FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 08/12/2022 |
3. Issuer Name and Ticker or Trading Symbol
Jushi Holdings Inc. [ JUSH/JUSHF ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) 08/12/2022 |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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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) |
Subordinate Voting Shares | 4,519,627(1) | D | |
Subordinate Voting Shares | 2,500,000 | I | OEP Opportunities, L.P. |
Subordinate Voting Shares | 1,400,000 | I | One East Capital Advisors, L.P. |
Subordinate Voting Shares | 2,703,350(1) | I | One East Partners L.P. |
Subordinate Voting Shares | 795,488 | I | ST2 LLC |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Stock Option (right to buy) | (2) | 10/27/2031 | Subordinate Voting Shares | 80,000 | 3.91 | D | |
Stock Option (right to buy) | 04/17/2022 | 04/17/2029 | Subordinate Voting Shares | 2,385,000 | 2 | D | |
Stock Option (right to buy) | (3) | 07/28/2032 | Subordinate Voting Shares | 3,000,000 | 1.93 | D | |
Warrant (right to buy) | 06/10/2019 | 06/10/2029 | Subordinate Voting Shares | 2,500,000 | 1 | I | OEP Opportunities, L.P. |
Warrant (right to buy) | 06/10/2019 | 06/10/2029 | Subordinate Voting Shares | 2,500,000 | 1 | I | One East Partners L.P. |
Warrant (right to buy) | 06/10/2019 | 06/10/2029 | Subordinate Voting Shares | 5,000,000 | 1 | D | |
Warrant (right to buy) | 06/10/2019 | 06/10/2029 | Subordinate Voting Shares | 1,375,000 | 0.5 | I | One East Capital Advisors LP |
Warrant (right to buy) | 06/10/2019 | 06/10/2029 | Subordinate Voting Shares | 1,400,000 | 1 | I | One East Capital Advisors LP |
Warrant (right to buy) | 07/11/2020 | 12/23/2024 | Subordinate Voting Shares | 1,500,000 | 1.25 | I | OEP Opportunities, L.P. |
Warrant (right to buy) | 09/27/2018 | 09/27/2023 | Subordinate Voting Shares | 175,000 | 1.5 | I | One East Partners L.P. |
Warrant (right to buy) | 07/11/2020 | 12/23/2024 | Subordinate Voting Shares | 1,500,000 | 1.25 | I | One East Partners L.P. |
Warrant (right to buy) | 06/10/2019 | 06/10/2029 | Subordinate Voting Shares | 150,000 | 1.35 | I | One East Management Services, LLC |
Warrant (right to buy) | 06/10/2019 | 06/10/2029 | Subordinate Voting Shares | 10,000 | 2 | I | One East Management Services, LLC |
Warrant (right to buy) | 07/11/2020 | 12/23/2024 | Subordinate Voting Shares | 3,000,000 | 1.25 | I | Serpentine Capital Management II LLC |
Warrant (right to buy) | 07/11/2020 | 12/23/2024 | Subordinate Voting Shares | 900,000 | 1.25 | I | JAC Serpentine, LLC |
Explanation of Responses: |
1. 100,000 shares previously reported as owned directly should have been reported as owned indirectly by One East Partners L.P. |
2. One-third of the Option will vest on each of the first, second and third anniversaries of the Vesting Commencement Date (5/1/2021), subject to continuous service. |
3. 33.33% of the total number of Shares subject to the Option shall be vested as of the Date of Grant (7/28/2022) and 33.33% of the total number of Shares subject to the Option will vest on each January 1 thereafter, subject to continuous service. |
Remarks: |
/s/ Louis Jon Barack, attorney-in-fact | 02/01/2023 | |
** Signature of Reporting Person | Date | |
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 5 (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. |