0001415889-21-002667.txt : 20210525
0001415889-21-002667.hdr.sgml : 20210525
20210525154525
ACCESSION NUMBER: 0001415889-21-002667
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210521
FILED AS OF DATE: 20210525
DATE AS OF CHANGE: 20210525
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Cherevka Holli
CENTRAL INDEX KEY: 0001717673
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35182
FILM NUMBER: 21960348
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
4
1
form4-05252021_120509.xml
X0306
4
2021-05-21
0001411906
Ampio Pharmaceuticals, Inc.
AMPE
0001717673
Cherevka Holli
C/O AMPIO PHARMACEUTICALS, INC.
373 INVERNESS PARKWAY, SUITE 200
ENGLEWOOD
CO
80112
false
true
false
false
CHIEF OPERATING OFFICER
Common Stock
2021-05-21
4
M
0
2603
.51
A
2603
D
Common Stock
2021-05-21
4
S
0
2603
2
D
0
D
Stock Option (Right to Buy)
0.51
2021-05-21
4
M
0
2603
0
D
2029-09-16
Common Stock
2603
152766
D
The option exercise reported on this Form 4 was effected pursuant to a Rule 10b5-1 Trading Plan adopted by the reporting person on March 12, 2021.
Options were granted and previously reported on a Form 4 filed on September 18, 2019, where 50% of the options awarded vested and became exercisable on the grant date of September 16, 2019 and the other 50% of the options awarded vested and became exercisable on the first anniversary of the grant date.
/s/ Daniel Stokely, Attorney-in-Fact
2021-05-25