Document:

Form of Warrant issued by Ampio Pharmaceuticals, Inc.

 Exhibit 10.2 

THE SECURITIES EVIDENCED HEREBY HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED. SUCH SECURITIES MAY NOT BE SOLD, OFFERED FOR SALE,
PLEDGED OR HYPOTHECATED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT OR PURSUANT TO AN EXEMPTION FROM REGISTRATION, ACCOMPANIED BY AN OPINION OF COUNSEL SATISFACTORY TO THE COMPANY THAT SUCH REGISTRATION IS NOT REQUIRED. 

THE SHARES ACQUIRABLE UNDER THIS WARRANT HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED, AND MAY NOT BE SOLD, TRANSFERRED,
ASSIGNED, PLEDGED OR HYPOTHECATED EXCEPT PURSUANT TO REGISTRATION UNDER THE SECURITIES ACT, OR PURSUANT TO AN AVAILABLE EXEMPTION FROM REGISTRATION. HEDGING TRANSACTIONS INVOLVING THE SHARES REPRESENTED HEREBY MAY NOT BE CONDUCTED UNLESS IN
COMPLIANCE WITH THE SECURITIES ACT. 
 WARRANT TO PURCHASE COMMON
STOCK 
 AMPIO PHARMACEUTICALS, INC. 

 

			
	Warrant No.:	  	[                    ]
	Issuance Date:	  	[                    ] (“Issuance
Date”)
	Warrant Shares:	  	[                    ]
	Exercise Price:	  	TBD*

  

	*	To be determined in accordance with provisions below. 

Ampio Pharmaceuticals, Inc. a Delaware corporation (the “Company” or “Ampio”) , hereby certifies that
for good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged,             , the registered holder hereof or his permitted assigns (the
“Holder”), is entitled, subject to the terms set forth below, to purchase from the Company, at a per-share exercise price equal to the selling price per share of the Common Stock in the Public Offering (the “Exercise
Price”), subject to adjustment as provided below, upon surrender of this Warrant to Purchase Common Stock (including any Warrants to Purchase Common Stock issued in exchange, transfer or replacement hereof, the “Warrant”),
at any time or times on or after the date hereof, but not after 11:59 p.m., Mountain Time, on December 31, 2013 (the “Expiration Date”), the number of fully paid nonassessable shares of Common Stock (the “Warrant
Shares”) which shall upon initial issuance of this Warrant equal 5% of the principal amount of the debenture issued by the Company to the Holder contemporaneously herewith (the “Debenture”). Capitalized
terms used in this Warrant that are not defined herein shall have the same meanings as set forth in the Debenture. This Warrant may be one of a series of warrants to purchase Common Stock (the “Warrants”) issued to the Holder and
other holders of debentures of like tenor. 
 1. EXERCISE OF WARRANT. 

(a) Warrant Shares. This Warrant shall be exercisable for up to      shares of Common Stock until
the Expiration Date, determined as described above. Merely by way of example, if the Debenture issued to the Holder is in the principal amount of $200,000, then the number of Warrants Shares issuable on exercise of this Warrant will be 10,000
Warrant Shares (i.e., $200,000 x 5%). 

