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*
Bluestone Jeffrey

(Last) (First) (Middle)
C/O PROVENTION BIO, INC.,
P.O. BOX 666

(Street)
OLDWICK NJ 08858

(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
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
04/10/2020
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
Common Stock par value $0.0001 per share 04/10/2020 M 32,246 A $2.36 39,571(1) I By the Bluestone Family Trust(2)
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
Employee Stock Option (right to buy) $2.36 02/27/2020 G(3) V 128,981 (4) 03/27/2029 Common Stock 128,981 $0 0 D
Employee Stock Option (right to buy) $2.36 02/27/2020 G(3) V 128,981 (4) 03/27/2029 Common Stock 128,981 $0 0 I By the Bluestone Family Trust(2)
Employee Stock Option (right to buy) $2.36 04/10/2020 M 32,246 (4) 03/27/2029 Common Stock 32,246 $0 96,735 I By the Bluestone Family Trust(2)
Employee Stock Option (right to buy) $12.54 02/27/2020 G(5) V 24,000 (6) 06/24/2029 Common Stock 24,000 $0 0 D
Employee Stock Option (right to buy) $12.54 02/27/2020 G(5) V 24,000 (6) 06/24/2029 Common Stock 24,000 $0 0 I By the Bluestone Family Trust(2)
Explanation of Responses:
1. Includes 7,325 shares of common stock, par value $0.0001 per share (the "Common Stock") previously reported as being owned directly which are owned indirectly by the Bluestone Family Trust.
2. The reporting person, together with his spouse are trustees and the reporting person, his spouse and children are the beneficiaries of the Bluestone Family Trust.
3. On February 27, 2020, the reporting person contributed options to purchase up to 128,981 shares of Common Stock to the Bluestone Family Trust as a gift. The option was granted on March 27, 2019, pursuant to the Issuer's Amended and Restated 2017 Equity Incentive Plan.
4. The option vests in eight equal semi-annual installments commencing on September 27, 2019 and will become fully vested on March 27, 2023.
5. On February 27, 2020, the reporting person contributed options to purchase up to 24,000 shares of Common Stock to the Bluestone Family Trust as a gift. The option was granted on June 24, 2019, pursuant to the Issuer's Amended and Restated 2017 Equity Incentive Plan.
6. The option fully vests on May 28, 2020.
/s/ Andrew Drechsler as attorney-in-fact 04/14/2020
** 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.