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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*
ABBOTT MICHAEL

(Last) (First) (Middle)
C/O COLUMBIA CARE INC.
680 FIFTH AVENUE, 24TH FLOOR

(Street)
NEW YORK NY 10019

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/14/2022
3. Issuer Name and Ticker or Trading Symbol
Columbia Care Inc. [ CCHW ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Executive Chairman
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)
Common Shares 321,151 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
Restricted Stock Units (1) (1) Common Shares 217,673 (2) D
Restricted Stock Units (3) (3) Common Shares 102,478 (2) D
Restricted Stock Units (4) (4) Common Shares 479,284 (2) D
Restricted Stock Units (5) (5) Common Shares 225,320 (2) D
Performance Stock Units (6) 04/29/2022 Common Shares 870,691 (6) D
Performance Stock Units (6) 04/29/2024 Common Shares 870,691 (6) D
Explanation of Responses:
1. 870,691 restricted stock units ("RSUs") were granted on April 29, 2019, with 653,018 vesting prior to the date of this Form 3. The remaining 217,673 RSUs vest on October 29, 2022. Settlement of vested RSUs will occur within 60 days of the applicable vesting date.
2. Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock.
3. 204,955 restricted stock units ("RSUs") were granted on September 30, 2019, with 102,477 vesting prior to the date of this Form 3. The remaining 102,478 RSUs vest as follows: 51,239 on April 29, 2022 and April 29, 2023. Settlement of vested RSUs will occur within 60 days of the applicable vesting date.
4. 639,045 restricted stock units ("RSUs") were granted on March 31, 2020, with 159,761 vesting prior to the date of this Form 3. The remaining RSUs will vest as follows: 159,761 on March 31, 2022 and March 31, 2023, and 159,762 on March 31, 2024. Settlement of vested RSUs will occur within 60 days of the applicable vesting date.
5. The restricted stock units ("RSUs") were granted on March 23, 2021, and vest as follows: 56,330 on March 23, 2022, March 23, 2023, March 23, 2024, and March 23, 2025. Settlement of vested RSUs will occur within 60 days of the applicable vesting date.
6. The performance stock units ("PSUs") were granted on April 29, 2019. Each PSU represents a contingent right to receive one share of the Issuer's common stock. The PSUs vest upon the Issuer's common stock achieving a specified price per share.
Remarks:
Exhibit 24.1 Power of Attorney
/s/ David Sirolly as attorney-in-fact for Michael Abbott 03/30/2022
** 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.