Ampio Pharmaceuticals (AMPE) Form 4 Ampio Pharmaceuticals / DAN STOKELY ownership change

SEC Form 4

FORM 4

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

1. Name and Address of Reporting Person^*

STOKELY DAN

(Last) (First) (Middle)

C/O AMPIO PHARMACEUTICALS, INC.

373 INVERNESS PARKWAY, SUITE 200

(Street)

ENGLEWOOD CO 80112

(City) (State) (Zip)

2. Issuer Name and Ticker or Trading Symbol
Ampio Pharmaceuticals, Inc. [ AMPE ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
CFO

3. Date of Earliest Transaction (Month/Day/Year)
02/12/2021

4. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	3. Transaction Code (Instr. 8)		4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)			5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)	6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
			Code	V	Amount	(A) or (D)	Price
Common Stock	02/12/2021		M(1)		42,000	A	$2.55	42,000	D
Common Stock	02/12/2021		M(1)		10,500	A	$2.55	52,500	D
Common Stock	02/12/2021		F		24,185	D	$2.55	28,315	D

Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)	2. Conversion or Exercise Price of Derivative Security	3. Transaction Date (Month/Day/Year)	3A. Deemed Execution Date, if any (Month/Day/Year)	4. Transaction Code (Instr. 8)		5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)		6. Date Exercisable and Expiration Date (Month/Day/Year)		7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4)		8. Price of Derivative Security (Instr. 5)	9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4)	10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
				Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Stock Option (Right to Buy)	$0.43	02/12/2021		M(1)			42,000	(2)	08/20/2029	Common Stock	42,000	$0	358,000	D
Stock Option (Right to Buy)	$0.5872	02/12/2021		M(1)			10,500	(3)	01/02/2030	Common Stock	10,500	$0	19,500	D

Explanation of Responses:

1. The option exercise reported on this Form 4 was effected pursuant to a Rule 10b5-1 Trading Plan adopted by the reporting person on December 23, 2020.

2. Options were granted and previously reported on a Form 4 dated August 22, 2019, where 50% of the stock option award vested and became exerciserable on the date of the August 20, 2019 grant and the remaining 50% of the stock option award vested and became exerciserable on July 31, 2020.

3. Options were granted and previously reported on a Form 4 dated January 6, 2020, where 50% of the option award vested and became exercisable on the January 2, 2020 date of the grant and the remaining 50% of the option award vested and became exercisable on July 31, 2020.

	/s/ Asad Salahuddin, Attorney-in-Fact	02/17/2021
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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