0001104659-23-044207.txt : 20230411
0001104659-23-044207.hdr.sgml : 20230411
20230411210906
ACCESSION NUMBER: 0001104659-23-044207
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230407
FILED AS OF DATE: 20230411
DATE AS OF CHANGE: 20230411
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Cozad Jeffrey Alley
CENTRAL INDEX KEY: 0001292845
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-55450
FILM NUMBER: 23814493
MAIL ADDRESS:
STREET 1: 909 MONTGOMERY STREET, SUITE 400
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94133
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Medicine Man Technologies, Inc.
CENTRAL INDEX KEY: 0001622879
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MANAGEMENT CONSULTING SERVICES [8742]
IRS NUMBER: 465289499
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 4880 HAVANA STREET
STREET 2: SUITE 201 SOUTH
CITY: DENVER
STATE: CO
ZIP: 80239
BUSINESS PHONE: 303-371-0387
MAIL ADDRESS:
STREET 1: 4880 HAVANA STREET
STREET 2: SUITE 201 SOUTH
CITY: DENVER
STATE: CO
ZIP: 80239
4
1
tm2312462-2_4seq1.xml
OWNERSHIP DOCUMENT
X0407
4
2023-04-07
0
0001622879
Medicine Man Technologies, Inc.
SHWZ
0001292845
Cozad Jeffrey Alley
C/O MEDICINE MAN TECHNOLOGIES, INC.
4880 HAVANA ST., STE. 201
DENVER
CO
80239
1
0
1
0
0
Series A Cumulative Convertible Preferred Stock
1.2
2023-04-07
4
P
0
2100
1000
A
Common Stock
2119219
39740
I
See Footnotes
Series A Cumulative Convertible Preferred Stock
1.2
2023-04-07
4
P
0
8290
1000
A
2023-05-30
Common Stock
8365870
39740
I
See Footnotes
Subject to adjustment, as described in the Certificate of Designation of Series A Cumulative Convertible Preferred Stock (the "Certificate of Designation") of Medicine Man Technologies, Inc. (the "Company").
The shares of Series A Cumulative Preferred Stock (the "Series A Preferred Shares") are convertible into shares of the Company's common stock (the "Common Shares") upon the events specified in the Certificate of Designation. The Series A Preferred Shares have no expiration date.
Represents the number of Common Shares issuable upon conversion of the Series A Preferred Shares on the date of the reported transaction. 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.
CRW Capital Holdings II, LLC (the "Holder") is the record holder of the reported shares. Jeffrey Cozad is a manager of CRW Capital, LLC, which is the sole manager of the Holder. Each of Mr. Cozad and CRW Capital, LLC disclaims beneficial ownership of the reported shares except to the extent of his or its pecuniary interest therein.
Pursuant to that certain Preferred Stock Secondary Purchase Agreement dated as of November 23, 2022 (the "Purchase Agreement") by and among the Holder and those certain sellers named therein (the "Sellers"), the Holder agreed to purchase these certain shares of Series A Preferred Shares at a subsequent closing occurring as of April 7, 2023.
Pursuant to the Purchase Agreement, the Holder acquired the right to purchase such Series A Preferred Shares for a period of up to one hundred and eighty (180) days after the date of the initial closing under the Purchase Agreement, which occurred on November 30, 2022.
The Holder is the holder of a right to buy the reported shares. Jeffrey Cozad is a manager of CRW Capital, LLC, which is the sole manager of the Holder. Each of Mr. Cozad and CRW Capital, LLC disclaims beneficial ownership of the reported shares except to the extent of his or its pecuniary interest therein.
/s/ Daniel R. Pabon attorney in fact for Jeffrey A. Cozad
2023-04-11