0001415889-21-004956.txt : 20211025
0001415889-21-004956.hdr.sgml : 20211025
20211025105920
ACCESSION NUMBER: 0001415889-21-004956
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211021
FILED AS OF DATE: 20211025
DATE AS OF CHANGE: 20211025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BUCHI J KEVIN
CENTRAL INDEX KEY: 0001209726
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35182
FILM NUMBER: 211342721
MAIL ADDRESS:
STREET 1: 41 MOORES ROAD
CITY: FRAZER
STATE: PA
ZIP: 19355
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Ampio Pharmaceuticals, Inc.
CENTRAL INDEX KEY: 0001411906
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 260179592
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 373 INVERNESS PARKWAY
STREET 2: SUITE 200
CITY: ENGLEWOOD
STATE: CO
ZIP: 80112
BUSINESS PHONE: 720-437-6500
MAIL ADDRESS:
STREET 1: 373 INVERNESS PARKWAY
STREET 2: SUITE 200
CITY: ENGLEWOOD
STATE: CO
ZIP: 80112
FORMER COMPANY:
FORMER CONFORMED NAME: Chay Enterprises, Inc.
DATE OF NAME CHANGE: 20070910
4
1
form4-10252021_071011.xml
X0306
4
2021-10-21
0001411906
Ampio Pharmaceuticals, Inc.
AMPE
0001209726
BUCHI J KEVIN
C/O AMPIO PHARMACEUTICALS, INC.
373 INVERNESS PARKWAY, SUITE 200
ENGLEWOOD
CO
80112
true
false
false
false
Stock Option (Right to Buy)
1.67
2021-10-21
4
A
0
150000
0
A
2031-10-13
Common Stock
150000
150000
D
The stock options vest as to 1/36 of the underlying shares monthly on the 13th day of each month for three years (until October 13, 2024). The vesting commencement date is October 13, 2021.
/s/ Dan Stokely, Attorney-in-Fact
2021-10-25