Statement of Changes in Beneficial Ownership (4)
21 December 2021 - 9:03AM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Yi Miyoko Christina |
2. Issuer Name and Ticker or Trading Symbol
Provention Bio, Inc.
[
PRVB
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chief Operations Officer |
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(Last)
(First)
(Middle)
C/O PROVENTION BIO, INC., 55 BROAD STREET, 2ND FLOOR |
3. Date of Earliest Transaction
(MM/DD/YYYY)
12/16/2021 |
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(Street)
RED BANK, NJ 07701
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code
(Instr. 8)
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4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code
(Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4) | 8. Price of Derivative Security
(Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Stock Option (right to buy) | $5.88 | 12/16/2021 | | A | | 150000 | | (1) | 12/16/2031 | Common Stock, par value $0.0001 | 150000 | $0 (2) | 150000 | D | |
| Explanation of Responses: |
| (1) | On December 16, 2021 the Reporting Person was granted a stock option for 150,000 shares of Common Stock which vests in four equal annual installments commencing on December 16, 2021. Reporting Person was also
granted 150,000 stock options under the Issuer's 2020 Inducement Plan with performance-based vesting triggers that will be reported, if and when vested, consistent with the applicable reporting requirements. |
| (2) | The stock options were granted pursuant to the Issuer's 2020 Inducement Plan. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Yi Miyoko Christina
C/O PROVENTION BIO, INC.
55 BROAD STREET, 2ND FLOOR
RED BANK, NJ 07701 |
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| Chief Operations Officer |
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Signatures
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| /s/ Thierry Chauche | | 12/20/2021 |
| **Signature of Reporting Person | Date |
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