CUSIP NO. 03209T 10 9
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1
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NAMES OF REPORTING PERSONS
Genesis Capital Management Limited
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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 Saint Vincent and the Grenadines
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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 1,542,707
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|
6
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SHARED VOTING POWER 0
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||
7
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SOLE DISPOSITIVE POWER 1,542,707
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||
8
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SHARED DISPOSITIVE POWER 0
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||
9
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AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,542,707
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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) 5.3%
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12
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TYPE OF REPORTING PERSON (See Instructions) HC/CO (incorporated under the International Business Companies Act)
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CUSIP NO. 03209T 10 9
|
1
|
NAMES OF REPORTING PERSONS
Herald Janssen
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||
2
|
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (See Instructions)
(a)
(b)
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||
3
|
SEC USE ONLY
|
||
4
|
CITIZENSHIP OR PLACE OF ORGANIZATION The Netherlands
|
||
NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH:
|
5
|
SOLE VOTING POWER 1,542,707
|
|
6
|
SHARED VOTING POWER 0
|
||
7
|
SOLE DISPOSITIVE POWER 1,542,707
|
||
8
|
SHARED DISPOSITIVE POWER 0
|
||
9
|
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,542,707
|
||
10
|
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES [_]
(See Instructions)
|
||
11
|
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 5.3%
|
||
12
|
TYPE OF REPORTING PERSON (See Instructions) IN
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CUSIP NO. 03209T 10 9
|
1
|
NAMES OF REPORTING PERSONS
Petrus H. Jacobs
|
||
2
|
CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (See Instructions)
(a)
(b)
|
||
3
|
SEC USE ONLY
|
||
4
|
CITIZENSHIP OR PLACE OF ORGANIZATION The Netherlands
|
||
NUMBER OF
SHARES
BENEFICIALLY
OWNED BY
EACH
REPORTING
PERSON
WITH:
|
5
|
SOLE VOTING POWER 1,542,707
|
|
6
|
SHARED VOTING POWER 0
|
||
7
|
SOLE DISPOSITIVE POWER 1,542,707
|
||
8
|
SHARED DISPOSITIVE POWER 0
|
||
9
|
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,542,707
|
||
10
|
CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES [_]
(See Instructions)
|
||
11
|
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 5.3%
|
||
12
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TYPE OF REPORTING PERSON (See Instructions) IN
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(a) Name of Issuer:
Address of Issuer's Principal Executive Offices:
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Ampio Pharmaceuticals, Inc.
5445 DTC Parkway, Suite 925
Greenwood Village, CO 80111
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(a) Name of Person Filing:
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Genesis Capital Management Limited,
Herald Janseen, and
Petrus H. Jacobs
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(b) Address of Principal Business Office or, if none, residence:
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Trust House, 112 Bonadie Street
Kingstown, Saint Vincent and the Grenadines
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(c) Citizenship:
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Genesis Capital Management Limited is a
corporation incorporated in Saint Vincent
and the Grenadines under the International
Business Companies Act, 1996.
Mr. Janssen and Mr. Jacobs are both citizens
of The Netherlands.
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(d) Title of Class of Securities:
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Common Stock, par value $0.0001 per share
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(e) CUSIP Number:
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03209T 10 9
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(a)
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¨ Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o).
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(b)
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¨ Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c).
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(c)
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¨ Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c).
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(d)
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¨ Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C 80a-8).
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(e)
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¨ An investment adviser in accordance with §240.13d- 1(b)(1)(ii)(E);
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(f)
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¨ An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F);
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(g)
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¨ A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G);
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(h)
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¨ A savings associations 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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¨ 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 (15 U.S.C. 80a-3);
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(j)
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¨ Group, in accordance with §240.13d-1(b)(1)(ii)(J).
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(a) Amount beneficially owned:
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1,542,707 shares of common stock. These shares are held by Genesis Capital Management Ltd and other funds it manages or controls. Each of Mr. Janssen and Mr. Jacobs are control persons of Genesis Capital Management Ltd, and each may be deemed to beneficially own the shares held by Genesis Capital Management Ltd and its related entities, insofar as they may be deemed to have the power to direct the voting or disposition of those shares.
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(b) Percent of class:
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5.3%
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(c) Number of shares as to which the person has:
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(i) Sole power to vote or to direct the vote
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1,542,707
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(ii) Shared power to vote or to direct the vote
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0
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(iii) Sole power to dispose or to direct the disposition of
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1,542,707
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(iv) Shared power to dispose or to direct the disposition of
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0
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GENESIS CAPITAL MANAGEMENT LIMITED
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/s/ Herald Janssen | ||
By: Herald Janssen | |||
Title: Chairman |
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/s/ Herald Janssen | ||
Herald Janssen |
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/s/ Petrus H. Jacobs | ||
Petrus H. Jacobs
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Exhibit A
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Joint Filing Undertaking
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GENESIS CAPITAL MANAGEMENT LIMITED
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|||
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/s/ Herald Janssen | ||
By: Herald Janssen | |||
Title: Chairman |
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/s/ Herald Janssen | ||
Herald Janssen |
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/s/ Petrus H. Jacobs | ||
Petrus H. Jacobs
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