Statement of Changes in Beneficial Ownership (4)
September 15 2017 - 4:32PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response...
0.5
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Zhang Jack Y.
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2. Issuer Name
and
Ticker or Trading Symbol
Amphastar Pharmaceuticals, Inc.
[
AMPH
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__
X
__ Director
__
X
__ 10% Owner
__
X
__ Officer (give title below)
_____ Other (specify below)
CEO & Chief Scientific Officer
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(Last)
(First)
(Middle)
C/O AMPHASTAR PHARMACEUTICALS, INC., 11570 6TH STREET
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3. Date of Earliest Transaction
(MM/DD/YYYY)
9/13/2017
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(Street)
RANCHO CUCAMONGA, CA 91730
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
_
X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock
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9/13/2017
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M
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176987
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D
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$11.53
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1731937
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D
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Common Stock
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9/13/2017
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F
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153882
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D
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$15.86
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1578055
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D
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Common Stock
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9/13/2017
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M
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138632
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D
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$11.53
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1197337
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I
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See footnote
(1)
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Common Stock
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9/13/2017
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F
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120504
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D
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$15.87
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1076833
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I
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See footnote
(1)
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Common Stock
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7461594
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I
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See footnote
(2)
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Common Stock
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5000
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I
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See footnote
(3)
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Common Stock
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200000
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I
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See footnote
(4)
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Table II - Derivative Securities Beneficially Owned (
e.g.
, puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3)
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2. Conversion or Exercise Price of Derivative Security
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3. Trans. Date
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3A. Deemed Execution Date, if any
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4. Trans. Code
(Instr. 8)
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
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8. Price of Derivative Security
(Instr. 5)
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4)
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11. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expiration Date
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Title
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Amount or Number of Shares
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Employee Stock Option (right to buy)
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$11.53
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9/13/2017
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M
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176987
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(5)
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9/28/2017
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Common Stock
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176987
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$0
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0
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D
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Employee Stock Option (right to buy)
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$11.53
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9/13/2017
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M
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138632
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(5)
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9/28/2017
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Common Stock
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138632
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$0
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0
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I
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See footnote
(1)
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Explanation of Responses:
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(1)
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The securities are held of record by Mary Z. Luo. The reporting persons are husband and wife.
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(2)
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The shares are held of record by APCL, of which the reporting persons are the sole owners.
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(3)
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The shares are held of record in an account for the benefit of the reporting persons' son. The reporting persons disclaim beneficial ownership of these shares, and the inclusion of these shares in this report should not be deemed an admission of beneficial ownership of any such shares for purposes of Section 16, or for any other purpose.
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(4)
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The shares are held of record by a trust for the benefit of the reporting persons' son. The reporting persons disclaim beneficial ownership of these shares, and the inclusion of these shares in this report should not be deemed an admission of beneficial ownership of any such shares for purposes of Section 16, or for any other purpose.
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(5)
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Shares subject to the option are fully vested and immediately exercisable
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Zhang Jack Y.
C/O AMPHASTAR PHARMACEUTICALS, INC.
11570 6TH STREET
RANCHO CUCAMONGA, CA 91730
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X
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X
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CEO & Chief Scientific Officer
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Luo Mary Z.
C/O AMPHASTAR PHARMACEUTICALS, INC.
11570 6TH STREET
RANCHO CUCAMONGA, CA 91730
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X
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X
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COO,Chief Scientist & Chairman
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Signatures
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/s/ Ken Stupak, by power of attorney for Jack Y. Zhang
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9/15/2017
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**
Signature of Reporting Person
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Date
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/s/ Ken Stupak, by power of attorney for Mary Z. Luo
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9/15/2017
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**
Signature of Reporting Person
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Date
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
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*
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If the form is filed by more than one reporting person,
see
Instruction 4(b)(v).
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**
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations.
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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Note:
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File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.
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