0001437749-24-013403.txt : 20240426 0001437749-24-013403.hdr.sgml : 20240426 20240426151013 ACCESSION NUMBER: 0001437749-24-013403 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20240426 DATE AS OF CHANGE: 20240426 EFFECTIVENESS DATE: 20240426 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Provisio Medical, Inc. CENTRAL INDEX KEY: 0001685703 ORGANIZATION NAME: IRS NUMBER: 200305318 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-511732 FILM NUMBER: 24882740 BUSINESS ADDRESS: STREET 1: 10449 HUNTERS RIDGE PLACE CITY: SAN DIEGO STATE: CA ZIP: 92127 BUSINESS PHONE: 5087409940 MAIL ADDRESS: STREET 1: 10449 HUNTERS RIDGE PLACE CITY: SAN DIEGO STATE: CA ZIP: 92127 D 1 primary_doc.xml X0708 D LIVE 0001685703 Provisio Medical, Inc. 10815 Rancho Bernardo Road Suite 110 San Diego CA CALIFORNIA 92127 (858) 524-3901 DELAWARE None None Corporation true Stephen Eric Ryan c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Executive Officer Director Promoter Aurelio Fernandez c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Director Timothy Lindenfelser c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Director Frank J. Del Rio c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Director Michael Chobotov c/o Provisio Medical, Inc. 10815 Rancho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Director John McCallum JAM Capital Partners PO Box 20097 St. Simons Island GA GEORGIA 31522 Director John Blake c/o Provisio Medical, Inc. 10815 Racho Bernardo Road, Suite 110 San Diego CA CALIFORNIA 92127 Executive Officer Other Technology Decline to Disclose 06b false 2024-04-19 false true true Series A Debentures false 100000 Dominari Securities LLC 18975 Dominari Securities LLC 18975 725 5th Avenue 23rd Floor New York NY NEW YORK 10022 All States 10000000 970000 9030000 false 6 0 0 Broker may also receive warrant compensation equal to 1% (up to 3%) of the Gross Proceeds sold by said broker. Term of five years, cashless exercise option, convertible into common shares, and exercise price = $3.91 per share. 500000 true false Provisio Medical, Inc. /s/ Stephen Eric Ryan Stephen Eric Ryan President 2024-04-26