SEC FORM 3/A 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*
KENNEDY JAMES A C

(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
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
02/15/2022
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 92,464 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
Proportionate Voting Shares (1) (1) Common Shares 18,234.28 0 I Held by 2008 Kennedy Family Trust dtd 07/25/2008
Restricted Stock Units (2) (2) Common Shares 6,154 (3) D
Restricted Stock Units (4) (4) Common Shares 36,171 (3) D
Explanation of Responses:
1. Each proportionate voting share is convertible into 100 common shares of the Issuer.
2. 18,461 restricted stock units ("RSUs") were granted on April 29, 2019, with 12,307 RSUs vesting prior the date of this Form 3. The remaining 6,154 RSUs will vest on April 29, 2022. Settlement of vested RSUs will occur within 60 days of the applicable vesting date.
3. Each restricted stock unit represents a contingent right to receive one share of the Issuer's common stock.
4. The restricted stock units ("RSUs") were granted on July 2, 2021, and fully vest on the date of the Issuer's 2022 annual shareholder meeting. Settlement of vested RSUs will occur as soon as administratively feasible following the applicable vesting date.
Remarks:
Exhibit 24.1 Power of Attorney (attached to Form 3 filed with Securities and Exchange Commission on February 15, 2022)
/s/ David Sirolly as attorney-in-fact for James A.C. Kennedy 10/20/2022
** 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.
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