0001104659-21-022185.txt : 20210212 0001104659-21-022185.hdr.sgml : 20210212 20210212180027 ACCESSION NUMBER: 0001104659-21-022185 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210212 FILED AS OF DATE: 20210212 DATE AS OF CHANGE: 20210212 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Baker David Charles CENTRAL INDEX KEY: 0001844060 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40034 FILM NUMBER: 21630454 MAIL ADDRESS: STREET 1: 100 N. 18TH STREET STREET 2: SUITE 300 CITY: PHILADELPHIA STATE: PA ZIP: 19103 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Vallon Pharmaceuticals, Inc. CENTRAL INDEX KEY: 0001824293 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 824369909 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: TWO LOGAN SQUARE STREET 2: 100 N. 18TH STREET, SUITE 300 CITY: PHILADELPHIA STATE: PA ZIP: 19103 BUSINESS PHONE: (267) 207-3606 MAIL ADDRESS: STREET 1: TWO LOGAN SQUARE STREET 2: 100 N. 18TH STREET, SUITE 300 CITY: PHILADELPHIA STATE: PA ZIP: 19103 4 1 tm214979-9_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-02-12 0 0001824293 Vallon Pharmaceuticals, Inc. VLON 0001844060 Baker David Charles C/O VALLON PHARMACEUTICALS, INC. 100 N. 18TH STREET, SUITE 300 PHILADELPHIA PA 19103 1 1 0 0 Chief Executive Officer Common Stock 2021-02-12 4 J 0 7843 6.40 A 7843 D Common Stock 2021-02-12 4 P 0 1000 8.00 A 8843 D Issued immediately prior to the closing of the initial public offering of the issuer's common stock in connection with the conversion of the promissory notes held by the reporting person, as disclosed in the prospectus, dated February 9, 2021, filed with the U.S. Securities and Exchange Commission on February 11, 2021, which forms a part of the Registration Statements on Form S-1 (File Nos. 333-249636 and 333-252925), originally filed on October 23, 2020, as amended. /s/ David Baker, attorney-in-fact 2021-02-12