0000905718-17-000532.txt : 20170504 0000905718-17-000532.hdr.sgml : 20170504 20170504164759 ACCESSION NUMBER: 0000905718-17-000532 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20170504 DATE AS OF CHANGE: 20170504 EFFECTIVENESS DATE: 20170504 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Provention Bio, Inc. CENTRAL INDEX KEY: 0001695357 IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-286073 FILM NUMBER: 17814799 BUSINESS ADDRESS: STREET 1: 110 OLD DRIFTWAY LANE CITY: LEBANON STATE: NJ ZIP: 08833 BUSINESS PHONE: 908-428-9136 MAIL ADDRESS: STREET 1: 110 OLD DRIFTWAY LANE CITY: LEBANON STATE: NJ ZIP: 08833 FORMER COMPANY: FORMER CONFORMED NAME: Provention Inc. DATE OF NAME CHANGE: 20170120 D 1 primary_doc.xml X0707 D LIVE 0001695357 Provention Bio, Inc. 110 OLD DRIFTWAY LANE LEBANON NJ NEW JERSEY 08833 646-414-6965 DELAWARE None Provention Inc. Corporation true 2016 Ashleigh Palmer 110 Old Driftway Lane Lebanon NJ NEW JERSEY 08833 Executive Officer Director Francisco Leon, M.D. 110 Old Driftway Lane Lebanon NJ NEW JERSEY 08833 Director Anthony DiGiandomenico 110 Old Driftway Lane Lebanon NJ NEW JERSEY 08833 Director Cameron Gray 110 Old Driftway Lane Lebanon NJ NEW JERSEY 08833 Director Biotechnology Decline to Disclose 06b false 2017-04-25 false true true Series A Preferred Stock false 0 MDB Capital Group, LLC 42677 None None 2425 CEDAR SPRINGS ROAD DALLAS TX TEXAS 75201 AL ALABAMA AZ ARIZONA CA CALIFORNIA CO COLORADO CT CONNECTICUT FL FLORIDA ID IDAHO IL ILLINOIS IN INDIANA KS KANSAS KY KENTUCKY LA LOUISIANA MD MARYLAND MA MASSACHUSETTS MI MICHIGAN MN MINNESOTA MO MISSOURI NV NEVADA NJ NEW JERSEY NY NEW YORK OH OHIO OK OKLAHOMA OR OREGON PA PENNSYLVANIA RI RHODE ISLAND TX TEXAS UT UTAH VT VERMONT VA VIRGINIA WA WASHINGTON WI WISCONSIN false Paulson Investment Company, LLC 5670 None None 566 WEST ADAMS ST. SUITE 750 CHICAGO IL ILLINOIS 60661 All States false 30000000 28454995 1545005 Offering is closed. false 158 1396850 0 Excludes value of warrants to purchase up to 558,740 shares of Series A Preferred Stock. 0 true Some of the proceeds may be used for general working capital purposes which may include the payment of salaries and other fees to those listed in Item 3. Two Directors are principals of MDB and will receive a portion of the fees paid to MDB. false Provention Bio, Inc. /s/ Ashleigh Palmer Ashleigh Palmer President 2017-05-04