0001949660-22-000003.txt : 20221006 0001949660-22-000003.hdr.sgml : 20221006 20221006120221 ACCESSION NUMBER: 0001949660-22-000003 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20221006 DATE AS OF CHANGE: 20221006 EFFECTIVENESS DATE: 20221006 FILER: COMPANY DATA: COMPANY CONFORMED NAME: Provision Impact Ventures LLC CENTRAL INDEX KEY: 0001949660 IRS NUMBER: 823973423 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-460945 FILM NUMBER: 221297549 BUSINESS ADDRESS: STREET 1: 2440 MUIRFIELD WAY CITY: GILROY STATE: CA ZIP: 95020 BUSINESS PHONE: (408) 963-9375 MAIL ADDRESS: STREET 1: 2440 MUIRFIELD WAY CITY: GILROY STATE: CA ZIP: 95020 D 1 primary_doc.xml X0708 D LIVE 0001949660 Provision Impact Ventures LLC 2440 MUIRFIELD WAY GILROY CA CALIFORNIA 95020 (408) 963-9375 DELAWARE None None Limited Liability Company true 2017 David Shoquist 2440 Muirfield Way Gilroy CA CALIFORNIA 95020 Executive Officer Chief Financial Officer Robert Jacobson 12814 Woodland Avenue Kansas City MO MISSOURI 64145 Executive Officer Chief Executive Officer Matthew Illian 1507 Oakwood Avenue Richmond VA VIRGINIA 23223 Promoter Finder fees paid. Irvin Henderson 1519 Lynne Avenue Henderson NC NORTH CAROLINA 27536 Promoter Owner's Representative. No fees paid. Michael Lynch 3305 Knob Oak Drive Grapevine TX TEXAS 76051 Promoter Finder fees issued in the form of a Note Payable. Residential No Revenues 06b false 2019-05-14 false true false 100000 Matthew Illian None None None 1507 Oakwood Avenue Richmond VA VIRGINIA 23223 VA VIRGINIA false Michael Lynch None None None 3305 Knob Oak Drive Grapevine TX TEXAS 76051 true 1900000 1800000 100000 The remaining $100,000 will not be sold false 12 0 70000 Fee of 35,000 paid in cash to Matthew Illian (raised $700,000 at 5% fee). Fee of $35,000 issued in the form of a Note Payable to Michael Lynch (raised $700,000 at 5% fee. 216800 Salary of $73,400 each was paid to Robert Jacobson, CEO and to David Shoquist, CFO for work on the project. Finder's fee of $35,000 was paid to Matthew Illian. Note Payable for $35,000 was issued to Michael Lynch. false Provision Impact Ventures LLC David Shoquist David Shoquist Chief Financial Officer 2022-10-06