Filing Details

Accession Number:
0001213900-18-010083
Form Type:
4
Zero Holdings:
No
Publication Time:
2018-08-02 16:03:09
Reporting Period:
2018-07-31
Accepted Time:
2018-08-02 16:03:09
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1513525 Adial Pharmaceuticals Inc. ADIL Pharmaceutical Preparations (2834) 800667150
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1718351 H. Robertson Gilliland 1180 Seminole Trail, Suite 495
Charlottesville, VA 22901
Yes No No No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2018-07-31 29,931 $0.00 95,424 No 4 C Indirect Owned by Keller Enterprises, LLC
Common Stock Acquisiton 2018-07-31 14,000 $0.00 109,424 No 4 P Indirect Owned by Keller Enterprises, LLC
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 C Indirect Owned by Keller Enterprises, LLC
No 4 P Indirect Owned by Keller Enterprises, LLC
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Convertible Note Disposition 2018-07-31 29,931 $0.00 29,931 $0.44
Common Stock Warrant to purchase common stock Acquisiton 2018-07-31 29,931 $0.00 29,931 $6.25
Common Stock Warrant to purchase common stock Acquisiton 2018-07-31 14,000 $0.00 43,931 $6.25
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Indirect
29,931 2018-07-31 2023-07-31 No 4 C Indirect
43,931 2018-07-31 2023-07-31 No 4 P Indirect
Footnotes
  1. The 29,931 shares of common stock and a warrant to purchase 29,931 shares of common stock were issued upon automatic conversion of a convertible note in the principal amount of $10,000 at a conversion price of $0.44 per share upon consummation of the initial public offering of the issuer on July 31, 2018.
  2. Mr. Gilliland is the principal of Keller Enterprises, LLC ("Keller").
  3. On July 31, 2018, Keller purchased 14,000 units (the "Units") in the initial public offering of the issuer 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 IPO.