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