0001415889-21-005018.txt : 20211028 0001415889-21-005018.hdr.sgml : 20211028 20211028203233 ACCESSION NUMBER: 0001415889-21-005018 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211027 FILED AS OF DATE: 20211028 DATE AS OF CHANGE: 20211028 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: 211360141 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 form4-10282021_051021.xml X0306 4 2021-10-27 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 PRESIDENT AND COO Common Stock 2021-10-27 4 F 0 41980 1.64 D 458020 D /s/ Daniel Stokely, Attorney-in-Fact 2021-10-28