0000945621-19-000244.txt : 20190710 0000945621-19-000244.hdr.sgml : 20190710 20190710103645 ACCESSION NUMBER: 0000945621-19-000244 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20190710 DATE AS OF CHANGE: 20190710 EFFECTIVENESS DATE: 20190710 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Provenance Blockchain, Inc. CENTRAL INDEX KEY: 0001774380 IRS NUMBER: 832455013 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-343855 FILM NUMBER: 19948328 BUSINESS ADDRESS: STREET 1: 237 KEARNY STREET, NO. 122 CITY: SAN FRANCISCO STATE: CA ZIP: 94108 BUSINESS PHONE: 415-842-2588 MAIL ADDRESS: STREET 1: 237 KEARNY STREET, NO. 122 CITY: SAN FRANCISCO STATE: CA ZIP: 94108 D 1 primary_doc.xml X0708 D LIVE 0001774380 Provenance Blockchain, Inc. 237 KEARNY STREET, NO. 122 SAN FRANCISCO CA CALIFORNIA 94108 415-842-2588 DELAWARE None None Other Non-stock membership corporation true 2018 Michael Cagney 237 Kearny Street, No. 122 San Francisco CA CALIFORNIA 94108 Director Interim Executive Director Eric Malchodi 237 Kearny Street, No. 122 San Francisco CA CALIFORNIA 94108 Director Interim Director June Ou 237 Kearny Street, No. 122 San Francisco CA CALIFORNIA 94108 Director Interim Director Other Technology Decline to Disclose 06b false 2019-06-28 false true Hash, the native digital asset of Issuer, which also represent membership interests in the Issuer. false 0 20000000 20000000 0 false 61 0 0 0 false Provenance Blockchain, Inc. /s/ Eric Malchodi Eric Malchodi Chief Compliance Officer 2019-07-10