SEC Form 4 · accession 0001209191-18-053316
Ampio Pharmaceuticals, Inc. · AMPE
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Holli Cherevka
Officer — Chief Operating Officer
Period of report
Oct 1, 2018
Accepted (ET)
Oct 2, 2018 · 5:27 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Option (Right to Buy)F2 | $4.72 | Oct 1, 2018 | D | 45,000 | D | — | Apr 2, 2023 | Common Stock | 45,000 | 0 | D |
| Employee Stock Option (Right to Buy)F2 | $0.75 | Oct 1, 2018 | A | 45,000 | A | — | Apr 2, 2023 | Common Stock | 45,000 | 45,000 | D |
| Employee Stock Option (Right to Buy)F2 | $3.43 | Oct 1, 2018 | D | 30,000 | D | — | Oct 6, 2024 | Common Stock | 30,000 | 0 | D |
| Employee Stock Option (Right to Buy)F2 | $0.75 | Oct 1, 2018 | A | 30,000 | A | — | Oct 6, 2024 | Common Stock | 30,000 | 30,000 | D |
| Employee Stock Option (Right to Buy)F2 | $1.03 | Oct 1, 2018 | D | 170,000 | D | — | Jul 15, 2026 | Common Stock | 170,000 | 0 | D |
| Employee Stock Option (Right to Buy)F2 | $0.75 | Oct 1, 2018 | A | 170,000 | A | — | Jul 15, 2026 | Common Stock | 170,000 | 170,000 | D |
| Employee Stock Option (Right to Buy)F2 | $4.16 | Oct 1, 2018 | D | 35,000 | D | — | Jan 14, 2023 | Common Stock | 35,000 | 0 | D |
| Employee Stock Option (Right to Buy)F2 | $0.75 | Oct 1, 2018 | A | 35,000 | A | — | Jan 14, 2023 | Common Stock | 35,000 | 35,000 | D |
| Employee Stock Option (Right to Buy)F2 | $8.62 | Oct 1, 2018 | D | 9,402 | D | — | Nov 8, 2023 | Common Stock | 9,402 | 0 | D |
| Employee Stock Option (Right to Buy)F2 | $0.75 | Oct 1, 2018 | A | 9,402 | A | — | Nov 8, 2023 | Common Stock | 9,402 | 9,402 | D |
Explanation of responses
- F1The transactions reported herein reflect a one-time stock option repricing (the "Option Repricing") that became effective on October 1, 2018 and are being reported in this manner solely to comply with the technical reporting requirements under Section 16(a) of the Securities Exchange Act of 1934. Pursuant to the Option Repricing, the exercise price of each "Relevant Option" has been amended to reduce such exercise price to $0.75. There have been no other changes to the terms of the Relevant Options.
- F2The stock options have vested and have become fully exercisable.