SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Gross Jane A

(Last) (First) (Middle)
2401 4TH AVENUE, SUITE 1050

(Street)
SEATTLE WA 98121

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/01/2016
3. Issuer Name and Ticker or Trading Symbol
Aptevo Therapeutics Inc. [ APVO ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
See Remarks
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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)
Common Stock 3,658(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: 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) 03/10/2017 03/10/2021 Common Stock 29,010 $2.47 D
Restricted Stock Units(1) 03/10/2017 03/10/2021 Common Stock 14,506 (2) D
Stock Option (right to buy)(1) (3) 03/09/2022 Common Stock 38,908 $2.55 D
Restricted Stock Units(1) (4) 03/09/2022 Common Stock 19,455 (2) D
Stock Option (right to buy)(1) (5) 02/28/2026 Common Stock 54,721 $2.97 D
Restricted Stock Units(1) (6) 02/28/2026 Common Stock 27,418 (2) D
Restricted Stock Units 08/01/2017 08/03/2026 Common Stock 38,093 (2) D
Restricted Stock Units (7) 02/10/2018 Common Stock 36,271 (2) D
Explanation of Responses:
1. Each security was originally issued by Emergent BioSolutions, Inc. and, as a result of the spin-off of the Issuer from Emergent BioSolutions, Inc. effective on August 1, 2016, was adjusted and assumed by the Issuer.
2. Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock.
3. The stock options were granted on March 10, 2015 and vest in two equal installments on March 9, 2017 and March 9, 2018.
4. The restricted stock units were granted on March 10, 2015 and vest as follows: 9,727 on March 9, 2017 and 9,728 on March 9, 2018.
5. The stock options were granted on March 1, 2016 and vest as follows: 18,241 on March 1, 2017, 18,241 on March 1, 2018 and 18,239 on March 1, 2019.
6. The restricted stock units were granted on March 1, 2016 and vest as follows: 9,140 on March 1, 2017, 9,140 on March 1, 2018 and 9,138 on March 1, 2019.
7. The restricted stock units were granted on August 3, 2016 and vest as follows: 18,135 on February 3, 2017, and 18,136 on February 3, 2018.
Remarks:
Title - SVP, Research and Non-Clinical Development. Exhibit List: Exhibit 24 - Power of Attorney.
/s/ Benjamin J. Stein, attorney-in-fact 09/12/2016
** 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.
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