0001717370-19-000002.txt : 20191030 0001717370-19-000002.hdr.sgml : 20191030 20191030150024 ACCESSION NUMBER: 0001717370-19-000002 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191028 FILED AS OF DATE: 20191030 DATE AS OF CHANGE: 20191030 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Evans David W CENTRAL INDEX KEY: 0001717370 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38861 FILM NUMBER: 191179594 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 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2019-10-28 0 0001642375 Guardion Health Sciences, Inc. GHSI 0001717370 Evans David W 4141 JUTLAND DRIVE, SUITE 215 SAN DIEGO CA 92117 1 1 0 0 Chief Science Officer Common Stock 2019-10-30 4 A 0 2000 0.332 A 1544500 D Warrant 0.342 2019-10-30 4 A 0 2000 0.01 A 2024-10-30 Common Stock 2000 2000 D Reporting Person purchased 2,000 Series B warrants in Issuer's follow-on public offering, which closed on October 30, 2019, which warrant will become exercisable only after the Issuer effectuates an amendment to its Charter to either (i) increase the number of authorized shares of common stock or (ii) implement a reverse stock split with respect to the shares of common stock. The Series B warrants will then be exercisable any time up to the date that is five years after the Charter Amendment is effectuated. /s/ Vincent J. Roth as attorney-in-fact for David W. Evans 2019-10-30