 (b) Mechanics of Exercise. Subject to the terms and conditions hereof
(including, without limitation, the limitations set forth in Section 1(g)), this Warrant may be exercised by the Holder on any day on or after the pricing and effectiveness of the Public Offering, in whole or in part, by (i) delivery of a
written notice, in the form attached hereto as Exhibit A (the “Exercise Notice”), of the Holder’s election to exercise this Warrant and (ii) payment to the Company of an amount equal to the applicable Exercise Price
multiplied by the number of Warrant Shares as to which this Warrant is being exercised (the “Aggregate Exercise Price”) in cash or by wire transfer of immediately available funds. The Holder shall not be required to deliver the
original Warrant in order to effect an exercise hereunder. Execution and delivery of the Exercise Notice with respect to less than all of the Warrant Shares shall have the same effect as cancellation of the original Warrant and issuance of a
new Warrant evidencing the right to purchase the remaining number of Warrant Shares. On or before the first Business Day following the date on which the Company has received each of the Exercise Notice and the Aggregate Exercise Price (the
“Exercise Delivery Documents”), the Company shall transmit by facsimile an acknowledgment of confirmation of receipt of the Exercise Delivery Documents to the Holder and the Company’s transfer agent (the “Transfer
Agent”). On or before the third Business Day following the date on which the Company has received all of the Exercise Delivery Documents (the “Share Delivery Date”), the Company shall cause the Transfer Agent to issue
and dispatch by overnight courier to the address as specified in the Exercise Notice, a certificate, registered in the Company’s share register in the name of the Holder or its designee, for the number of shares of Common Stock to which the
Holder is entitled pursuant to such exercise or, alternatively, the Company shall cause the Transfer Agent to credit the account of the Holder’s designated broker with DTC through the DWAC system. Upon delivery of the Exercise Notice and
Aggregate Exercise Price referred to in clause (ii) above, the Holder shall be deemed for all corporate purposes to have become the holder of record of the Warrant Shares with respect to which this Warrant has been exercised, irrespective of
the date of delivery of the certificates evidencing such Warrant Shares. If this Warrant is submitted in connection with any exercise pursuant to this Section 1(b) and the number of Warrant Shares represented by this Warrant is greater
than the number of Warrant Shares being acquired upon an exercise, then the Company shall as soon as practicable and in no event later than three Business Days after any exercise and at its own expense, issue a new Warrant (in accordance with
Section 7(d)) representing the right to purchase the number of Warrant Shares purchasable immediately prior to such exercise under this Warrant, less the number of Warrant Shares with respect to which this Warrant is exercised. This
Warrant may not be exercised for less than 100 shares (as appropriately adjusted for stock splits, combinations and similar events). No fractional shares of Common Stock are to be issued upon the exercise of this Warrant, but rather the number
of shares of Common Stock to be issued shall be rounded up to the nearest whole number. The Company shall pay any and all taxes which may be payable with respect to the issuance and delivery of Warrant Shares upon exercise of this Warrant.

 (c) Exercise Price. For purposes of this Warrant, “Exercise Price” means the per-share
price equal to the per-share price of the Common Stock sold in the Public Offering, subject to adjustment as provided herein. If for any reason the Public Offering is not completed on or before March 31, 2011, then the Exercise Price will
thereafter be set at a price equal to the lowest closing price of the Company’s Common Stock, as reported by the OTC Bulletin Board, in the period commencing April 1, 2011 and ending May 31, 2011. 

(d) Disputes. In the case of a dispute as to the determination of the Exercise Price or the arithmetic calculation of
the Warrant Shares, the Company shall promptly issue to the Holder the number of Warrant Shares that are not disputed and resolve such dispute in accordance with Section 12. 

2. ADJUSTMENT OF EXERCISE PRICE AND NUMBER OF WARRANT SHARES. The Exercise Price and the number of Warrant Shares shall
be adjusted from time to time as follows: 
 (a) Adjustment upon Subdivision or Combination of Common
Stock. If the Company at any time on or after the Issuance Date subdivides (by any stock split, stock dividend, recapitalization or otherwise) one or more classes of its outstanding shares of Common Stock into a greater number of shares,
the Exercise Price in effect immediately prior to such subdivision will be proportionately reduced and the number of Warrant Shares will be proportionately increased. If the Company at any time on or after the Issuance Date combines (by
combination, reverse stock split or otherwise) one or more classes of its outstanding shares of Common Stock into a smaller number of shares, the Exercise Price in effect immediately prior to such combination will be proportionately increased and
the number of Warrant Shares will be proportionately decreased. Any adjustment under this Section 2(a) shall become effective at the close of business on the date the subdivision or combination becomes effective. 

