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