Amended Statement of Ownership (sc 13g/a)
07 Janvier 2020 - 8:21PM
Edgar (US Regulatory)
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 3)*
Ampio
Pharmaceuticals, Inc.
(Name of Issuer)
Common Stock, $.0001 par value per share
(Title of Class of Securities)
03209T109
(CUSIP Number)
December 31, 2019**
(Date of Event Which Requires Filing of This Statement)
Check the appropriate box to
designate the rule pursuant to which this Schedule is filed:
☐ Rule 13d-1(b)
☒ Rule 13d-1(c)
☐ Rule 13d-1(d)
*
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The remainder of this cover page shall be filled out for a reporting persons initial filing on this form
with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
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**
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Date of the most recent required filing.
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The information in the remainder of this cover page shall not be deemed to be filed for the purpose of Section 18 of the Securities Exchange
Act of 1934 (Act) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
CUSIP No. 03209T109
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1
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NAMES OF
REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Bruce E. Terker (1)
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER
OF A GROUP (see instructions)
(a) ☐ (b) ☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF
ORGANIZATION
Pennsylvania
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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5
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SOLE VOTING POWER
0
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6
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SHARED VOTING POWER
11,525,331 (1)
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7
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SOLE DISPOSITIVE POWER
0
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8
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SHARED DISPOSITIVE POWER
11,525,331 (1)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
11,525,331 (1)
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10
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CHECK BOX IF THE AGGREGATE AMOUNT IN
ROW (9) EXCLUDES CERTAIN SHARES (see instructions)
☐
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT
IN ROW (9)
7.26%
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12
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TYPE OF REPORTING PERSON (see
instructions)
IN
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CUSIP No. 03209T109
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1
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NAMES OF
REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Ballyshannon Partners, L.P. (IRS Identification No. 23-2751854) (2)
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER
OF A GROUP (see instructions)
(a) ☐ (b) ☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF
ORGANIZATION
Pennsylvania
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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5
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SOLE VOTING POWER
0
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6
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SHARED VOTING POWER
4,913,333 (2)
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7
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SOLE DISPOSITIVE POWER
0
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8
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SHARED DISPOSITIVE POWER
4,913,333 (2)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
4,913,333 (2)
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10
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CHECK BOX IF THE AGGREGATE AMOUNT IN
ROW (9) EXCLUDES CERTAIN SHARES (see instructions)
☐
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT
IN ROW (9)
3.10%
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12
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TYPE OF REPORTING PERSON (see
instructions)
PN
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CUSIP No. 03209T109
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1
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NAMES OF
REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Ballyshannon Family Partnership, L.P. (IRS Identification No. 23-3086095) (3)
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER
OF A GROUP (see instructions)
(a) ☐ (b) ☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF
ORGANIZATION
Pennsylvania
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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5
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SOLE VOTING POWER
0
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6
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SHARED VOTING POWER
2,340,666 (3)
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7
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SOLE DISPOSITIVE POWER
0
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8
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SHARED DISPOSITIVE POWER
2,340,666 (3)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
2,340,666 (3)
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10
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CHECK BOX IF THE AGGREGATE AMOUNT IN
ROW (9) EXCLUDES CERTAIN SHARES (see instructions)
☐
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT
IN ROW (9)
1.48%
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12
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TYPE OF REPORTING PERSON (see
instructions)
PN
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CUSIP No. 03209T109
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1
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NAMES OF
REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Insignia Partners, L.P. (Identification No. 23-3054280) (4)
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER
OF A GROUP (see instructions)
(a) ☐ (b) ☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF
ORGANIZATION
Pennsylvania
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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5
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SOLE VOTING POWER
0
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6
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SHARED VOTING POWER
1,000,000 (4)
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7
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SOLE DISPOSITIVE POWER
0
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8
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SHARED DISPOSITIVE POWER
1,000,000 (4)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
1,000,000 (4)
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10
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CHECK BOX IF THE AGGREGATE AMOUNT IN
ROW (9) EXCLUDES CERTAIN SHARES (see instructions)
☐
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT
IN ROW (9)
0.63%
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12
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TYPE OF REPORTING PERSON (see
instructions)
PN
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CUSIP No. 03209T109
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1
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NAMES OF
REPORTING PERSONS
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Odyssey Capital Group, L.P. (Identification No. 23-2600849) (5)
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2
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CHECK THE APPROPRIATE BOX IF A MEMBER
OF A GROUP (see instructions)
(a) ☐ (b) ☐
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3
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SEC USE ONLY
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4
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CITIZENSHIP OR PLACE OF
ORGANIZATION
Pennsylvania
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NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH
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5
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SOLE VOTING POWER
0
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6
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SHARED VOTING POWER
3,271,332 (5)
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7
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SOLE DISPOSITIVE POWER
0
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8
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SHARED DISPOSITIVE POWER
3,271,332 (5)
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9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
3,271,332 (5)
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10
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CHECK BOX IF THE AGGREGATE AMOUNT IN
ROW (9) EXCLUDES CERTAIN SHARES (see instructions)
☐
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11
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PERCENT OF CLASS REPRESENTED BY AMOUNT
IN ROW (9)
2.06%
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12
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TYPE OF REPORTING PERSON (see
instructions)
PN
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CUSIP No. 03209T109
Item 1(a).
