SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Johnson Bankole A.

(Last) (First) (Middle)
1001 RESEARCH PARK BLVD., SUITE 100

(Street)
CHARLOTTESVILLE VA 22911

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ADIAL PHARMACEUTICALS, INC. [ ADIL ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
X Officer (give title below) Other (specify below)
Chief Medical Officer
3. Date of Earliest Transaction (Month/Day/Year)
03/28/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 03/28/2019 P 40,000 A $3.1452 314,768 D
Common Stock 03/29/2019 P 30,000 A $3.4718 344,768 D
Common Stock 03/29/2019 P 2,500 A $3.4676 347,268 D
Common Stock 03/29/2019 P 600 A $3.2967 347,868 D
Common Stock 40,463 I Medico-Trans Company, LLC(1)
Common Stock 848,336 I En Fideicomiso De Mi Vida 11/23/2010 (Trust)(2)
Common Stock 93,000 I En Fidecomiso de Todos Mis Suenos Grantor Retained Annuity Trust dated June 27, 2017(2)
Common Stock 22,320 I En Fideicomiso De Mis Suenos 11/23/2010 (Trust)(2)
Common Stock 10,000 I De Mi Amor 11/23/2010 (Trust)(2)
Common Stock 4,650 I Efunbowale Johnson(3)
Common Stock 1,395 I Ade Johnson(3)
Common Stock 1,395 I Lola Johnson(3)
Common Stock 930 I Lina Tiouririne(3)
Common Stock 930 I Aida Tiouririne(3)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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 $5.7 (4) 06/30/2027 Common Stock 5,580 5,580 D
Stock Option $3.01 (5) 03/23/2029 Common Stock 250,000 250,000 D
Warrant to purchase common stock $7.63 10/10/2017 12/31/2031 Common Stock 3,275 3,275 D
Warrant to purchase common stock $6.25 07/31/2018 07/31/2023 Common Stock 189,714 189,714 D
Warrant to purchase common stock $5 11/12/2018 07/31/2023 Common Stock 17,600 17,600 D
Explanation of Responses:
1. Medico-Trans Company, LLC is controlled by Bankole Johnson.
2. Dr. Johnson is the trustee of each of these trusts.
3. Dr. Johnson has a voting proxy on this person's behalf that entitles him to vote these shares.
4. Options to buy 3,100 shares are currently exercisable with the remaining options to buy 2,480 shares vesting 1/36th (155 shares) on the first day of each month over the remaining 16 months.
5. Options to buy 250,000 shares vest pro rata on a monthly basis over 36 months commencing March 24, 2019.
/s/ Bankole Johnson 04/01/2019
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.