0001415889-21-000728.txt : 20210217 0001415889-21-000728.hdr.sgml : 20210217 20210217145117 ACCESSION NUMBER: 0001415889-21-000728 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210212 FILED AS OF DATE: 20210217 DATE AS OF CHANGE: 20210217 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: 21644111 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 form4-02172021_110207.xml X0306 4 2021-02-12 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 Common Stock 2021-02-12 4 M 0 42000 2.55 A 42000 D Common Stock 2021-02-12 4 M 0 10500 2.55 A 52500 D Common Stock 2021-02-12 4 F 0 24185 2.55 D 28315 D Stock Option (Right to Buy) 0.43 2021-02-12 4 M 0 42000 0 D 2029-08-20 Common Stock 42000 358000 D Stock Option (Right to Buy) 0.5872 2021-02-12 4 M 0 10500 0 D 2030-01-02 Common Stock 10500 19500 D The option exercise reported on this Form 4 was effected pursuant to a Rule 10b5-1 Trading Plan adopted by the reporting person on December 23, 2020. Options were granted and previously reported on a Form 4 dated August 22, 2019, where 50% of the stock option award vested and became exerciserable on the date of the August 20, 2019 grant and the remaining 50% of the stock option award vested and became exerciserable on July 31, 2020. Options were granted and previously reported on a Form 4 dated January 6, 2020, where 50% of the option award vested and became exercisable on the January 2, 2020 date of the grant and the remaining 50% of the option award vested and became exercisable on July 31, 2020. /s/ Asad Salahuddin, Attorney-in-Fact 2021-02-17