SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
STEFANSKY DAVID

(Last) (First) (Middle)
C/O AQUAMED TECHNOLOGIES, INC.
2150 CABOT BOULEVARD, WEST, SUITE B

(Street)
LANGHORNE PA 19067

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/10/2019
3. Issuer Name and Ticker or Trading Symbol
AquaMed Technologies, Inc. [ NONE ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 1,634,750 I By Bezalel Partners LLC(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
1. Name and Address of Reporting Person*
STEFANSKY DAVID

(Last) (First) (Middle)
C/O AQUAMED TECHNOLOGIES, INC.
2150 CABOT BOULEVARD, WEST, SUITE B

(Street)
LANGHORNE PA 19067

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
X Director X 10% Owner
Officer (give title below) Other (specify below)
1. Name and Address of Reporting Person*
BEZALEL PARTNERS LLC

(Last) (First) (Middle)
C/O KRIEGER & PRAGER LLP
39 BROADWAY, STE 920

(Street)
NEW YORK NY 10006

(City) (State) (Zip)

Relationship of Reporting Person(s) to Issuer
Director X 10% Owner
Officer (give title below) Other (specify below)
Explanation of Responses:
1. Represents shares of common stock held by Bezalel Partners LLC ("Bezalel"). David Stefansky is the managing member of Bezalel and has the sole power to vote and direct the voting of, and to dispose and to direct the disposition of, the shares of common stock beneficially owned by Bezalel.
/s/ David Stefansky 10/08/2019
Bezalel Partners LLC, by /s/ David Stefansky, Managing Member 10/08/2019
** 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 5 (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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.