 3. NONCIRCUMVENTION. The Company hereby covenants and agrees that the
Company will not, by amendment of its Certificate of Incorporation, Bylaws or through any reorganization, transfer of assets, consolidation, merger, scheme of arrangement, dissolution, issue or sale of securities, or any other voluntary action,
avoid or seek to avoid the observance or performance of any of the terms of this Warrant, and will at all times in good faith carry out all the provisions of this Warrant and take all action as may be required to protect the rights of the
Holder. Without limiting the generality of the foregoing, the Company (i) shall not increase the par value of any shares of Common Stock receivable upon the exercise of this Warrant above the Exercise Price then in effect, (ii) shall
take all such actions as may be necessary or appropriate in order that the Company may validly and legally issue fully paid and nonassessable shares of Common Stock upon the exercise of this Warrant, and (iii) shall, so long as any of the
Warrants are outstanding, take all action necessary to reserve and keep available out of its authorized and unissued shares of Common Stock, solely for the purpose of effecting the exercise of the Warrants, a sufficient number of shares of Common
Stock as shall from time to time be necessary to effect the exercise of the Warrants then outstanding (without regard to any limitations on exercise). 

4. WARRANT HOLDER NOT DEEMED A SHAREHOLDER. Except as otherwise specifically provided herein, the Holder, solely in such
Person’s capacity as a holder of this Warrant, shall not be entitled to vote or receive dividends or be deemed the holder of share capital of the Company for any purpose, nor shall anything contained in this Warrant be construed to confer upon
the Holder, solely in such Person’s capacity as the Holder of this Warrant, any of the rights of a shareholder of the Company or any right to vote, give or withhold consent to any corporate action (whether any reorganization, issue of stock,
reclassification of stock, consolidation, merger, conveyance or otherwise), receive notice of meetings, receive dividends or subscription rights, or otherwise, prior to the issuance to the Holder of the Warrant Shares which such Person is then
entitled to receive upon exercise of this Warrant. In addition, nothing contained in this Warrant shall be construed as imposing any liabilities on the Holder to purchase any securities (upon exercise of this Warrant or otherwise) or as a
shareholder of the Company, whether such liabilities are asserted by the Company or by creditors of the Company. Notwithstanding this Section 4, the Company shall provide the Holder with copies of the same notices and other information
given to the shareholders of the Company generally, contemporaneously with the giving thereof to the shareholders. 

5. REISSUANCE OF WARRANTS. 

(a) Transfer of Warrant. If this Warrant is to be transferred, the Holder shall surrender this Warrant to the Company,
whereupon the Company will forthwith issue and deliver upon the order of the Holder a new Warrant (in accordance with Section 5(d)), registered as the Holder may request, representing the right to purchase the number of Warrant Shares being
transferred by the Holder and, if less than the total number of Warrant Shares then underlying this Warrant is being transferred, a new Warrant (in accordance with Section 5(d)) to the Holder representing the right to purchase the number of
Warrant Shares not being transferred. Applicable transfer taxes, if any, shall be paid by the Holder. If the Holder proposes to transfer this Warrant to multiple Persons or entities, the Company shall have the right to condition any such
transfers on the receipt of a legal opinion from counsel to the Holder that such transfers are in compliance with the provisions of the Securities Act of 1933, as amended. 

(b) Lost, Stolen or Mutilated Warrant. Upon receipt by the Company of evidence reasonably satisfactory to the Company
of the loss, theft, destruction or mutilation of this Warrant, and, in the case of loss, theft or destruction, of any indemnification undertaking by the Holder to the Company in customary form and, in the case of mutilation, upon surrender and
cancellation of this Warrant, the Company shall execute and deliver to the Holder a new Warrant (in accordance with Section 5(d)) representing the right to purchase the Warrant Shares then underlying this Warrant. 

(c) Exchangeable for Multiple Warrants. This Warrant is exchangeable, upon the surrender hereof by the Holder at the
principal office of the Company, for a new Warrant or Warrants (in accordance with Section 5(d)) representing in the aggregate the right to purchase the number of Warrant Shares then underlying this Warrant, and each such new Warrant will
represent the right to purchase such portion of such Warrant Shares as is designated by the Holder at the time of such surrender; provided, however, that no Warrants for fractional shares of Common Stock shall be given. 

