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