0001144204-17-035606.txt : 20170705 0001144204-17-035606.hdr.sgml : 20170705 20170705144629 ACCESSION NUMBER: 0001144204-17-035606 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170630 FILED AS OF DATE: 20170705 DATE AS OF CHANGE: 20170705 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Alliqua BioMedical, Inc. CENTRAL INDEX KEY: 0001054274 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 582349413 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1010 STONY HILL ROAD STREET 2: SUITE 200 CITY: YARDLEY STATE: PA ZIP: 19067 BUSINESS PHONE: 215-702-8550 MAIL ADDRESS: STREET 1: 1010 STONY HILL ROAD STREET 2: SUITE 200 CITY: YARDLEY STATE: PA ZIP: 19067 FORMER COMPANY: FORMER CONFORMED NAME: Alliqua, Inc. DATE OF NAME CHANGE: 20101222 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WAGNER MARK T CENTRAL INDEX KEY: 0001172343 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36278 FILM NUMBER: 17947408 MAIL ADDRESS: STREET 1: 800 WASHINGTON AVENUE NORTH SUITE 400 CITY: MINNEAPOLIS STATE: MN ZIP: 55432 4 1 v470262_4.xml OWNERSHIP DOCUMENT X0306 4 2017-06-30 0 0001054274 Alliqua BioMedical, Inc. ALQA 0001172343 WAGNER MARK T C/O ALLIQUA BIOMEDICAL, INC. 1010 STONY HILL ROAD YARDLEY PA 19067 1 0 0 0 Stock Option (right to buy) 0.37 2017-06-30 4 A 0 90000 0 A 2027-06-30 Common Stock 90000 90000 D The option vests in eleven equal monthly installments with one-eleventh (1/11) vesting on the thirtieth (30th) day of each of the next eleven (11) months (or, if there is no 30th day in a month, on the last day of that month), with the first such vesting date occurring on July 30, 2017, provided that the reporting person is providing services to the Issuer on the applicable vesting date and subject to the terms and conditions of the Alliqua BioMedical, Inc. 2014 Long-Term Incentive Plan. /s/ Mark Wagner 2017-07-05