(d) Issuance of New Warrants. Whenever the Company is required to issue a new Warrant pursuant to the terms of this
Warrant, such new Warrant (i) shall be of like tenor with this Warrant, (ii) shall represent, as indicated on the face of such new Warrant, the right to purchase the Warrant Shares then underlying this Warrant (or in the case of a new
Warrant being issued pursuant to Section 5(a) or Section 5(c), the Warrant Shares designated by the Holder which, when added to the number of shares of Common Stock underlying the other new Warrants issued in connection with such issuance,
does not exceed the number of Warrant Shares then underlying this Warrant), (iii) shall have an issuance date, as indicated on the face of such new Warrant which is the same as the Issuance Date, and (iv) shall have the same rights and
conditions as this Warrant. 

 6. NOTICES. Whenever notice is required to be given under this Warrant,
unless otherwise provided herein, such notice shall be given in accordance with Section 6.2 of the Debenture. The Company shall provide the Holder with prompt written notice of all actions taken pursuant to this Warrant, including in
reasonable detail a description of such action and the reason therefore. Without limiting the generality of the foregoing, the Company will give written notice to the Holder (i) immediately upon any adjustment of the Exercise Price,
setting forth in reasonable detail, and certifying, the calculation of such adjustment and (ii) at least fifteen days prior to the date on which the Company closes its books or takes a record with respect to any dividend or distribution upon
the shares of Common Stock. 
 7. AMENDMENT AND WAIVER. Except as otherwise provided herein, the provisions of
this Warrant may be amended and the Company may take any action herein prohibited, or omit to perform any act herein required to be performed by it, only if the Company has obtained the written consent of the Holder to such action or performance. No
such amendment shall be effective to the extent that it applies to less than all of the holders of the Warrants then outstanding. 

8. GOVERNING LAW. This Agreement shall be governed by, and construed in accordance with, the internal laws of the State
of Colorado without regard to the choice of law principles thereof. 
 9. CONSTRUCTION; HEADINGS. This Warrant
shall be deemed to be jointly drafted by the Company and all the Holder and shall not be construed against any Person as the drafter hereof. The headings of this Warrant are for convenience of reference and shall not form part of, or affect the
interpretation of, this Warrant. 
 10. DISPUTE RESOLUTION. In the case of a dispute as to the determination of
the Exercise Price or the arithmetic calculation of the Warrant Shares, the Company shall submit the disputed determinations or arithmetic calculations via facsimile within two Business Days of receipt of the Exercise Notice giving rise to such
dispute, as the case may be, to the Holder. If the Holder and the Company are unable to agree upon such determination or calculation of the Exercise Price or the Warrant Shares within three Business Days of such disputed determination or
arithmetic calculation being submitted to the Holder, then the Company shall, within two Business Days submit via facsimile (a) the disputed determination of the Exercise Price to an independent, reputable investment bank selected by the
Company and approved by the Holder, or (b) the disputed arithmetic calculation of the Warrant Shares to the Company’s independent, outside accountant. The Company shall cause at its expense the investment bank or the accountant, as
the case may be, to perform the determinations or calculations and notify the Company and the Holder of the results no later than ten Business Days from the time it receives the disputed determinations or calculations. Such investment
bank’s or accountant’s determination or calculation, as the case may be, shall be binding upon all parties absent manifest error. 

11. TRANSFER. This Warrant may be offered for sale, sold, transferred or assigned without the consent of the Company,
except as may otherwise be prohibited by U.S. or other applicable securities laws. 
 12. CERTAIN
DEFINITIONS. For purposes of this Warrant, the following terms shall have the following meanings: 

(a) “Business Day” means any day other than Saturday, Sunday or other day on which commercial banks in the State
of Colorado are authorized or required by law to remain closed. 
 (b) “Common Stock” means (i) the
Company’s shares of Common Stock, par value $0.0001 per share, and (ii) any share capital into which such Common Stock shall have been changed or any share capital resulting from a reclassification of such Common Stock. 

(c) “Person” means an individual, a limited liability company, a partnership, a joint venture, a corporation, a
trust, an unincorporated organization, any other entity and a government or any department or agency thereof. 

