0001493152-21-011586.txt : 20210514 0001493152-21-011586.hdr.sgml : 20210514 20210514194722 ACCESSION NUMBER: 0001493152-21-011586 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210512 FILED AS OF DATE: 20210514 DATE AS OF CHANGE: 20210514 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bluestone Jeffrey CENTRAL INDEX KEY: 0001771814 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38552 FILM NUMBER: 21926940 MAIL ADDRESS: STREET 1: C/O PROVENTION BIO, INC. STREET 2: P.O. BOX 666 CITY: OLDWICK STATE: NJ ZIP: 08858 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 2021-05-12 0 0001695357 Provention Bio, Inc. PRVB 0001771814 Bluestone Jeffrey C/O PROVENTION BIO, INC. 55 BROAD STREET, 2ND FLOOR RED BANK NJ 07701 1 0 0 0 Stock Option (right to buy) 6.80 2021-05-12 4 A 0 23000 0 A 2031-05-12 Common Stock, par value $0.0001 23000 23000 D The options will vest in full and become exercisable upon the earlier to occur of (a) the business day before the Issuer's next annual meeting of stockholders and (b) May 12, 2022. The securities were granted pursuant to the Issuer's Amended and Restated 2017 Equity Incentive Plan. /s/ Andrew Drechsler, as attorney-in-fact 2021-05-14