Initial Statement of Beneficial Ownership (3)
04 January 2023 - 10:07AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Hermans Kate |
2. Date of Event Requiring Statement (MM/DD/YYYY)
1/1/2023
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3. Issuer Name and Ticker or Trading Symbol
Ambrx Biopharma Inc. [AMAM]
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(Last)
(First)
(Middle)
C/O AMBRX BIOPHARMA INC., 10975 TORREY PINES ROAD |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
LA JOLLA, CA 92037
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (right to buy) | (1) | 6/29/2032 | Ordinary Shares (2) | 210000 | $0.38 | D | |
Stock Option (right to buy) | (3) | 7/7/2032 | Ordinary Shares (2) | 105000 | $0.43 | D | |
Stock Option (right to buy) | 12/15/2022 | 8/14/2032 | Ordinary Shares (2) | 210000 | $0.35 | D | |
Explanation of Responses: |
(1) | The Ordinary Shares subject to the option vest in thirty-six equal monthly installments following June 30, 2022. |
(2) | The Ordinary Shares of the Issuer may be represented by American Depositary Shares ("ADSs"). Each ADS represents seven Ordinary Shares of the Issuer. |
(3) | The Ordinary Shares subject to the option will vest on the earlier of (i) the one-year anniversary of the date of grant, or (ii) the day immediately prior to the date of the next Annual Grant Date as defined in the Company's Non-Employee Director Compensation Policy. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Hermans Kate C/O AMBRX BIOPHARMA INC. 10975 TORREY PINES ROAD LA JOLLA, CA 92037 | X |
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Signatures
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/s/ Sonja Nelson, Attorney-in-Fact for Kate Hermans | | 1/3/2023 |
**Signature of Reporting Person | Date |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
* | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
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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