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Name of Issuer
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Ampio Pharnaceuticals, Inc.
Item 1(b).
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Address of Issuers Principal Executive Offices:
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373 Inverness Parkway, Suite 200
Englewood, CO 80112
Item 2(a).
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Name of Person Filing:
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Bruce E. Terker (1)*
Ballyshannon Partners, L.P. (2)
Ballyshannon Family Partnership, L.P. (3)
Insignia Partners, L.P. (4)
Odyssey Capital Group, L.P. (5)
Item 2(b).
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Address of Principal Business Office or, in none, Residence:
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950 West Valley Road, Suite 2900
Wayne, PA 19087
Bruce E. Terker is a US Citizen (1)
Ballyshannon Partners, L.P. Pennsylvania USA (2)
Ballyshannon Family Partnership, L.P. Pennsylvania USA (3)
Insignia Partners, L.P. Pennsylvania, USA (4)
Odyssey Capital Group, L.P. Pennsylvania, USA (5)
Item 2(d).
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Title of Class of Securities:
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Common Stock, $.0001 par value per share
Item 2(e).
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CUSIP Number 03209T109
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*
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Bruce E. Terker is the Sole Owner of Ballyshannon Partners, Inc., the General Partner of (2) Ballyshannon
Partners, L.P., (3) Ballyshannon Family Partnership, L.P., (4) Insignia Partners, L.P. and is the Sole Owner of Odyssey Capital Group, Inc., the General Partner of (5) Odyssey Capital Group, L.P.
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CUSIP No. 03209T109
Item 3.
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If this Statement is filed pursuant to 240.13d-1(b) or (c), check whether the person filing is a:
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(a)
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☐
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Broker or dealer registered under Section 15 of the Act;
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(b)
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☐
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Bank as defined in Section 3(a)(6) of the Act;
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(c)
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☐
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Insurance company as defined in Section 3(a)(19) of the Act;
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(d)
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☐
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Investment company registered under Section 8 of the Investment Company Act of 1940;
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(e)
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☐
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An investment adviser in accordance with Rule 13d-1(b)(1)(ii)(E);
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(f)
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☐
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An employee benefit plan or endowment fund in accordance with Rule 13d-1(b)(1)(ii)(F);
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(g)
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☐
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A parent holding company or control person in accordance with Rule 13d-1(b)(1)(ii)(G);
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(h)
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☐
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A savings association as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C.1813);
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(i)
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☐
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A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940;
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(j)
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☐
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A non-U.S. institution in accordance with Rule 240.13d-1(b)(1)(ii)(J);
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(k)
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☐
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Group, in accordance with Rule 240.13d-1(b)(1)(ii)(K). If filing as a non-U.S. institution in accordance with Rule 240.13-d1(b)(1)(ii)(J), please specify the type of institution:
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Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in
Item 1.
*
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Bruce E. Terker is the beneficial owner of 11,525,331 shares of common stock. Bruce E. Terker is the Sole Owner
of Ballyshannon Partners, Inc., the General Partner of (2) Ballyshannon Partners, L.P., (3) Ballyshannon Family Partnership, L.P., (4) Insignia Partners, L.P., and is the Sole Owner of Odyssey Capital Group, Inc. the General Partner
of (5) Odyssey Capital Group, L.P.
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(a)
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Amount Beneficially Owned
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(1) 11,525,331
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(Mr. Terker may be deemed a beneficial owner of the shares held by
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(2) Ballyshannon Partners, L.P., (3) Ballyshannon Family Partnership, L.P.,
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(4) Insignia Partners, L.P. and (5) Odyssey Capital Group, L.P. because
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he is the sole owner of the General Partner of those partnerships.)
