0001209191-16-133291.txt : 20160719
0001209191-16-133291.hdr.sgml : 20160719
20160719160826
ACCESSION NUMBER: 0001209191-16-133291
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20160715
FILED AS OF DATE: 20160719
DATE AS OF CHANGE: 20160719
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gould Gregory A
CENTRAL INDEX KEY: 0001252905
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35182
FILM NUMBER: 161773599
MAIL ADDRESS:
STREET 1: 1111 MAIN STREET, SUITE 660
CITY: VANCOUVER
STATE: WA
ZIP: 98660
FORMER NAME:
FORMER CONFORMED NAME: GOULD GREGORY A
DATE OF NAME CHANGE: 20030708
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2016-07-15
0
0001411906
Ampio Pharmaceuticals, Inc.
AMPE
0001252905
Gould Gregory A
C/O AMPIO PHARMACEUTICALS, INC.
373 INVERNESS PARKWAY, SUITE 200
ENGLEWOOD
CO
80112
0
1
0
0
Chief Financial Officer
Stock Option (Right to Buy)
1.03
2016-07-15
4
A
0
150000
0.00
A
2026-07-15
Common Stock
150000
416666
D
The Stock Option vests and becomes exercisable in three equal installments. 1/3rd of the shares vested on the grant date July 15, 2016; 1/3rd of the shares shall vest on July 15, 2017; and 1/3rd of the shares shall vest on July 15, 2018.
/s/ Gregory A. Gould
2016-07-19