0001213900-19-005524.txt : 20190401 0001213900-19-005524.hdr.sgml : 20190401 20190401165744 ACCESSION NUMBER: 0001213900-19-005524 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190328 FILED AS OF DATE: 20190401 DATE AS OF CHANGE: 20190401 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Johnson Bankole A. CENTRAL INDEX KEY: 0001718158 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38323 FILM NUMBER: 19721506 MAIL ADDRESS: STREET 1: 1180 SEMINOLE TRAIL STREET 2: SUITE 495 CITY: CHARLOTTESVILLE STATE: VA ZIP: 22901 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ADIAL PHARMACEUTICALS, INC. CENTRAL INDEX KEY: 0001513525 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 800667150 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1180 SEMINOLE TRAIL STREET 2: SUITE 495 CITY: CHARLOTTESVILLE STATE: VA ZIP: 22902 BUSINESS PHONE: 434-422-9800 MAIL ADDRESS: STREET 1: 1180 SEMINOLE TRAIL STREET 2: SUITE 495 CITY: CHARLOTTESVILLE STATE: VA ZIP: 22902 FORMER COMPANY: FORMER CONFORMED NAME: ADial Pharmaceuticals, L.L.C. DATE OF NAME CHANGE: 20170515 FORMER COMPANY: FORMER CONFORMED NAME: Adial Pharmaceuticals, L.L.C. DATE OF NAME CHANGE: 20110218 4 1 ownership.xml X0306 4 2019-03-28 0 0001513525 ADIAL PHARMACEUTICALS, INC. ADIL 0001718158 Johnson Bankole A. 1001 RESEARCH PARK BLVD., SUITE 100 CHARLOTTESVILLE VA 22911 0 1 1 0 Chief Medical Officer Common Stock 2019-03-28 4 P 0 40000 3.1452 A 314768 D Common Stock 2019-03-29 4 P 0 30000 3.4718 A 344768 D Common Stock 2019-03-29 4 P 0 2500 3.4676 A 347268 D Common Stock 2019-03-29 4 P 0 600 3.2967 A 347868 D Common Stock 40463 I Medico-Trans Company, LLC Common Stock 848336 I En Fideicomiso De Mi Vida 11/23/2010 (Trust) Common Stock 93000 I En Fidecomiso de Todos Mis Suenos Grantor Retained Annuity Trust dated June 27, 2017 Common Stock 22320 I En Fideicomiso De Mis Suenos 11/23/2010 (Trust) Common Stock 10000 I De Mi Amor 11/23/2010 (Trust) Common Stock 4650 I Efunbowale Johnson Common Stock 1395 I Ade Johnson Common Stock 1395 I Lola Johnson Common Stock 930 I Lina Tiouririne Common Stock 930 I Aida Tiouririne Stock Option 5.70 2027-06-30 Common Stock 5580 5580 D Stock Option 3.01 2029-03-23 Common Stock 250000 250000 D Warrant to purchase common stock 7.63 2017-10-10 2031-12-31 Common Stock 3275 3275 D Warrant to purchase common stock 6.25 2018-07-31 2023-07-31 Common Stock 189714 189714 D Warrant to purchase common stock 5.00 2018-11-12 2023-07-31 Common Stock 17600 17600 D Medico-Trans Company, LLC is controlled by Bankole Johnson. Dr. Johnson is the trustee of each of these trusts. Dr. Johnson has a voting proxy on this person's behalf that entitles him to vote these shares. Options to buy 3,100 shares are currently exercisable with the remaining options to buy 2,480 shares vesting 1/36th (155 shares) on the first day of each month over the remaining 16 months. Options to buy 250,000 shares vest pro rata on a monthly basis over 36 months commencing March 24, 2019. /s/ Bankole Johnson 2019-04-01