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