0001104659-21-068828.txt : 20210518 0001104659-21-068828.hdr.sgml : 20210518 20210518160603 ACCESSION NUMBER: 0001104659-21-068828 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210514 FILED AS OF DATE: 20210518 DATE AS OF CHANGE: 20210518 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Baker David Charles CENTRAL INDEX KEY: 0001844060 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40034 FILM NUMBER: 21935991 MAIL ADDRESS: STREET 1: 100 N. 18TH STREET STREET 2: SUITE 300 CITY: PHILADELPHIA STATE: PA ZIP: 19103 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Vallon Pharmaceuticals, Inc. CENTRAL INDEX KEY: 0001824293 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 824369909 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: TWO LOGAN SQUARE STREET 2: 100 N. 18TH STREET, SUITE 300 CITY: PHILADELPHIA STATE: PA ZIP: 19103 BUSINESS PHONE: (267) 207-3606 MAIL ADDRESS: STREET 1: TWO LOGAN SQUARE STREET 2: 100 N. 18TH STREET, SUITE 300 CITY: PHILADELPHIA STATE: PA ZIP: 19103 4 1 tm2116776-2_4.xml OWNERSHIP DOCUMENT X0306 4 2021-05-14 0 0001824293 Vallon Pharmaceuticals, Inc. VLON 0001844060 Baker David Charles C/O VALLON PHARMACEUTICALS, INC. 100 N. 18TH STREET, SUITE 300 PHILADELPHIA PA 19103 1 1 0 0 Chief Executive Officer Stock Option (Right to Buy) 3.66 2021-05-14 4 A 0 100000 0.00 A 2031-05-14 Common Stock 100000 100000 D Vests as to 25% of the underlying shares of common stock on the first annual anniversary of the date of grant, then in 12 equal quarterly installments such that the stock option is fully vested on the fourth annual anniversary of the date of grant. /s/ David Baker 2021-05-18