Form D Raw Data - Electronic Filing Depository

EFDID: 480287EFD: Raw Data

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

Accession: 0001437749-23-009699 () (EDGAR Files) (Form D)

Edgar Posted: Apr. 6, 2023
EFD Posted: Apr. 7, 2023

- < edgarSubmission >

< schemaVersion > X0708 </ schemaVersion >

< submissionType > D </ 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 > Michael </ firstName >

< lastName > Chobotov </ 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 > John </ firstName >

< lastName > McCallum </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

< street1 > JAM Capital Partners </ street1 >

< street2 > PO Box 20097 </ street2 >

< city > St. Simons Island </ city >

< stateOrCountry > GA </ stateOrCountry >

< stateOrCountryDescription > GEORGIA </ stateOrCountryDescription >

< zipCode > 31522 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Director </ relationship >

</ relatedPersonRelationshipList >

< relationshipClarification />

</ relatedPersonInfo >

- < relatedPersonInfo >

- < relatedPersonName >

< firstName > John </ firstName >

< lastName > Blake </ lastName >

</ relatedPersonName >

- < relatedPersonAddress >

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

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

< city > San Diego </ city >

< stateOrCountry > CA </ stateOrCountry >

< stateOrCountryDescription > CALIFORNIA </ stateOrCountryDescription >

< zipCode > 92127 </ zipCode >

</ relatedPersonAddress >

- < relatedPersonRelationshipList >

< relationship > Executive Officer </ 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 > false </ isAmendment >

</ newOrAmendment >

- < dateOfFirstSale >

< value > 2023-04-03 </ 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 > 100000 </ minimumInvestmentAccepted >

- < salesCompensationList >

- < recipient >

< recipientName > LifeSci Capital </ recipientName >

< recipientCRDNumber > 168404 </ recipientCRDNumber >

< associatedBDName > LifeSci Capital </ associatedBDName >

< associatedBDCRDNumber > 168404 </ associatedBDCRDNumber >

- < recipientAddress >

< street1 > 250 West 55th Street </ street1 >

< street2 > 34th Floor </ street2 >

< city > New York </ city >

< stateOrCountry > NY </ stateOrCountry >

< stateOrCountryDescription > NEW YORK </ stateOrCountryDescription >

< zipCode > 10019 </ zipCode >

</ recipientAddress >

- < statesOfSolicitationList >

< value > All States </ value >

</ statesOfSolicitationList >

</ recipient >

</ salesCompensationList >

- < offeringSalesAmounts >

< totalOfferingAmount > 25000000 </ totalOfferingAmount >

< totalAmountSold > 4519532 </ totalAmountSold >

< totalRemaining > 20480468 </ totalRemaining >

</ offeringSalesAmounts >

- < investors >

< hasNonAccreditedInvestors > false </ hasNonAccreditedInvestors >

< totalNumberAlreadyInvested > 19 </ totalNumberAlreadyInvested >

</ investors >

- < salesCommissionsFindersFees >

- < salesCommissions >

< dollarAmount > 115500 </ dollarAmount >

< isEstimate > true </ isEstimate >

</ salesCommissions >

- < findersFees >

< dollarAmount > 0 </ dollarAmount >

</ findersFees >

< clarificationOfResponse > Broker also to receive warrant compensation = equity warrants equal to 1% of the Gross Proceeds sold by said broker. Term of five years, cashless exercise option, convertible into common shares, and exercise price = 125% of the price per share paid by in </ clarificationOfResponse >

</ salesCommissionsFindersFees >

- < useOfProceeds >

- < grossProceedsUsed >

< dollarAmount > 500000 </ 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 > 2023-04-05 </ signatureDate >

</ signature >

</ signatureBlock >

</ offeringData >

</ edgarSubmission >