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