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