SEC Form 4 · accession 0001209191-17-050642
Ampio Pharmaceuticals, Inc. · AMPE
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
III Thomas E. Chilcott
Officer — Chief Financial Officer
Period of report
Aug 23, 2017
Accepted (ET)
Aug 29, 2017 · 6:51 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001411906
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (Right to Buy)F1 | $0.48 | Aug 23, 2017 | A | 200,000 | A | — | Aug 23, 2027 | Common Stock | 200,000 | 200,000 | D |
Explanation of responses
- F1This option shall vest as follows: (i) 100,000 shares of common stock vests on August 23, 2017 and (ii) 100,000 shares of common stock vests 365 days thereafter. In the event of a change in control of the Company or in the event of death, disability, termination without cause or for good reason (as such terms are defined in the Employment Agreement), all outstanding stock options held by the Reporting Person will become fully vested and exercisable.