0001209191-17-053669.txt : 20170921 0001209191-17-053669.hdr.sgml : 20170921 20170921214258 ACCESSION NUMBER: 0001209191-17-053669 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170919 FILED AS OF DATE: 20170921 DATE AS OF CHANGE: 20170921 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Cherevka Holli CENTRAL INDEX KEY: 0001717673 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35182 FILM NUMBER: 171096641 MAIL ADDRESS: STREET 1: C/O AMPIO PHARMACEUTICALS, INC. STREET 2: 373 IVERNESS PARKWAY CITY: ENGLEWOOD STATE: CO ZIP: 80112 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2017-09-19 0 0001411906 Ampio Pharmaceuticals, Inc. AMPE 0001717673 Cherevka Holli C/O AMPIO PHARMACEUTICALS, INC. 373 INVERNESS PARKWAY, SUITE 200 ENGLEWOOD CO 80112 0 1 0 0 Chief Operating Officer Stock Option (Right to Buy) 4.16 2023-01-14 Common Stock 35000 D Stock Option (Right to Buy) 4.72 2023-04-02 Common Stock 45000 D Stock Option (Right to Buy) 8.62 2023-11-08 Common Stock 80000 D Stock Option (Right to Buy) 3.43 2024-10-06 Common Stock 30000 D Stock Option (Right to Buy) 1.03 2026-07-15 Common Stock 170000 D Stock Option (Right to Buy) 0.51 2026-08-08 Common Stock 30000 D Stock Option (Right to Buy) 0.55 2027-09-19 Common Stock 200000 D The Stock Options vested and became exercisable in four installments. 1/4th of the options vested on the grant date of January 14, 2013, 1/4 th of the options vested on January 14, 2014, 1/4th of the options vested on January 14, 2015 and 1/4th of the options vested on January 14, 2016. The Stock Options vested and became exercisable in four installments. 1/4th of the options vested on the grant date of April 2, 2013, 1/4 th of the options vested on January 14, 2014, 1/4th of the options vested on January 14, 2015 and 1/4th of the options vested on January 14, 2016. The Stock Options vested and became exercisable monthly over 36 months in equal installments. The Stock Options vested and became exercisable in two installments. 1/2 of the options vested on the grant date of October 6, 2014, and 1/2th of the options vested on October 6, 2015. The Stock Options vest and become exercisable in three installments. 1/3rd of the options vested on the grant date of July 15, 2016, 1/3rd of the options vested on July 15, 2017 and 1/3rd of the options vest on July 15, 2018. The Stock Options vest and become exercisable immediately. The Stock Options vest and become exercisable in two equal installments. 1/2 of the options vested on the grant date of September 19, 2017; and the additional 1/2 of the options shall vest on September 19, 2018. /s/ Holli Cherevka 2017-09-21