SEC Form 3
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*
Cabral James

(Last) (First) (Middle)
C/O JUSHI HOLDINGS INC.
301 YAMATO ROAD, SUITE 3250

(Street)
BOCA RATON FL 33431

(City) (State) (Zip)
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 ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Accounting Executive
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
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 106,415 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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) (1) 07/28/2032 Subordinate Voting Shares 170,000 $1.93 D
Stock Option (right to buy) (1) 07/28/2032 Subordinate Voting Shares 155,000 $1.93 D
Stock Option (right to buy) (2) 07/28/2032 Subordinate Voting Shares 300,000 $1.93 D
Stock Option (right to buy) (3) 08/27/2031 Subordinate Voting Shares 150,000 $4.71 D
Explanation of Responses:
1. This Option will vest as to 33 1/3% of the total number of Shares subject to the Option on each yearly anniversary after the Vesting Commencement Date (5/1/2022), subject to continuous service.
2. This Option will vest as to 20% of the total number of Shares subject to the Option on each yearly annviersary after the Vesting Commencement Date (7/1/2022), subject to continuous service.
3. Subject to Optionholder's Continuous Service on each vesting date, this Option will vest as follows: 17% of the total number of Shares subject to the Option will vest on December 31, 2021, 33% will vest on December 31, 2022, 33% will vest on December 31, 2023 and 17% will vest on June 30, 2024.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Louis Jon Barack, attorney-in-fact 08/12/2022
** 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 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.