0001415889-21-005524.txt : 20211124 0001415889-21-005524.hdr.sgml : 20211124 20211124165059 ACCESSION NUMBER: 0001415889-21-005524 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211122 FILED AS OF DATE: 20211124 DATE AS OF CHANGE: 20211124 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MARTINO MICHAEL A CENTRAL INDEX KEY: 0001238250 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35182 FILM NUMBER: 211447532 MAIL ADDRESS: STREET 1: C/O AMBIT BIOSCIENCES CORPORATION STREET 2: 11080 ROSELLE STREET CITY: SAN DIEGO STATE: CA ZIP: 92121 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 form4-11242021_011146.xml X0306 4 2021-11-22 0001411906 Ampio Pharmaceuticals, Inc. AMPE 0001238250 MARTINO MICHAEL A C/O AMPIO PHARMACEUTICALS, INC. 373 INVERNESS PARKWAY, SUITE 200 ENGLEWOOD CO 80112 true true false false INTERIM CHAIRMAN AND CEO Stock Option (Right to Buy) 1.14 2021-11-22 4 A 0 750000 0 A 2031-11-22 Common Stock 750000 750000 D The stock option vested and became exercisable with respect to 500,000 shares of common stock on November 22, 2021, and will vest with respect to the remaining 250,000 shares of common stock on November 22, 2022. /s/ Dan Stokely, Attorney-in-Fact 2021-11-24