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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549
SCHEDULE 13G
UNDER THE SECURITIES EXCHANGE ACT OF 1934
(AMENDMENT NO. ____)*
PACIFICHEALTH LABORATORIES, INC
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(Name of Issuer)
COMMON STOCK, $.0025 PAR VALUE
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(Title of Class of Securities)
695113 10 0
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(CUSIP Number)
*The remainder of this cover page shall be filled out for a reporting person's
initial filing on this form with respect to the subject class of securities, and
for any subsequent amendment containing information which would alter the
disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed
to be "filed" for the purpose of Section 18 of the Securities Exchange Act of
1934 ("Act") or otherwise subject to the liabilities of that section of the Act
but shall be subject to all other provisions of the Act (however, see the
Notes).
(Continued on following page(s))
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Page 1 of 4 Pages
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CUSIP No. 695113 10 0 13G Page 2 of 4 Pages
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1. NAMES OF REPORTING PERSON
S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON
Jonathan D. Rahn, SS# ###-##-####
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2. CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP:
(a) |_|
(b) |_|
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3. SEC USE ONLY
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4. CITIZENSHIP OR PLACE OF ORGANIZATION
USA
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5. SOLE VOTING POWER
NUMBER OF 343,000 shares of Common Stock
SHARES --------------------------------------------------------
BENEFICIALLY 6. SHARED VOTING POWER
OWNED BY None
EACH --------------------------------------------------------
REPORTING 7. SOLE DISPOSITIVE POWER
PERSON WITH 343,000 shares of Common Stock
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8. SHARED DISPOSITIVE POWER
None
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9. AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING
PERSON
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343,000 shares of Common Stock, which includes
presently-exercisable options to acquire 100,000 shares
of Common Stock
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10. CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES
CERTAIN SHARES |_|
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11. PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW 9
7.4%
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12. TYPE OF REPORTING PERSON
IN
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CUSIP NO. 695113 10 0 PAGE 3 OF 4 PAGES
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ITEM 1 (a) NAME OF ISSUER: PacificHealth Laboratories, Inc.
ITEM 1 (b) ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES:
1460 Route 9 North, Woodbridge, NJ 07095
ITEM 2 (a) NAME OF PERSON FILING: Jonathan D. Rahn
ITEM 2 (b) ADDRESS OF PRINCIPAL BUSINESS OFFICE OR, IF NONE, RESIDENCE:
413 Gatewood Road, Cherry Hill, NJ 08003
ITEM 2 (c) CITIZENSHIP: U.S.A.
ITEM 2 (d) TITLE OF CLASS OF SECURITIES: Common Stock, $.0025 par value
ITEM 2 (e) CUSIP NUMBER: 695113 10 0
ITEM 3 IF THIS STATEMENT IS FILED PURSUANT TO RULE 13D-1(b) OR
13D-2(b): Not applicable
ITEM 4 OWNERSHIP
(a) AMOUNT BENEFICIALLY OWNED: 343,000 shares of Common Stock, which
includes presently-exercisable options to acquire 100,000 shares of Common
Stock
(b) PERCENT OF CLASS: 7.4%
(c) NUMBER OF SHARES AS TO WHICH SUCH PERSON HAS:
(i) SOLE POWER TO VOTE OR DIRECT THE VOTE
343,000 Shares
(ii) SHARED POWER TO VOTE OR DIRECT THE VOTE
0 Shares
(iii) SOLE POWER TO DISPOSE OR TO DIRECT THE DISPOSITION OF
343,000 Shares
(iv) SHARED POWER TO DISPOSE OR TO DIRECT THE DISPOSITION OF
0 Shares
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CUSIP NO. 695113 10 0 PAGE 4 OF 4 PAGES
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ITEM 5 OWNERSHIP OF FIVE PERCENT OR LESS OF A CLASS
Not applicable
ITEM 6 OWNERSHIP OF MORE THAN FIVE PERCENT ON BEHALF OF ANOTHER PERSON
Not applicable
ITEM 7 IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE
SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY
Not applicable
ITEM 8 IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF A GROUP
Not applicable
ITEM 9 NOTICE OF DISSOLUTION OF GROUP
Not applicable
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
February 6, 1998
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(Date)
/s/ Jonathan D. Rahn
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(Signature)
Jonathan D. Rahn
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(Name/Title)
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