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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 01/04/2021 | 3. Issuer Name and Ticker or Trading Symbol HARVEST HEALTH & RECREATION INC. [ HRVSF ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) |
Multiple Voting Shares | 37,660 | D | |
Multiple Voting Shares | 4,707.5 | I | By Daniel Reiner, as the trustee for the Grantor Retained Annuity Trust |
Multiple Voting Shares | 254,939.2(1) | I | By High Alpine Advisors, LLC |
Subordinate Voting Shares | 7,562,949 | D | |
Subordinate Voting Shares | 548,280 | I | By High Alpine Advisors, LLC |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 |
Explanation of Responses: |
1. On March 10, 2020, Mr. Reiner acquired 54,828 Multiple Voting Shares from the Issuer through the acquisition of Interurban Capital Group Inc. On May 22, 2020, the lock-up expired on 10% of the original issuance and was converted to Subordinate Voting Shares. On December 30, 2020, in accordance with the terms of a secured convertible note issued by a subsidiary of the Issuer in favor of High Alpine Advisors, LLC, such indebtedness was converted into 205,594 Multiple Voting Shares of Harvest Health & Recreation Inc. |
/s/ Allison McBride, Attorney-in-fact | 01/04/2021 | |
** 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. |