0001415889-21-004876.txt : 20211015
0001415889-21-004876.hdr.sgml : 20211015
20211015144306
ACCESSION NUMBER: 0001415889-21-004876
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20211013
FILED AS OF DATE: 20211015
DATE AS OF CHANGE: 20211015
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Stevens David R
CENTRAL INDEX KEY: 0001292382
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35182
FILM NUMBER: 211325786
MAIL ADDRESS:
STREET 1: 300 ELLIOTT AVENUE WEST
STREET 2: SUITE 500
CITY: SEATTLE
STATE: WA
ZIP: 98119-4114
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
form4-10152021_111058.xml
X0306
4
2021-10-13
0001411906
Ampio Pharmaceuticals, Inc.
AMPE
0001292382
Stevens David R
C/O AMPIO PHARMACEUTICALS, INC.
373 INVERNESS PARKWAY, SUITE 200
ENGLEWOOD
CO
80112
true
false
false
false
Stock Option (Right to Buy)
1.67
2021-10-13
4
A
0
120000
0
A
2031-10-13
Common Stock
120000
120000
D
The options vest as follows: 50% on the grant date and 50% on March 31, 2022.
/s/ Daniel Stokely, Attorney-in-Fact
2021-10-15