SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Herschkowitz Samuel

(Last) (First) (Middle)
122 WILLOW STREET

(Street)
BROOKLYN NY 11217

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Skyline Medical Inc. [ SKLN ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
08/06/2013
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Convertible Promissory Note (1) 08/06/2013 J(1) 0(1) (1) (1) Common Stock, par value $0.01 per share 59,656,285 (1) 0(2)(3) I See footnote(4)
Explanation of Responses:
1. On August 6, 2013, SOK Partners LLC ("SOK Partners") advanced an additional $100,000 to the Issuer under the Convertible Promissory Note, dated March 28, 2012, made by the Issuer in favor of SOK Partners (the "Grid Note"). The Grid Note may be converted at any time by the holder into shares of the Issuer's common stock, par value $0.01 per share ("Shares"). The August 6, 2013 advance is convertible into 7,142,857 Shares.
2. The aggregate principal amount and accrued interest of $527,054 as of August 6, 2013 under the Grid Note is convertible into an aggregate of 37,646,714 Shares.
3. Dr. Herschkowitz holds a Convertible Promissory Note, dated December 20, 2011, made by the Issuer in the principal amount of $240,000 (the "First Note"). The aggregate principal amount and accrued interest of $308,134 as of August 6, 2013 under the Grid Note is convertible at any time by the holder into an aggregate of 22,009,571 Shares.
4. Atlantic Partners Alliance LLC is the sole member of SOK Partners. Dr. Herschkowitz is one of the members of Atlantic Partners Alliance LLC and may therefore be deemed to be the beneficial holder of securities of the Issuer held by SOK Partners.
/s/ Samuel Herschkowitz 08/08/2013
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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