0001213900-19-026186.txt : 20191213
0001213900-19-026186.hdr.sgml : 20191213
20191213210040
ACCESSION NUMBER: 0001213900-19-026186
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191212
FILED AS OF DATE: 20191213
DATE AS OF CHANGE: 20191213
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: 191285734
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
OWNERSHIP DOCUMENT
X0306
4
2019-12-12
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
351055
D
Common Stock
40463
I
Medico-Trans Company, LLC
Common Stock
2019-12-12
4
S
0
150000
1.00
D
698336
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
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.
/s/ Bankole Johnson
2019-12-13