SEC Form 4 · accession 0001213900-18-010083

ADIAL PHARMACEUTICALS, INC. · ADIL

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director

Period of report

Jul 31, 2018

Accepted (ET)

Aug 2, 2018 · 4:03 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001513525

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2	Jul 31, 2018	C	29,931	—	A	95,424	I	Owned by Keller Enterprises, LLC
Common Stock^F3,F2	Jul 31, 2018	P$0	14,000	—	A	109,424	I	Owned by Keller Enterprises, LLC

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Convertible Note^F1,F2	$0.44	Jul 31, 2018	C	29,931	D	—	—	Common Stock	29,931	0	I
Warrant to purchase common stock^F1,F2	$6.25	Jul 31, 2018	C	29,931	A	Jul 31, 2018	Jul 31, 2023	Common Stock	29,931	29,931	I
Warrant to purchase common stock^F3,F2	$6.25	Jul 31, 2018	P	14,000	A	Jul 31, 2018	Jul 31, 2023	Common Stock	43,931	43,931	I

F1The 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.
F2Mr. Gilliland is the principal of Keller Enterprises, LLC ("Keller").
F3On 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.