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PROVENTION BIO, INC.
Date Filed :
Dec 09, 2022
View Exhibits
SEC FORM 4
SEC Form 4
FORM 4
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden
hours per response:
0.5
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b).
1. Name and Address of Reporting Person
*
Palmer Ashleigh
(Last)
(First)
(Middle)
C/O PROVENTION BIO, INC.
55 BROAD STREET, 2ND FLOOR
(Street)
RED BANK
NJ
07701
(City)
(State)
(Zip)
2. Issuer Name
and
Ticker or Trading Symbol
Provention Bio, Inc.
[
PRVB
]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X
Director
10% Owner
X
Officer (give title below)
Other (specify below)
Director and CEO
3. Date of Earliest Transaction (Month/Day/Year)
12/08/2022
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X
Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3)
2. Transaction Date (Month/Day/Year)
2A. Deemed Execution Date, if any (Month/Day/Year)
3. Transaction Code (Instr. 8)
4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code
V
Amount
(A) or (D)
Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3)
2. Conversion or Exercise Price of Derivative Security
3. Transaction Date (Month/Day/Year)
3A. Deemed Execution Date, if any (Month/Day/Year)
4. Transaction 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 (Month/Day/Year)
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: 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)
$
12.62
12/08/2022
A
20,663
(1)
12/08/2022
07/15/2030
Common Stock, par value $0.0001
20,663
$
0
(2)
75,763
(3)
D
Explanation of Responses:
1. As previously reported on a Form 4 filed on July 16, 2020, on July 15, 2020 the Reporting Person was granted a stock option for 137,750 shares of Common Stock, 55,100 of which option shares vest in four equal annual installments commencing on July 15, 2021 and 82,650 of which option shares vest upon completion of certain performance milestones. This amount represents the vesting of 20,663 of the 82,650 performance option shares on December 8, 2022 upon the satisfaction of certain performance milestones. This Form 4 is being filed solely to report the vesting of such previously reported 20,663 option shares.
2. The stock options were granted pursuant to the Issuer's Amended and Restated 2017 Equity Incentive Plan.
3. Represents the 55,100 time-based option shares referred to in footnote (1) plus the 20,663 vested performance option shares referred to in footnote (1).
/s/ Thierry Chauche, as attorney-in-fact
12/09/2022
** Signature of Reporting Person
Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person,
see
Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.
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