0001493152-20-013475.txt : 20200716
0001493152-20-013475.hdr.sgml : 20200716
20200716180110
ACCESSION NUMBER: 0001493152-20-013475
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200715
FILED AS OF DATE: 20200716
DATE AS OF CHANGE: 20200716
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Wysenski Nancy
CENTRAL INDEX KEY: 0001294596
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38552
FILM NUMBER: 201032293
MAIL ADDRESS:
STREET 1: 2200 SUNBURST STREET
CITY: CHATSWORTH
STATE: CA
ZIP: 90401
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Provention Bio, Inc.
CENTRAL INDEX KEY: 0001695357
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: P.O. BOX 666
CITY: OLDWICK
STATE: NJ
ZIP: 08858
BUSINESS PHONE: 908-428-9136
MAIL ADDRESS:
STREET 1: P.O. BOX 666
CITY: OLDWICK
STATE: NJ
ZIP: 08858
FORMER COMPANY:
FORMER CONFORMED NAME: Provention Inc.
DATE OF NAME CHANGE: 20170120
4
1
ownership.xml
X0306
4
2020-07-15
0
0001695357
Provention Bio, Inc.
PRVB
0001294596
Wysenski Nancy
C/O PROVENTION BIO, INC., P.O. BOX 666
OLDWICK,
NJ
08858
1
0
0
0
Option (right to buy)
12.62
2020-07-15
4
A
0
22200
0
A
2030-07-15
Common Stock, par value $0.0001
22200
22200
D
22,200 option shares vest on July 15, 2021.
The securities were granted pursuant to the Issuer's Amended and Restated 2017 Equity Incentive Plan.
/s/ Andrew Drechsler as attorney-in-fact
2020-07-16