0001415889-20-002891.txt : 20201215
0001415889-20-002891.hdr.sgml : 20201215
20201215141855
ACCESSION NUMBER: 0001415889-20-002891
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201212
FILED AS OF DATE: 20201215
DATE AS OF CHANGE: 20201215
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bar-Or David
CENTRAL INDEX KEY: 0001530630
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35182
FILM NUMBER: 201389205
MAIL ADDRESS:
STREET 1: C/O AMPIO PHARMACEUTICALS, INC.
STREET 2: 373 INVERNESS PARKWAY, SUITE 200
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
4
1
form4-12152020_111245.xml
X0306
4
2020-12-12
0001411906
Ampio Pharmaceuticals, Inc.
AMPE
0001530630
Bar-Or David
C/O AMPIO PHARMACEUTICALS, INC.
373 INVERNESS PARKWAY, SUITE 200
ENGLEWOOD
CO
80112
true
false
false
false
Stock Option (Right to Buy)
1.50
2020-12-12
4
A
0
36000
0
A
2030-12-12
Common Stock
36000
36000
D
The option vests at a rate of 3,000 shares per month, beginning on January 12, 2021, until fully vested.
/s/ Asad Salahuddin, Attorney-in-Fact
2020-12-15