0001415889-21-001543.txt : 20210317 0001415889-21-001543.hdr.sgml : 20210317 20210317183516 ACCESSION NUMBER: 0001415889-21-001543 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210316 FILED AS OF DATE: 20210317 DATE AS OF CHANGE: 20210317 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: 21752171 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 form4-03172021_030303.xml X0306 4 2021-03-16 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 2021-03-16 4 M 0 40000 0.43 A 68315 D Common Stock 2021-03-16 4 S 0 40000 1.8262 D 28315 D Stock Option (Right to Buy) 0.43 2021-03-16 4 M 0 40000 0 D 2029-08-20 Common Stock 40000 318000 D Options were granted and previously reported on a Form 4 dated August 22, 2019, where 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 on July 31, 2020. /s/ Asad Salahuddin, Attorney-in-Fact 2021-03-17