0001493152-22-001751.txt : 20220120 0001493152-22-001751.hdr.sgml : 20220120 20220120171948 ACCESSION NUMBER: 0001493152-22-001751 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220119 FILED AS OF DATE: 20220120 DATE AS OF CHANGE: 20220120 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Palmer Ashleigh CENTRAL INDEX KEY: 0001493714 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38552 FILM NUMBER: 22543199 MAIL ADDRESS: STREET 1: PROVENTION BIO, INC. STREET 2: 110 OLD DRIFTWAY LANE CITY: LEBANON STATE: NJ ZIP: 08833 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: 55 BROAD STREET, 2ND FLOOR CITY: RED BANK STATE: NJ ZIP: 07701 BUSINESS PHONE: 908-428-9136 MAIL ADDRESS: STREET 1: 55 BROAD STREET, 2ND FLOOR CITY: RED BANK STATE: NJ ZIP: 07701 FORMER COMPANY: FORMER CONFORMED NAME: Provention Inc. DATE OF NAME CHANGE: 20170120 4 1 ownership.xml X0306 4 2022-01-19 0 0001695357 Provention Bio, Inc. PRVB 0001493714 Palmer Ashleigh C/O PROVENTION BIO, INC. 55 BROAD STREET, 2ND FLOOR RED BANK NJ 07701 1 1 0 0 Director and CEO Stock Option (right to buy) 4.37 2022-01-19 4 A 0 360000 0 A 2032-01-19 Common Stock, par value $0.0001 360000 360000 D The options will vest and become exercisable as to 25% on the one-year anniversary of the grant date (January 19, 2023) and the remaining 75% will vest and become exercisable monthly over 36 months such that the options are fully vested and exercisable on the four-year anniversary of the grant date (January 19, 2026). The securities were granted pursuant to the Issuer's Amended and Restated 2017 Equity Incentive Plan. /s/ Thierry Chauche, as attorney-in-fact 2022-01-20