.
Represents stock options previously granted to Mr. Rosenblum, which were cancelled on January 6, 2014 pursuant to the Rosenblum Cancellation Agreement.
/s/ Richard Rosenblum
2014-01-08