 13. REGISTRATION RIGHTS. If the Company at any time proposes to register
any of its Common Stock under the Securities Act of 1933, as amended (“1933 Act”) for sale to the public, whether for its own account or for the account of other security holders or both, except with respect to registration
statements on Forms S-4, S-8 or another form not available for registering the Common Stock for sale to the public, provided such shares are not otherwise registered for resale by the Holder pursuant to an effective registration statement, the
Company will cause the common stock issuable to the Holder hereunder (the “Registrable Warrant Shares”) to be included with the securities to be covered by the registration statement proposed to be filed by the Company. In the
event that any registration pursuant to this Section 13 shall be, in whole or in part, an underwritten public offering of common stock of the Company, the number of shares of Registrable Warrant Shares to be included in such an underwriting may
be reduced by the managing underwriter if and to the extent that the Company and the underwriter shall reasonably be of the opinion that such inclusion would adversely affect the marketing of the securities by the Company
therein. Notwithstanding the foregoing provisions, the Company may withdraw or delay or suffer a delay of any registration statement referred to in this Section 13 without thereby incurring any liability to the Holder due to such
withdrawal or delay. These registration rights shall not encompass or apply to registration of the Registrable Warrant Shares in the Public Offering. 

[Signature Page Follows] 

 IN WITNESS WHEREOF, the Company has caused this Warrant to Purchase Common Stock to be duly
executed as of the Issuance Date set out above. 
  

			
	AMPIO PHARMACEUTICALS, INC
		
	By:	 	  

		 	Donald B. Wingerter, Jr.
		 	Chief Executive Officer

 EXHIBIT A 

EXERCISE NOTICE 

TO BE EXECUTED BY THE REGISTERED HOLDER TO EXERCISE THIS 

WARRANT TO PURCHASE COMMON STOCK 

OF 

AMPIO PHARMACEUTICALS, INC. 

The undersigned holder hereby exercises the right to purchase      of the shares of Common Stock (“Warrant
Shares”) of Ampio Pharmaceuticals, Inc. a Delaware corporation (the “Company”), evidenced by the attached Warrant to Purchase Common Stock (the “Warrant”). Capitalized terms used herein and not
otherwise defined shall have the respective meanings set forth in the Warrant. 
 1. Exercise Price. The Holder hereby elects
to exercise the Warrant to purchase      Warrant Shares for an aggregate cash exercise price of $        , and a copy of documents evidencing the payment of such amount to the
Company is included with this Exercise Notice. 
 2. Delivery of Warrant Shares. The Company shall deliver the foregoing
Warrant Shares to the Holder in accordance with the terms of the Warrant. 
 Date:
                 ,              

Name of Registered Holder 
  

			
	By:	 	 
	Name:	 	
	Title:	 	

 ACKNOWLEDGMENT 

The Company hereby acknowledges this Exercise Notice and hereby directs [Insert Name of Transfer Agent] to issue the above indicated number of
shares of Common Stock in accordance with the Transfer Agent Instructions dated                      from the Company and acknowledged and
agreed to by [Insert Name of Transfer Agent]. 
  

			
	AMPIO PHARMACEUTICALS, INC.
		
	By:	 	 
	Name:	 	
	Title:Form of Registrant's Common Stock Certificate

 Exhibit 4.1 

 

 

 NUMBER 

IG 

IDENTIVE 

GROUP 

SHARES 

INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE 

SEE REVERSE FOR CERTAIN DEFINITIONS AND A STATEMENT AS TO RIGHTS, PREFERENCES, PRIVILEGES AND RESTRICTIONS, IF ANY

 This Certifies that CUSIP 45170X 10 6 

ISIN US 45170X1063 

is the record holder of 

FULLY PAID AND NONASSESSABLE SHARES OF COMMON STOCK, $.001 PAR VALUE PER SHARE, OF 

IDENTIVE GROUP, INC. 

transferable on the books of the Corporation by the holder hereof in person or by duly authorized Attorney upon surrender
of this certificate properly endorsed. This certificate is not valid until countersigned by the Transfer Agent and registered by the Registrar. 

