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