0001144204-19-019054.txt : 20190410
0001144204-19-019054.hdr.sgml : 20190410
20190410160555
ACCESSION NUMBER: 0001144204-19-019054
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190409
FILED AS OF DATE: 20190410
DATE AS OF CHANGE: 20190410
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FAVISH MICHAEL
CENTRAL INDEX KEY: 0001255541
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38861
FILM NUMBER: 19741738
MAIL ADDRESS:
STREET 1: 15150 AVENUE OF SCIENCE
STREET 2: SUITE 200
CITY: SAN DIEGO
STATE: CA
ZIP: 92128
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Guardion Health Sciences, Inc.
CENTRAL INDEX KEY: 0001642375
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 474428421
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 15150 AVENUE OF SCIENCE, SUITE 200
CITY: SAN DIEGO
STATE: CA
ZIP: 92128
BUSINESS PHONE: 858-605-9055
MAIL ADDRESS:
STREET 1: 15150 AVENUE OF SCIENCE, SUITE 200
CITY: SAN DIEGO
STATE: CA
ZIP: 92128
FORMER COMPANY:
FORMER CONFORMED NAME: Guardion Health Sciences, LLC
DATE OF NAME CHANGE: 20150513
4
1
tv518626_form4.xml
FORM 4
X0306
4
2019-04-09
0
0001642375
Guardion Health Sciences, Inc.
GHSI
0001255541
FAVISH MICHAEL
15150 AVENUE OF SCIENCE, SUITE 200
SAN DIEGO
CA
92128
1
1
1
0
Chief Executive Officer
Common Stock
2019-04-09
4
A
0
1000
4
A
1000
D
Common Stock
3117647
I
Held in the Michael Favish Living Trust Dated Jan 31, 2007
Common Stock
130000
I
Held by wife, Karen M. Favish
Stock Option (Right to Buy)
4.40
2019-04-09
4
A
0
1250000
0
A
2024-04-09
Common Stock
1250000
1250000
D
The Option shall vest ratably over three years commencing one twelfth on June 30, 2019, and one twelfth at the end of each calendar quarter thereafter until fully vested.
/s/ Vincent J. Roth, attorney-in-fact for Michael Favish
2019-04-10