Initial Statement of Beneficial Ownership (3)

Date : 12/30/2019 @ 9:47PM
Source : Edgar (US Regulatory)
Stock : Guardion Health Sciences Inc (GHSI)
Quote : 0.3001  0.001 (0.33%) @ 4:19PM

Initial Statement of Beneficial Ownership (3)

FORM 3
        
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response...
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

Anderson Kelly
2. Date of Event Requiring Statement (MM/DD/YYYY)
12/26/2019 

3. Issuer Name and Ticker or Trading Symbol

Guardion Health Sciences, Inc. [GHSI]
(Last)        (First)        (Middle)

15150 AVENUE OF SCIENCE,, SUITE 200
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)

__X__ Director                          _____ 10% Owner
_____ Officer (give title below)        _____ Other (specify below)
(Street)

SAN DIEGO, CA 92128      

(City)              (State)              (Zip)
5. If Amendment, Date Original Filed(MM/DD/YYYY)
 

6. Individual or Joint/Group Filing(Check Applicable Line)

_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1.Title of Security
(Instr. 4)
2. Amount of Securities Beneficially Owned
(Instr. 4)
3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5)
4. Nature of Indirect Beneficial Ownership
(Instr. 5)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 4)
2. Date Exercisable and Expiration Date
(MM/DD/YYYY)
3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4)
4. Conversion or Exercise Price of Derivative Security5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5)
6. Nature of Indirect Beneficial Ownership
(Instr. 5)
Date ExercisableExpiration DateTitleAmount or Number of Shares

Explanation of Responses:
No securities are beneficially owned.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director10% OwnerOfficerOther
Anderson Kelly
15150 AVENUE OF SCIENCE,
SUITE 200
SAN DIEGO, CA 92128
X



Signatures
/s/ Vincent J. Roth, Power of attorney12/30/2019
**Signature of Reporting PersonDate

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