Statement of Changes in Beneficial Ownership (4)
May 03 2022 - 6:05PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0287
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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
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1. Name and Address of Reporting Person
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HART DAVID JAMES |
2. Issuer Name and Ticker or Trading Symbol
Columbia Care Inc.
[
CCHW
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Operating Officer |
(Last)
(First)
(Middle)
C/O COLUMBIA CARE INC., 680 FIFTH AVENUE, 24TH FLOOR |
3. Date of Earliest Transaction
(MM/DD/YYYY)
4/29/2022 |
(Street)
NEW YORK, NY 10019
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Shares | 4/29/2022 | | M | | 38937 | A | (1) | 866840 | D | |
Common Shares | 4/29/2022 | | M | | 168089 | A | (1) | 1034929 | D | |
Common Shares | 4/29/2022 | | M | | 109551 | A | (1) | 1114480 | D | |
Common Shares | 4/29/2022 | | M | | 29280 | A | (1) | 1173760 | D | |
Common Shares | 4/29/2022 | | F | | 138341 | D | $2.75 (2) | 1035419 | D | |
Common Shares | | | | | | | | 14000 | I | Held in Individual Retirement Account |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Restricted Stock Units | (1) | 4/29/2022 | | M | | | 38937 | (3) | (3) | Common Shares | 38937 | $0 | 116814 | D | |
Restricted Stock Units | (1) | 4/29/2022 | | M | | | 168089 | (4) | (4) | Common Shares | 168089 | $0 | 0 | D | |
Restricted Stock Units | (1) | 4/29/2022 | | M | | | 109551 | (5) | (5) | Common Shares | 109551 | $0 | 219102 | D | |
Restricted Stock Units | (1) | 4/29/2022 | | M | | | 29280 | (6) | (6) | Common Shares | 29280 | $0 | 29280 | D | |
Explanation of Responses: |
(1) | Each restricted stock unit ("RSU") represents a contingent right to receive one share of the Issuer's common stock. |
(2) | Converted from Canadian withholding price of C$3.50 using an exchange rate of C$1.2734 = US $1.00. |
(3) | 155,751 RSUs were granted March 23, 2021, and as follows: 1/4 annually beginning March 23, 2022. Settlement of vested RSUs will occur within 60 days of the applicable vesting date. |
(4) | 672,356 RSUs were granted on September 28, 2018, and vest as follows: 1/4 annually beginning March 31, 2019.
Settlement of vested RSUs will occur within 60 days of the applicable vesting date. |
(5) | 438,203 RSUs were granted 3/31/2020, and vest as follows: 1/4 annually beginning March 31, 2021. Settlement of vested RSUs will occur within 60 days of the applicable vesting date. |
(6) | 117,118 RSUs were granted on September 30, 2019, and vest as follows: 1/4 annually beginning April 29, 2020. Settlement of vested RSUs will occur within 60 days of the applicable vesting date. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
HART DAVID JAMES C/O COLUMBIA CARE INC. 680 FIFTH AVENUE, 24TH FLOOR NEW YORK, NY 10019 |
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| Chief Operating Officer |
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Signatures
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/s/ David Sirolly as attorney-in-fact for David James Hart | | 5/2/2022 |
**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 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 control number. |
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