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