0001539252-16-000004.txt : 20161026 0001539252-16-000004.hdr.sgml : 20161026 20161026104541 ACCESSION NUMBER: 0001539252-16-000004 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20161026 DATE AS OF CHANGE: 20161026 EFFECTIVENESS DATE: 20161026 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Provista Diagnostics Inc. CENTRAL INDEX KEY: 0001539252 IRS NUMBER: 274282214 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-273217 FILM NUMBER: 161951799 BUSINESS ADDRESS: STREET 1: 17301 N. PERIMETER DRIVE, SUITE 100 CITY: SCOTTSDALE STATE: AZ ZIP: 85085 BUSINESS PHONE: 602-224-5500 MAIL ADDRESS: STREET 1: 17301 N. PERIMETER DRIVE, SUITE 100 CITY: SCOTTSDALE STATE: AZ ZIP: 85085 D 1 primary_doc.xml X0707 D LIVE 0001539252 Provista Diagnostics Inc. 17301 N. PERIMETER DRIVE, SUITE 100 SCOTTSDALE AZ ARIZONA 85255 602-224-5500 DELAWARE None None Corporation true David Reese 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Executive Officer Director Uriel E. Kusiatin 55 Broad Street, 18th Floor New York NY NEW YORK 10004 Executive Officer Anne Busquet 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Director Jeffrey Gilman 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Director Robert Hariri 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Director Jack Levine 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Director John Macaskill 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Director John Zicarelli 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Director Yoji Nimura 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Director Thomas Mendell 17301 N. Perimeter Dr., Suite 100 Scottsdale AZ ARIZONA 85255 Director Biotechnology Decline to Disclose 06b false 2016-10-13 false true true false 0 6000000 2564948 3435052 The Issuer is offering up to $6,000,000 in principal amount of convertible promissory notes. This Form D is also intended to cover the underlying equity securities. false 5 0 0 0 false Provista Diagnostics Inc. /s/ Uriel E. Kusiatin Uriel E. Kusiatin Chief Financial Officer 2016-10-25