0001493152-18-018148.txt : 20181231 0001493152-18-018148.hdr.sgml : 20181231 20181231180043 ACCESSION NUMBER: 0001493152-18-018148 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20181228 FILED AS OF DATE: 20181231 DATE AS OF CHANGE: 20181231 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: 181260429 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: 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 2018-12-28 0 0001695357 Provention Bio, Inc. PRVB 0001493714 Palmer Ashleigh C/O PROVENTION BIO, INC. P.O. BOX 666 OLDWICK NJ 08858 1 1 0 0 President and CEO Common Stock 2018-12-28 4 P 0 5000 1.73 A 2542500 D Common Stock 2018-12-31 4 P 0 825 1.58 A 2543325 D /s/ Andrew Drechsler, as attorney-in-fact 2018-12-31