0001717370-17-000001.txt : 20171006 0001717370-17-000001.hdr.sgml : 20171006 20171006172108 ACCESSION NUMBER: 0001717370-17-000001 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170929 FILED AS OF DATE: 20171006 DATE AS OF CHANGE: 20171006 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Evans Tamara A CENTRAL INDEX KEY: 0001718289 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55723 FILM NUMBER: 171128081 MAIL ADDRESS: STREET 1: 4141 JUTLAND DRIVE, SUITE 215 CITY: SAN DIEGO STATE: CA ZIP: 92117 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Evans David W CENTRAL INDEX KEY: 0001717370 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55723 FILM NUMBER: 171128082 MAIL ADDRESS: STREET 1: 4141 JUTLAND DRIVE, SUITE 215 CITY: SAN DIEGO STATE: CA ZIP: 92117 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 3 1 primary_doc.xml PRIMARY DOCUMENT X0206 3 2017-09-29 0 0001642375 Guardion Health Sciences, Inc. None 0001717370 Evans David W 4141 JUTLAND DRIVE, SUITE 215 SAN DIEGO CA 92117 1 0 1 0 0001718289 Evans Tamara A 4141 JUTLAND DRIVE, SUITE 215 SAN DIEGO CA 92117 0 0 1 0 Common Stock 3050000 I Shares are held indirectly in the name of VectorVision, Inc. Dr. Evans and his wife, Tamara Evans, own all of the issued and outstanding stock of VectorVision, Inc. Dr. Evans owns 28% and Mrs. Evans owns 72% of the VectorVision, Inc. stock. They exercise joint investment control and voting control over the shares of the Issuer held in the name VectorVision, Inc. Out of the 3,050,000 shares of the Issuer reported herein, 250,000 of these shares serve as security for VectorVision, Inc.'s indemnification obligations (the "Holdback Shares") as more fully set forth in the Asset Purchase and Reorganization Agreement effective September 29, 2017 between the Issuer and VectorVision, Inc., which was filed by the Issuer with the SEC on October 5, 2017 on a Current Report on Form 8-K as Exhibit 2.1. /Vincent J. Roth, attorney-in-fact for David W. Evans/ 2017-10-06 /Vincent J. Roth, attorney-in-fact for Tamara Evans/ 2017-10-06