0001415889-19-000949.txt : 20190822 0001415889-19-000949.hdr.sgml : 20190822 20190822150451 ACCESSION NUMBER: 0001415889-19-000949 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190820 FILED AS OF DATE: 20190822 DATE AS OF CHANGE: 20190822 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: STOKELY DAN CENTRAL INDEX KEY: 0001277543 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35182 FILM NUMBER: 191045801 MAIL ADDRESS: STREET 1: 4810 EASTGATE MALL 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 form4-08222019_120838.xml X0306 4 2019-08-20 0001411906 Ampio Pharmaceuticals, Inc. AMPE 0001277543 STOKELY DAN C/O AMPIO PHARMACEUTICALS, INC. 373 INVERNESS PARKWAY, SUITE 200 ENGLEWOOD CO 80112 false true false false CFO Stock Option (Right to Buy) 0.3887 2019-08-20 4 D 0 430000 0 D 2029-07-31 Common Stock 430000 0 D Stock Option (Right to Buy) 0.43 2019-08-20 4 A 0 400000 0 A 2029-08-20 Common Stock 400000 400000 D This option was cancelled by mutual agreement between the company and the reporting person. 50% of the stock option award vests and becomes exerciserable on the date of grant, the remaining 50% of the stock option award vests and becomes exerciserable in July 31, 2020. /s/ Daniel Stokely 2019-08-22