UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549INITIAL 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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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | SEC 1473 (7-02) | ||
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 control number. |
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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) |
6. Nature of Indirect Beneficial Ownership (Instr. 5) |
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Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Common Stock Warrants (right to buy) | 11/01/2019 | 11/01/2022 | Common stock, no par value | 2,913,750 (1) | $ 0.25 (2) | D | |
Employee Stock Options (right to buy) | (3) | 11/21/2029(4) | Common stock, no par value | 1,666,667 (3) | $ 0.5 (5) | D | |
LP Units of Jimmy Jang L.P. | (6) | (6) | Common stock, no par value | 27,182,540 (6) | $ 0 | I | See Footnote (7) |
Rights of TILT Holdings Inc. | (6) | (6) | Common stock, no par value | 27,182,540 (6) | $ 0 | I | See Footnote (8) |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
Scatterday Mark C/O TILT HOLDINGS INC. 2801 E. CAMELBACK ROAD #180 PHOENIX, AZ 85016 |
X |
/s/ Mark M. Higgins as attorney-in-fact for Mark Scatterday | 06/21/2022 | |
**Signature of Reporting Person | Date |
* | 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). |
(1) | Each warrant is exercisable for one share of the Issuer's common stock, no par value ("Common Stock"). |
(2) | The exercise price of the warrants is $0.33 Canadian dollars per share of common stock. The amount in column 4 is converted to U.S. dollars using the exchange rate as of June 17, 2022 as reported by the Bank of Canada. |
(3) | Each option is exercisable for one share of Common Stock. The options are fully vested. |
(4) | The options will expire on the earlier of (i) November 21, 2029 and (ii) the date that is three months after the termination of the Reporting Person's services to the Issuer. |
(5) | The exercise price of the options is $0.65 Canadian dollars per share of common stock. The amount in column 4 is converted to U.S. dollars using the exchange rate as of June 17, 2022 as reported by the Bank of Canada. |
(6) | Each LP unit ("Unit") of Jimmy Jang L.P. ("Jimmy Jang"), a subsidiary of the Issuer, is convertible together with one right ("Right") of TILT Holdings Inc. for one share of Common Stock at any time upon request of the Reporting Person. |
(7) | The Units are held by the Mak One LLLP ("Mak One"), of which the Reporting Person is the owner of 100% of the partnership interests. |
(8) | The Rights are held by the Mak One, of which the Reporting Person is the owner of 100% of the partnership interests. |
Remarks: Exhibit List: Exhibit 24.1 - Power of Attorney |