Form D Raw Data - Electronic Filing Depository

EFDID: 361638EFD: Raw Data

Issuer: Provisio Medical, Inc. (0001685703) - D/A

Accession: 0001437749-21-014130 () (EDGAR Files) (Form D)

Edgar Posted: Jun. 4, 2021
EFD Posted: Jun. 4, 2021

- < edgarSubmission >

< schemaVersion > X0708 </ schemaVersion >

< submissionType > D/A </ submissionType >

< testOrLive > LIVE </ testOrLive >

- < primaryIssuer >

< cik > 0001685703 </ cik >

< entityName > Provisio Medical, Inc. </ entityName >

- < issuerAddress >

< street1 > 10815 Rancho Bernardo Road </ street1 >

< street2 > Suite 110 </ street2 >

< city > San Diego </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 92127 </ zipCode >

</ issuerAddress >

< issuerPhoneNumber > (858) 524-3901 </ issuerPhoneNumber >

< jurisdictionOfInc > DELAWARE </ jurisdictionOfInc >

- < issuerPreviousNameList >

< previousName > None </ previousName >

</ issuerPreviousNameList >

- < edgarPreviousNameList >

< value > None </ value >

</ edgarPreviousNameList >

< entityType > Corporation </ entityType >

- < yearOfInc >

< overFiveYears > true </ overFiveYears >

</ yearOfInc >

</ primaryIssuer >

- < relatedPersonsList >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Stephen </ firstName >

< middleName > Eric </ middleName >

< lastName > Ryan </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > c/o Provisio Medical, Inc. </ street1 >

< street2 > 10815 Rancho Bernardo Road, Suite 110 </ street2 >

< city > San Diego </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 92127 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ relationship >

< relationship > Director </ relationship >

< relationship > Promoter </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Aurelio </ firstName >

< lastName > Fernandez </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > c/o Provisio Medical, Inc. </ street1 >

< street2 > 10815 Rancho Bernardo Road, Suite 110 </ street2 >

< city > San Diego </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 92127 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Timothy </ firstName >

< lastName > Lindenfelser </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > c/o Provisio Medical, Inc. </ street1 >

< street2 > 10815 Rancho Bernardo Road, Suite 110 </ street2 >

< city > San Diego </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 92127 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > Frank </ firstName >

< middleName > J. </ middleName >

< lastName > Del Rio </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > c/o Provisio Medical, Inc. </ street1 >

< street2 > 10815 Rancho Bernardo Road, Suite 110 </ street2 >

< city > San Diego </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 92127 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > George </ firstName >

< lastName > Quinoy </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > c/o Provisio Medical, Inc. </ street1 >

< street2 > 10815 Rancho Bernardo Road, Suite 110 </ street2 >

< city > San Diego </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 92127 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

</ relatedPersonsList >

- < offeringData >

- < industryGroup >

< industryGroupType > Other Technology </ industryGroupType >

</ industryGroup >

- < issuerSize >

< revenueRange > Decline to Disclose </ revenueRange >

</ issuerSize >

- < federalExemptionsExclusions >

< item > 06b </ item >

</ federalExemptionsExclusions >

- < typeOfFiling >

- < newOrAmendment >

< isAmendment > true </ isAmendment >

< previousAccessionNumber > 0001437749-21-000958 </ previousAccessionNumber >

</ newOrAmendment >

- < dateOfFirstSale >

< value > 2021-01-15 </ value >

</ dateOfFirstSale >

</ typeOfFiling >

- < durationOfOffering >

< moreThanOneYear > false </ moreThanOneYear >

</ durationOfOffering >

- < typesOfSecuritiesOffered >

< isEquityType > true </ isEquityType >

< isOtherType > true </ isOtherType >

< descriptionOfOtherType > Preferred Stock </ descriptionOfOtherType >

</ typesOfSecuritiesOffered >

- < businessCombinationTransaction >

< isBusinessCombinationTransaction > false </ isBusinessCombinationTransaction >

</ businessCombinationTransaction >

< minimumInvestmentAccepted > 50000 </ minimumInvestmentAccepted >

< salesCompensationList />

- < offeringSalesAmounts >

< totalOfferingAmount > 4000002 </ totalOfferingAmount >

< totalAmountSold > 4000002 </ totalAmountSold >

< totalRemaining > 0 </ totalRemaining >

</ offeringSalesAmounts >

- < investors >

< hasNonAccreditedInvestors > false </ hasNonAccreditedInvestors >

< totalNumberAlreadyInvested > 16 </ totalNumberAlreadyInvested >

</ investors >

- < salesCommissionsFindersFees >

- < salesCommissions >

< dollarAmount > 0 </ dollarAmount >

</ salesCommissions >

- < findersFees >

< dollarAmount > 0 </ dollarAmount >

</ findersFees >

</ salesCommissionsFindersFees >

- < useOfProceeds >

- < grossProceedsUsed >

< dollarAmount > 400000 </ dollarAmount >

< isEstimate > true </ isEstimate >

</ grossProceedsUsed >

</ useOfProceeds >

- < signatureBlock >

< authorizedRepresentative > false </ authorizedRepresentative >

- < signature >

< issuerName > Provisio Medical, Inc. </ issuerName >

< signatureName > /s/ Stephen Eric Ryan </ signatureName >

< nameOfSigner > Stephen Eric Ryan </ nameOfSigner >

< signatureTitle > President </ signatureTitle >

< signatureDate > 2021-06-03 </ signatureDate >

</ signature >

</ signatureBlock >

</ offeringData >

</ edgarSubmission >