# EDGAR Filing Document

**Accession Number:** 0001713863
**File Stem:** 0001209191-23-005396
**Filing Date:** 2023-1
**Character Count:** 5382
**Document Hash:** 9add3ba15c1dbccb60bfebf17646c634
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001209191-23-005396.hdr.sgml**: 20230130

**ACCESSION NUMBER**: 0001209191-23-005396

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230128

**FILED AS OF DATE**: 20230130

**DATE AS OF CHANGE**: 20230130

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Polinsky David
- **CENTRAL INDEX KEY:** 0001726896

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-38411
- **FILM NUMBER:** 23566028

**MAIL ADDRESS:**
- **STREET 1:** 90 BOOTH AVENUE
- **CITY:** ENGLEWOOD
- **STATE:** NJ
- **ZIP:** 07631
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Rafael Holdings, Inc.
- **CENTRAL INDEX KEY:** 0001713863
- **STANDARD INDUSTRIAL CLASSIFICATION:** REAL ESTATE [6500]
- **IRS NUMBER:** 822296593
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 0731

**BUSINESS ADDRESS:**
- **STREET 1:** 520 BROAD STREET
- **CITY:** NEWARK
- **STATE:** NJ
- **ZIP:** 07120
- **BUSINESS PHONE:** 212-658-1450

**MAIL ADDRESS:**
- **STREET 1:** 520 BROAD STREET
- **CITY:** NEWARK
- **STATE:** NJ
- **ZIP:** 07120

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Polinsky David<br><sub>(Last) (First) (Middle)</sub><br>C/O RAFAEL HOLDINGS, INC.<br>520 BROAD ST<br><sub>(Street)</sub><br>NEWARK, NJ 07102<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>Rafael Holdings, Inc. [ RFL ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2023-01-28 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director   [ ] 10% Owner<br>[X] Officer (give title below)   [ ] Other (specify below)<br>_Chief Financial Officer_ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |
| Class B Common Stock, par value $.01 per share | 130780<sup>(1)</sup> | D |  |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Employee Stock Option (right to buy) | <sup>(2)</sup> | 2032-01-18 | Class B Common Stock | 50000 | $4.57 | D |  |
| Employee Stock Option (right to buy) | <sup>(3)</sup> | 2033-01-22 | Class B Common Stock | 50000 | $2.10 | D |  |

---

### Footnotes:

(1) Consists of 17,864 fully vested restricted shares and 112,916 unvested restricted shares that vest as follows: 5,416 on September 23, 2023; 25,000 on December 21, 2023; 6,250 on each of March 21, 2024, June 21, 2024 and September 21, 2024; 3,750 on September 23, 2024; 6,250 on each of December 21, 2024, March 21, 2025,  June 21, 2025 and September 21, 2025; 3,750 on September 23, 2025; and 6,250 on each of December 21, 2025, March 21, 2025, June 21, 2026, September 21, 2026 and December 21, 2026.

(2) The option vests as follows: 12,500 on January 19, 2023 and 3,125 on each of April 19, 2023, July 19, 2023, October 19, 2023, January 19, 2024, April 19, 2024, July 19, 2024, October 19, 2024, January 19, 2025, April 19, 2025, July 19, 2025, October 19, 2025 and January 19, 2026.

(3) The option vests as follows: 12,500 on January 23, 2024 and 3,125 on each of April 23, 2024, July 23, 2024, October 23, 2024, January 23, 2025, April 23, 2025, July 23, 2025, October 23, 2025, January 23, 2026, April 23, 2026, July 23, 2026, October 23, 2026 and January 23, 2027.

**Signature:** Joyce J Mason, by Power of Attorney  
**Date:** 2023-01-30

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**