Statement of Changes in Beneficial Ownership (4)
May 18 2021 - 4:09PM
Edgar (US Regulatory)
FORM 4
[ ]
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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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
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Ammer Richard |
2. Issuer Name and Ticker or Trading Symbol
Vallon Pharmaceuticals, Inc.
[
VLON
]
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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)
C/O VALLON PHARMACEUTICALS, INC., 100 N. 18TH STREET, SUITE 300 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
5/14/2021 |
(Street)
PHILADELPHIA, PA 19103
(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 |
Stock Option (Right to Buy) | $3.66 | 5/14/2021 | | A | | 15000 | | (1) | 5/14/2031 | Common Stock | 15000 | $0.00 | 15000 | D | |
Stock Option (Right to Buy) | $3.66 | 5/14/2021 | | A | | 10204 | | (2) | 5/14/2031 | Common Stock | 10204 | $0.00 | 10204 | D | |
Explanation of Responses: |
(1) | The stock option vests in 24 equal monthly installments such that the stock option is fully vested on the second annual anniversary of the date of grant. |
(2) | The stock option vests as to 50% of the underlying shares of common stock on June 30, 2021, then in two equal installments on September 30, 2021 and December 31, 2021, such that the stock option fully vests on December 31, 2021. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Ammer Richard C/O VALLON PHARMACEUTICALS, INC. 100 N. 18TH STREET, SUITE 300 PHILADELPHIA, PA 19103 | X |
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Signatures
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/s/ David Baker, attorney-in-fact | | 5/18/2021 |
**Signature of Reporting Person | Date |
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