0001493152-21-018719.txt : 20210805 0001493152-21-018719.hdr.sgml : 20210805 20210805160702 ACCESSION NUMBER: 0001493152-21-018719 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210803 FILED AS OF DATE: 20210805 DATE AS OF CHANGE: 20210805 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: King-Jones Heidy CENTRAL INDEX KEY: 0001794898 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38552 FILM NUMBER: 211148161 MAIL ADDRESS: STREET 1: C/O AXCELLA HEALTH INC. STREET 2: 840 MEMORIAL DRIVE CITY: CAMBRIDGE STATE: MA ZIP: 02139 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 2021-08-03 0 0001695357 Provention Bio, Inc. PRVB 0001794898 King-Jones Heidy C/O PROVENTION BIO, INC. 55 BROAD STREET, 2ND FLOOR RED BANK NJ 07701 0 1 0 0 Chief Legal Officer Stock Option (right to buy) 11.23 2021-08-03 4 A 0 30000 0 A 2021-08-03 2030-08-03 Common Stock, par value $0.0001 30000 150000 D As previously reported on a Form 4 filed on August 3, 2020, on August 3, 2020 the Reporting Person was granted a stock option for 300,000 shares of Common Stock, 120,000 of which option shares vest in four equal annual installments commencing on August 3, 2021 and 180,000 of which option shares vest upon completion of certain performance milestones. This amount represents the vesting of 30,000 of the 180,000 performance option shares on August 3, 2021 upon the satisfaction of certain performance milestones. This Form 4 is being filed solely to report the vesting of such previously reported 30,000 option shares. The stock options were granted pursuant to the Issuer's Amended and Restated 2017 Equity Incentive Plan. Represents the 120,000 time-based option shares referred to in footnote (1) plus the 30,000 vested performance option shares referred to in footnote (1). Excludes 150,000 of the previously reported 300,000 option shares referred to in footnote (1) that are performance option shares that remain subject to vesting upon completion of certain performance milestones. /s/ Andrew Drechsler, as attorney-in-fact 2021-08-05