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