WITNESS the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers. 

Dated 

SECRETARY 

CHIEF EXECUTIVE OFFICER 

IDENTIVE GROUP, INC. 

CORPORATE 

SEAL 

DEC. 13, 

1996 

DELAWARE 

©SECURITY-COLUMBIAN UNITED STATES BANKNOTE CORPORATION 

COUNTERSIGNED AND REGISTERED: 

AMERICAN STOCK TRANSFER & TRUST COMPANY, LLC 

(NEW YORK, NY) 

TRANSFER AGENT AND REGISTRAR 

BY 

AUTHORIZED SIGNATURE 

AMERICAN BANK NOTE COMPANY 

711 ARMSTRONG LANE 

COLUMBIA, TENNESSEE 38401 

(931) 388-3003 

SALES: DENISE LITTLE 931-490-1706 

PROOF OF: JUNE 23, 2010 

IDENTIVE GROUP, INC. 

TSB 1863 FC 

OPERATOR: JB 

NEW 

COLORS SELECTED FOR PRINTING: Logo prints in BLACK. Intaglio prints in SC-4 OLIVE. 

COLOR: This proof was printed from a digital file or artwork on a graphics quality, color laser printer. It is a good
representation of the color as it will appear on the final product. However, it is not an exact color rendition, and the final printed product may appear slightly different from the proof due to the difference between the dyes and printing ink.

 PLEASE INITIAL THE APPRORIATE SELECTION FOR THIS PROOF: OK AS IS OK WITH CHANGES MAKE CHANGES AND SEND ANOTHER
PROOF 
 © S:C.B.Co. 

 A statement of the powers, designations, preferences and relative, participating, optional
or other special rights of each class of stock or series thereof and the qualifications, limitations or restrictions of such preferences and/or rights as established, from time to time, by the Certificate of Incorporation of the Corporation and by
any certificate of determination, the number of shares constituting each class and series, and the designations thereof, may be obtained by the holder hereof upon request and without charge at the principal office of the Corporation. 

The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written
out in full according to applicable laws or regulations: 
  

																	
	TEN COM	 	—	 	as tenants in common	  	UNIF GIFT MIN ACT –	 	  
	 	Custodian	 	  

	TEN ENT	 	—	 	as tenants by the entireties	  		 		 	(Cust) 	 		 	(Minor) 	 	
	JT TEN	 	—	 	 as joint tenants with right of

survivorship and not as tenants
 in
common
	  		 	 under Uniform Gifts to Minors

		 		 	  		 	Act	 	  

		 		 	  		 		 		 	(State)	 		 	
		 		 		  	UNIF TRF MIN ACT –	 		 	  
	 	Custodian (until age	 	  
	 	)
		 		 		  		 		 	(Cust)	 		 		 	
		 		 		  		 		 	                           
  under Uniform Transfers	 	
		 		 		  		 		 	(Minor)	 		 		 	
		 		 		  		 		 	to Minors Act                       
                                  	 	
		 		 		  		 		 	(State)	 	

 Additional abbreviations may also be used though not in the above list. 

FOR VALUE RECEIVED,
                                        
hereby sell, assign and transfer unto 
  

	
	 PLEASE INSERT SOCIAL SECURITY OR OTHER

IDENTIFYING NUMBER OF ASSIGNEE
  

	 
	 

 
  
  

(PLEASE PRINT OR TYPEWRITE NAME AND ADDRESS, INCLUDING ZIP CODE, OF ASSIGNEE) 

 
  
  

 
  
  

			
	  
	 	Shares

 of the common stock represented by
the within Certificate, and do hereby irrevocably constitute and appoint 

			
	  
	 	Attorney

 to transfer the said stock on the books of the
within named Corporation with full power of substitution in the premises. 
  

			
	Dated	 	  

  

			
	X	 	  

	X	 	  

	NOTICE:	 	THE SIGNATURE(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY
CHANGE WHATEVER.

 Signature(s) Guaranteed 
  

			
	By	 	  

	THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN
APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17Ad-15.

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