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*
SOK Partners LLC

(Last) (First) (Middle)
144 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)
08/31/2015
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
Senior Convertible Note $11.25(1) 08/31/2015 J(1) 1(1) 07/23/2014 07/23/2015(2) Common Stock, par value $0.01 per share (1) $100,000 0(1) D
Explanation of Responses:
1. On July 23, 2014, the Issuer issued a senior convertible note in the original principal amount of $122,195.60 (the "Note") to SOK Partners, LLC ("SOK Partners"). The Note was convertible at any time after issuance, at the holder's option, into shares of the Company's common stock, par value $0.01 per share (the "Common Stock"), at a conversion price equal to the lesser of (i) 72.5% (or if an event of default has occurred and is continuing, 70%) of the average of the lowest three volume weighted average prices of the Common Stock during the ten consecutive trading days prior to the conversion date, and (ii) $11.25 (as adjusted for stock splits, stock dividends, recapitalizations or similar events). On August 31, 2015, in consideration of the payment by the Issuer of $167,694.12, the outstanding principal, accrued interest and penalties payable under the Note were repaid and the note was cancelled.
2. The Note was due on July 23, 2015; provided, however, this date may be extended at the option of the holder in accordance with the terms of the Note.
/s/ Samuel Herschkowitz, President, SOK PARTNERS LLC, By: Atlantic Partners Alliance LLC, its sole member 09/10/2015
** Signature of Reporting Person Date
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* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
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