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