Filing Details

Accession Number:
0001213900-18-010095
Form Type:
4
Zero Holdings:
No
Publication Time:
2018-08-02 16:14:33
Reporting Period:
2018-07-31
Accepted Time:
2018-08-02 16:14:33
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
1718069 Iii B. William Stilley 1180 Seminole Trail,
Suite 495
Charlottesville, VA 22901
Chief Executive Officer Yes Yes Yes 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 36,800 $0.00 372,402 No 4 J Direct
Common Stock Acquisiton 2018-07-31 52,227 $0.00 424,629 No 4 C Direct
Common Stock Acquisiton 2018-07-31 80,000 $0.00 504,000 No 4 P Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 J Direct
No 4 C Direct
No 4 P Direct
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Convertible Note Disposition 2018-07-31 52,227 $0.00 52,227 $0.44
Common Stock Warrant to purchase common stock Acquisiton 2018-07-31 36,800 $0.00 36,800 $6.25
Common Stock Warrant to purchase common stock Acquisiton 2018-07-31 52,227 $0.00 52,227 $6.25
Units Warrant to purchase units Acquisiton 2018-07-31 36,800 $0.00 73,600 $5.00
Common Stock Warrant to purchase common stock Acquisiton 2018-07-31 80,000 $0.00 80,000 $6.25
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Direct
36,800 2018-07-31 2023-07-31 No 4 J Direct
89,027 No 4 C Direct
36,800 2018-07-31 2023-07-31 No 4 J Direct
169,027 2018-07-31 2023-07-31 No 4 P Direct
Reported Non-Derivative Holdings
Sec. Name Remaning Holdings Nature of Ownership Explanation
Common Stock 132,141 Indirect Owned jointly by Mr. Stilley and his wife, Anne T. Stilley
Footnotes
  1. The 36,800 shares of common stock and warrant to purchase 36,800 shares of common stock were received by the reporting person upon consummation of the initial public offering on July 31, 2018 in accordance with a Securities Purchase Agreement dated February 22, 2018.
  2. The 52,227 shares of common stock and a warrant to purchase 52,227 shares of common stock were issued upon automatic conversion of a convertible note in the principal amount of $17,449 together with interest accrued thereon at a conversion price of $0.44 per share upon consummation of the initial public offering.
  3. On July 31, 2018, Mr. Stilley purchased 80,000 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.
  4. The warrant to purchase 36,800 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 73,600 shares.