0001104659-21-022190.txt : 20210212
0001104659-21-022190.hdr.sgml : 20210212
20210212180226
ACCESSION NUMBER: 0001104659-21-022190
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: Ammer Richard
CENTRAL INDEX KEY: 0001843671
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40034
FILM NUMBER: 21630480
MAIL ADDRESS:
STREET 1: C/O VALLON PHARMACEUTICALS, INC.
STREET 2: 100 N. 18TH STREET, 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
tm214979-8_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2021-02-12
0
0001824293
Vallon Pharmaceuticals, Inc.
VLON
0001843671
Ammer Richard
C/O VALLON PHARMACEUTICALS, INC.
100 N. 18TH STREET, SUITE 300
PHILADELPHIA
PA
19103
1
0
0
0
Common Stock
2021-02-12
4
J
0
47063
6.40
A
47063
I
By SALMON Pharma GmbH
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.
The reporting person disclaims beneficial ownership of these securities except to the extent of her pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.
/s/ David Baker, attorney-in-fact
2021-02-12