ADIAL PHARMACEUTICALS, INC.|4Aug 2, 4:08 PM ET

En Fidecomiso de Mi Vida 11/23/2010 Trust 4

4 · ADIAL PHARMACEUTICALS, INC. · Filed Aug 2, 2018

Insider Transaction Report

Form 4

Period: 2018-07-31

ADIAL PHARMACEUTICALS, INC.ADIL

Johnson Bankole A.

Director10% Owner

Transactions

Purchase
Common Stock
2018-07-31+1,400→ 1,400 total
Award
Common Stock
2018-07-31+40,382→ 313,750 total(indirect: By LLC)
Conversion
Convertible Note
2018-07-31$0.44/sh−153,114$67,370→ 0 total
Exercise: $0.44→ Common Stock (153,114 underlying)
Other
Common Stock
2018-07-31+17,600→ 273,368 total
Other
Warrant to purchase common stock
2018-07-31+17,600→ 17,600 total
Exercise: $6.25From: 2018-07-31Exp: 2023-07-31→ Common Stock (17,600 underlying)
Other
Warrant to purchase units
2018-07-31+17,600→ 17,600 total
Exercise: $5.00From: 2018-07-31Exp: 2023-07-31→ Units (35,200 underlying)
Conversion
Warrant to purchase common stock
2018-07-31+153,114→ 170,714 total
Exercise: $6.25→ Common Stock (153,114 underlying)
Purchase
Warrant to purchase common stock
2018-07-31+1,400→ 169,314 total
Exercise: $6.25From: 2018-07-31Exp: 2023-07-31→ Common Stock (1,400 underlying)
Conversion
Common Stock
2018-07-31$0.44/sh+153,114$67,370→ 255,768 total

Holdings

Common Stock
(indirect: By Trust)
7,440
Common Stock
(indirect: Lina Tiouririne)
930
Common Stock
(indirect: By Trust)
850,896
Common Stock
(indirect: By Trust)
93,000
Common Stock
(indirect: By Trust)
22,320
Common Stock
(indirect: Ade Johnson)
1,395
Common Stock
(indirect: Lola Johnson)
1,395
Common Stock
(indirect: Aida Tiouririne)
930
Common Stock
(indirect: Efunbowale Johnson)
4,650

Footnotes (9)

[F1]The 153,114 shares of common stock and a warrant to purchase 153,114 shares of common stock were issued upon automatic conversion of a convertible note in the principal amount of $52,000 together with interest accrued thereon at a conversion price of $0.44 per share upon consummation of the initial public offering on July 31, 2018.
[F2]The 17,600 shares were received upon consummation of the initial public offering in accordance with a Securities Purchase Agreement dated February 22, 2018.
[F3]On July 31, 2018, Dr. Johnson purchased 1,400 units (the "Units") in the initial public offering at a price of $5.00 per Unit, which corresponds to a price of $4.99 per share of common stock and $0.01 per warrant. Each Unit consisted of one share of common stock and a warrant to purchase one share of common stock. The shares of common stock and warrants were immediately separable upon issuance of the Units in the initial public offering.
[F4]The 40,382 shares were received upon consummation of the initial public offering in accordance with a Services Agreement with Medico-Trans Company, LLC.
[F5]Medico-Trans Company, LLC is controlled by Bankole Johnson.
[F6]Dr. Johnson is the trustee of each of these trusts.
[F7]Dr. Johnson has a voting proxy on this person's behalf that entitles him to vote these shares.
[F8]A warrant to purchase 17,600 shares of common stock was issued upon consummation of the initial public offering in accordance with a Securities Purchase Agreement dated February 22, 2018.
[F9]The warrant to purchase 17,600 units was received by the reporting person upon consummation of the initial public offering in accordance with a Securities Purchase Agreement dated February 22, 2018. Each unit consisted of a share of common stock and a warrant to purchase a share of common stock. The aggregate number of shares of common stock included in the units and underlying the warrants included in the units is 35,200 shares.

Documents

1 file

4
ownership.xmlPrimary
OWNERSHIP DOCUMENT