0001179110-15-014166.txt : 20151022 0001179110-15-014166.hdr.sgml : 20151022 20151022164622 ACCESSION NUMBER: 0001179110-15-014166 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20151020 FILED AS OF DATE: 20151022 DATE AS OF CHANGE: 20151022 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Skyline Medical Inc. CENTRAL INDEX KEY: 0001446159 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 331007393 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 2915 COMMERS DRIVE, STREET 2: SUITE 900 CITY: EAGAN STATE: MN ZIP: 55121 BUSINESS PHONE: 651-389-4800 MAIL ADDRESS: STREET 1: 2915 COMMERS DRIVE, STREET 2: SUITE 900 CITY: EAGAN STATE: MN ZIP: 55121 FORMER COMPANY: FORMER CONFORMED NAME: BioDrain Medical, Inc. DATE OF NAME CHANGE: 20080925 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kornberg Joshua CENTRAL INDEX KEY: 0001545669 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36790 FILM NUMBER: 151170674 MAIL ADDRESS: STREET 1: 1 GRAND ARMY PLAZA STREET 2: #9F CITY: BROOKLYN STATE: NY ZIP: 11238 4 1 edgar.xml FORM 4 - X0306 4 2015-10-20 0 0001446159 Skyline Medical Inc. SKLN 0001545669 Kornberg Joshua 2915 COMMERS DRIVE, SUITE 900 EAGAN MN 55121 1 1 1 0 CEO and President Common Stock, $.01 par value 6961 D Common Stock, $.01 par value 805982 I By SOK Partners LLC Common Stock, $.01 par value 615281 I By Atlantic Partners Alliance LLC Stock Option (right to buy) 2.63 2015-10-20 4 A 0 209126 0 A 2015-10-20 2025-10-20 Common Stock, $.01 par value 209126 209126 D A limited liability company of which the Reporting Person is one of the managers. The Reporting Person disclaims beneficial ownership of such shares, except for those as to which he may have a pecuniary interest therein. A limited liability company, of which the Reporting Person is a member. The Reporting Person disclaims beneficial ownership of such shares, except for those as to which he may have a pecuniary interest therein. /s/ Joshua Kornberg 2015-10-22