Statement of Changes in Beneficial Ownership (4)
November 25 2020 - 4:50PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Schuyler Kevin |
2. Issuer Name and Ticker or Trading Symbol
ADIAL PHARMACEUTICALS, INC.
[
ADIL
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
1180 SEMINOLE TRAIL, SUITE 495 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
11/23/2020 |
(Street)
CHARLOTTESVILLE, VA 22901
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Warrant to purchase common stock | $0.0054 | 11/23/2020 | | G | | 1010 | | 7/31/2018 | 7/31/2023 | Common Stock (1) | 1010 | (1) | 1010 | I | See footnote (1) |
Warrants to purchase common stock | $7.63 | 11/23/2020 | | G | | 8649 | | 7/31/2018 | 7/31/2023 | Common Stock (1) | 8649 | (1) | 8649 | I | See footnote (1) |
Warrants to purchase common stock | $6.25 | 11/23/2020 | | G | | 89600 | | 7/31/2018 | 7/31/2023 | Common Stock (1) | 89600 | (1) | 89600 | I | See footnote (1) |
Warrants to purchase common stock | $6.25 | 11/23/2020 | | G | | 89600 | | 7/31/2018 | 7/31/2023 | Common Stock (1) | 89600 | (1) | 89600 | I | See footnote (1) |
Warrants to purchase common stock | $6.25 | 11/23/2020 | | G | | 82461 | | 7/31/2018 | 7/31/2023 | Common Stock (1) | 82461 | (1) | 82461 | I | See footnote (1) |
Warrant to purchase common stock | $5 | 11/23/2020 | | G | | 89600 | | 7/31/2018 | 7/31/2023 | Common Stock (1) | 89600 | (1) | 89600 | I | See footnote (1) |
Warrant to purchase common stock | $0.0054 | 11/23/2020 | | G | | | 1010 | 7/31/2018 | 7/31/2023 | Common Stock (1) | 1010 | (1) | 0 | D | |
Warrants to purchase common stock | $7.63 | 11/23/2020 | | G | | | 8649 | 7/31/2018 | 7/31/2023 | Common Stock (1) | 8649 | (1) | 0 | D | |
Warrant to purchase common stock | $6.25 | 11/23/2020 | | G | | | 89600 | 7/31/2018 | 7/31/2023 | Common Stock (1) | 89600 | (1) | 0 | D | |
Warrant to purchase common stock | $6.25 | 11/23/2020 | | G | | | 89600 | 7/31/2018 | 7/31/2023 | Common Stock (1) | 89900 | (1) | 0 | D | |
Warrant to purchase common stock | $6.25 | 11/23/2020 | | G | | | 82461 | 7/31/2018 | 7/31/2023 | Common Stock (1) | 82461 | (1) | 0 | D | |
Warrant to purchase common stock | $5 | 11/23/2020 | | G | | | 89600 | 7/31/2018 | 7/31/2023 | Common Stock (1) | 89600 | (1) | 0 | D | |
Explanation of Responses: |
(1) | Represents a transfer of warrants from Mr. Kevin Schuyler to The Kevin William Schuyler 2020 Irrevocable Perpetuities Trust, the trustee of which is Mr. Schuyler's wife and the beneficiaries of which are Mr. Schuyler's wife and children. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Schuyler Kevin 1180 SEMINOLE TRAIL, SUITE 495 CHARLOTTESVILLE, VA 22901 | X |
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Signatures
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/s/ Kevin Schuyler | | 11/24/2020 |
**Signature of Reporting Person | Date |
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