Initial Statement of Beneficial Ownership (3)
March 09 2021 - 5:35PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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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Cozad Jeffrey Alley |
2. Date of Event Requiring Statement (MM/DD/YYYY)
2/26/2021
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3. Issuer Name and Ticker or Trading Symbol
Medicine Man Technologies, Inc. [SHWZ]
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(Last)
(First)
(Middle)
4740 W. MOCKINGBIRD LANE, P.O. BOX 195579 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
DALLAS, TX 75209
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 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) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 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) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Series A Cumulative Convertible Preferred Stock | (1) | (1) | Common Stock | 19375000 (2) | $1.20 (3) | I | See Footnote (4) |
Explanation of Responses: |
(1) | The shares of Series A Cumulative Convertible Preferred Stock (the "Series A Preferred Shares") are convertible into shares of the common stock (the "Common Shares") of Medicine Man Technologies, Inc. (the "Company") upon the events specified in the Company's Certificate of Designation of Series A Cumulative Convertible Preferred Stock (the "Certificate of Designation"). The Series A Preferred Shares have no expiration date. |
(2) | Represents the number of Common Shares issuable upon conversion of the Series A Preferred Shares on the date of event requiring this report. Each Series A Preferred Share shall be convertible into that number of Common Shares equal to the preference amount (initially $1,000) plus any accrued dividends with respect to such share, divided by the conversion price (initially $1.20), subject to adjustment as set forth in the Certificate of Designation. The Series A Preferred Shares earn a cumulative dividend of 8% per annum. |
(3) | Subject to adjustment, as described in the Certificate of Designation. |
(4) | CRW Capital Cann Holdings, LLC (the "Holder") is the record holder of the reported shares. Mr. Cozad is a manager of CRW Capital, LLC, which is the sole manager of the Holder. Mr. Cozad disclaims beneficial ownership of the reported shares except to the extent of his pecuniary interest therein. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Cozad Jeffrey Alley 4740 W. MOCKINGBIRD LANE P.O. BOX 195579 DALLAS, TX 75209 |
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Signatures
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/s/ Jeffrey A. Cozad | | 3/9/2021 |
**Signature of Reporting Person | Date |
Medicine Man Technologies (CE) (USOTC:SHWZ)
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