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*
Kornberg Joshua

(Last) (First) (Middle)
1 GRAND ARMY PLAZA #9F

(Street)
BROOKLYN NY 11238

(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)
X Director X 10% Owner
X Officer (give title below) Other (specify below)
CEO and President
3. Date of Earliest Transaction (Month/Day/Year)
08/04/2014
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
Warrants $0.325(2) 08/04/2014 J(1)(2) 1(2) 08/04/2014 02/04/2019 Common Stock, par value $0.01 per share 56,148 (1)(2) 2(1)(2) D
Explanation of Responses:
1. On February 4, 2014, Mr. Kornberg acquired 250 shares of Series A Convertible Preferred Stock for an aggregate purchase price of $25,000 and a warrant to purchase an aggregate of 19,231 shares of common stock, par value $0.01 per share ("Common Stock"), exercisable for five years, at an exercise price of $0.325 per share (subject to adjustment in certain circumstances), pursuant to a Securities Purchase Agreement, dated February 4, 2014, between the Issuer and the purchasers (the "Purchasers") listed on Schedule I thereto (the "SPA").
2. On August 4, 2014, Mr. Kornberg acquired an additional warrant to purchase an aggregate of 56,148 shares of Common Stock, exercisable until February 4, 2019, at an exercise price of $0.325 per share (subject to adjustment in certain circumstances), which was triggered by a provision in the SPA requiring the Issuer to issue additional warrants to the Purchasers in the event that the Issuer's Common Stock was not listed on the Nasdaq Stock Market, the New York Stock Exchange or the NYSE MKT by August 3, 2014.
/s/ Josh Kornberg 08/04/2014
** 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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