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