SEC Form 4 · accession 0001209191-17-054277
Ampio Pharmaceuticals, Inc. · AMPE
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Philip H Coelho
Director
Period of report
Sep 23, 2017
Accepted (ET)
Sep 28, 2017 · 5:15 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001411906
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Sep 27, 2017 | P | 10,000 | $0.627 | A | 104,727 | D |
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)F2 | $0.60 | Sep 23, 2017 | A | 30,000 | A | — | Sep 23, 2027 | Common Stock | 30,000 | 30,000 | D |
Explanation of responses
- F1This transaction was executed in multiple trades at prices ranging from $0.6196 to $0.6322. The price reported above reflects the weighted average price. The Reporting Person hereby undertakes to provide upon request to the SEC staff, the Issuer or a security holder of the Issuer full information regarding the number of shares and prices at which the transaction was effected.
- F2The stock option vests and becomes exercisable in 12 equal monthly installments from the date of grant.