SEC Form 4 · accession 0001209191-18-053322
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
Oct 1, 2018
Accepted (ET)
Oct 2, 2018 · 5:29 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)F2 | $0.94 | Oct 1, 2018 | D | 75,000 | D | — | Jan 18, 2027 | Common Stock | 75,000 | 0 | D |
| Stock Option (Right to Buy)F2 | $0.75 | Oct 1, 2018 | A | 75,000 | A | — | Jan 18, 2027 | Common Stock | 75,000 | 75,000 | 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 vest and become exercisable in three equal installments. One-third of the options vested on the grant date of January 18, 2017; one-third of the options vested on January 18, 2018 and one-third of the options shall vest on January 18, 2019.