Form D
View Original Filing
Notice of Exempt Offering of Securities
Item 1. Issuer's Identity
Name of Issuer:
ALLIQUA, INC.
Jurisdiction of Incorporation/Organization
FL
Year of Incorporation/Organization
Over Five Years Ago
Previous Name(s)
- HEPALIFE TECHNOLOGIES INC
- ZETA CORP
- ZETA CORP /CA
Item 2 Issuer Principal Place of Business and Contact Information
2150 CABOT BOULEVARD WEST
LANGHORNE, PA 19047
Phone Number:
subscription required
Item 3. Related Persons
Name
RICHARD ROSENBLUM
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
DAVID STEFANSKY
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
JEROME ZELDIS
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
JOSEPH LEONE
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
KENNETH LONDONER
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
KENNETH PEARSEN
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
JEFFREY SKLAR
Address
subscription required
Relationship(s)
Clarification of Response
Item 3. Related Persons
Name
BRIAN POSNER
Address
subscription required
Relationship(s)
Clarification of Response
CHIEF FINANCIAL OFFICER OF THE ISSUER
Item 3. Related Persons
Name
DAVID JOHNSON
Address
subscription required
Relationship(s)
- EXECUTIVE OFFICER
- DIRECTOR
Clarification of Response
PRESIDENT, CHIEF EXECUTIVE OFFICER AND DIRECTOR OF THE ISSUER
Item 4. Industry Group
BIOTECHNOLOGY
Item 5. Issuer Size
Revenue Range (for issuer not specifying "hedge" or "other investment" fund in Item 4 above)
DECLINE TO DISCLOSE
Item 6. Federal Exemptions and Exclusions Claimed
Item 7. Type of Filing
New Notice
Date of First Sale in this Offering:
10/22/2013
Item 8. Duration of Offering
Does the issuer intend this offering to last more than one year?
No
Item 9. Type(s) of Securities Offered
- Equity
- Option, Warrant or Other Right to Acquire Another Security
Item 10. Business Combination Transaction
Is this offering being made in connection with a business combination
transaction, such as a merger, acquisition or exchange offer?
No
Clarification of Response
Item 11. Minimum Investment
Minimum Investment accepted from any outside investor
0
Item 12. Sales Compensation
Recipient
SUMMER STREET RESEARCH PARTNERS
Recipient CRD Number
127412
(Associated) Broker or Dealer)
NONE
(Associated) Broker or Dealer CRD Number
NONE
Address
708 3RD AVENUE
5TH FLOOR
NEW YORK, NY 10017
States of Solicitation
Item 13. Offering and Sales Amounts
Total Offering Amount
1000000
Total Amount Sold
1000000
Total Remaining to be Sold
0
Clarification of Response
Item 14. Investors
Securities in the offering have been or may be sold to persons
who do not qualify as accredited investors,
Number of non-accredited investors who already have invested in the offering:
Total number of investors who already have invested in the offering:
1
Item 15. Sales Commissions and Finders' Fees Expenses
Sales Commissions:
70000.0
Finders' Fees
0.0
Clarification of Response
THE ISSUER ALSO ISSUED A FIVE YEAR WARRANT TO PURCHASE 777,778 SHARES OF COMMON STOCK AT AN EXERCISE PRICE OF $.10 PER SHARE TO THE PLACEMENT AGENT AS CONSIDERATION FOR SERVING AS THE PLACEMENT AGENT.
Item 16. Use of Proceeds
Provide the amount of the gross proceeds of the offering
that has been or is proposed to be used for payments to any of the persons required
to be named as executive officers,directors or promoters in response to Item 3 above.
0.0
Clarification of Response
Signature and Submission
Issuer Name
ALLIQUA, INC.
Issuer Signature
BRIAN POSNER
Signer Name
BRIAN POSNER
Signer Title
CHIEF FINANCIAL OFFICER
Signature Date
11/06/2013