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(2) 4,913,333
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(3) 2,340,666
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(4) 1,000,000
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(5) 3,271,332
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(b)
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Percent of Class:
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(1) 7.26%
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(2) 3.10%
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(3) 1.48%
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(4) 0.63%
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(5) 2.06%
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(c)
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Number of shares as to which such person has:
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(i) sole power to vote or to direct the vote:
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0
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(ii) shared power to vote or to direct the vote:
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(1) 11,525,331
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(2) 4,913,333
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(3) 2,340,666
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(4) 1,000,000
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(5) 3,271,332
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(iii) sole power to dispose or direct the disposition of:
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0
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(iv) shared power to dispose or to direct the disposition of:
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(1) 11,525,331
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(2) 4,913,333
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(3) 2,340,666
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(4) 1,000,000
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(5) 3,271,332
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CUSIP No. 03209T109
Item 5.
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Ownership of Five Percent or Less of a Class.
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If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of
more than five percent of the class of securities, check the following ☐
Item 6.
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Ownership of More than Five Percent on Behalf of Another Person.
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N/A
Item 7.
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Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the
Parent Holding Company.
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N/A
Item 8.
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Identification and Classification of Members of the Group.
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N/A
Item 9.
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Notice of Dissolution of Group.
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N/A
N/A
CUSIP No. 03209T109
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
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Date: January 7, 2020
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/s/ Bruce E. Terker
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Bruce E. Terker
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Ballyshannon Partners, L.P.
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By: Ballyshannon Partners, Inc., its General Partner
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By:
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/s/ Bruce E. Terker
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Name:
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Bruce E. Terker
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Title:
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President of the General Partner
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Ballyshannon Family Partnership, L.P.
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By: Ballyshannon Partners, Inc., its General Partner
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By:
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/s/ Bruce E. Terker
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Name:
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Bruce E. Terker
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Title:
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President of the General Partner
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Insignia Partners, L.P.
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By: Ballyshannon Partners, Inc., its General Partner
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By:
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/s/ Bruce E. Terker
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Name:
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Bruce E. Terker
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Title:
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President of the General Partner
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Odyssey Capital Group, L.P.
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By: Odyssey Capital Group, Inc., its General Partner
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By:
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/s/ Bruce E. Terker
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Name:
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Bruce E. Terker
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Title:
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Chairman of the General Partner
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CUSIP No. 03209T109
AGREEMENT TO JOINTLY FILE SCHEDULE 13G
AGREEMENT dated as of January 7, 2020 by and among Bruce E. Terker, Ballyshannon Partners, L.P., Ballyshannon Family Partnership, L.P., Insignia
Partners, L.P. and Odyssey Capital Group, L.P. (collectively, the Reporting Persons).
WHEREAS, pursuant to paragraph (k) of Rule 13d-1
promulgated under Subsection 12(d)(1) of the Securities Exchange Act of 1934, as amended (the Exchange Act), the Reporting Persons hereto have decided to satisfy their filing obligation under the Exchange Act by a single joint filing:
NOW, THEREFORE, the Reporting Persons hereby agree as follows:
1.
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The Schedule 13G with respect to Ampio Pharmaceuticals, Inc. to which this is attached as Exhibit A, is filed
on behalf of each of the Reporting Persons.
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2.
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Each Reporting Person is responsible for the completeness and accuracy of the information concerning such
Reporting Person contained therein.
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IN WITNESS WHEREOF, the undersigned hereunto set their hands as of the date first
above written.
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Date: January 7, 2020
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/s/ Bruce E. Terker
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Bruce E. Terker
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Ballyshannon Partners, L.P.
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By: Ballyshannon Partners, Inc., its General Partner
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By:
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/s/ Bruce E. Terker
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Name:
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Bruce E. Terker
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Title:
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President of the General Partner
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Ballyshannon Family Partnership, L.P.
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By: Ballyshannon Partners, Inc., its General Partner
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By:
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/s/ Bruce E. Terker
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Name:
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Bruce E. Terker
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Title:
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President of the General Partner
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Insignia Partners, L.P.
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By: Ballyshannon Partners, Inc., its General Partner
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By:
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/s/ Bruce E. Terker
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Name:
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Bruce E. Terker
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Title:
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President of the General Partner
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Odyssey Capital Group, L.P.
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By: Odyssey Capital Group, Inc., its General Partner
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By:
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/s/ Bruce E. Terker
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Name:
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Bruce E. Terker
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Title:
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Chairman of the General Partner
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Ampio Pharmaceuticals (CE) (USOTC:AMPE)
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