# EDGAR Filing Document

**Accession Number:** 0001876882
**File Stem:** 0001437749-25-035478
**Filing Date:** 2025-11
**Character Count:** 7140
**Document Hash:** 6f6b78732f6e2bb44e24a28bfb113df3
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001437749-25-035478.hdr.sgml**: 20251117

**ACCESSION NUMBER**: 0001437749-25-035478

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20251113

**FILED AS OF DATE**: 20251117

**DATE AS OF CHANGE**: 20251117

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Carrillo Sabas D
- **CENTRAL INDEX KEY:** 0001876882

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 000-56626
- **FILM NUMBER:** 251492132

**MAIL ADDRESS:**
- **STREET 1:** 11516 DOWNEY AVE
- **CITY:** DOWNEY
- **STATE:** CA
- **ZIP:** 90241
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** BLUM HOLDINGS, INC.
- **CENTRAL INDEX KEY:** 0001996210
- **STANDARD INDUSTRIAL CLASSIFICATION:** RETAIL-MISCELLANEOUS RETAIL [5900]
- **ORGANIZATION NAME:** 07 Trade & Services
- **EIN:** 933735199
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 3242 SOUTH HALLADAY STREET
- **STREET 2:** SUITE 202
- **CITY:** SANTA ANA
- **STATE:** CA
- **ZIP:** 92705
- **BUSINESS PHONE:** 3238410046

**MAIL ADDRESS:**
- **STREET 1:** 3242 SOUTH HALLADAY STREET
- **STREET 2:** SUITE 202
- **CITY:** SANTA ANA
- **STATE:** CA
- **ZIP:** 92705

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Carrillo Sabas D<br><sub>(Last) (First) (Middle)</sub><br>11516 DOWNEY AVE<br><sub>(Street)</sub><br>DOWNEY, CA 90241<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-11-13 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_Chief Executive Officer_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>BLUM HOLDINGS, INC. [ BLMH ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2025-11-13 |  | J<sup>(3)</sup> |  | 1530612 | A | 0.98<sup>(4)</sup> | 6462766 | I | Adnant, LLC<sup>(1)</sup> |
| Common Stock | 2025-11-13 |  | J<sup>(5)</sup> |  | 2482308 | A | 0.98<sup>(5)</sup> | 8945074 | I | Adnant, LLC<sup>(1)</sup> |
| Common Stock |  |  |  |  |  |  |  | 92389 | D |  |
| Series V Preferred Stock |  |  |  |  |  |  |  | 3571429<sup>(2)</sup> | I | Adnant, LLC<sup>(1)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Warrants to Purchase Common Stock | $0.4600 |  |  |  |  |  |  | 2024-12-30 | 2027-12-31 | Common Stock | 595238 |  | 595238 | I | Adnant, LLC<sup>(1)</sup> |

---

### Footnotes:

(1) Reporting Person is the CEO and managing member of Adnant, LLC.

(2) Each share of Series V Preferred Stock is convertible at the option of the holder into 1/3 of a share of Common Stock at any time from and after the first anniversary of the issuance date. Each share of Series V Preferred Stock automatically converts into Common Stock on the fourth anniversary of the issuance date.

(3) Conversion of outstanding accounts payable in the amount of $1,500,000 owed by the Company to Adnant, LLC into shares of common stock.

(4) Conversion price of $0.98 per share.

(5) On November 13, 2025, Blum Holdings, Inc. (the "Company") issued 2,482,308 shares of Common Stock to Adnant,LLC ("Adnant") pursuant to the Debt Conversion Agreement between the Company and Adnant dated December 30, 2024. The Debt Conversion Agreement provides that, if the Company enters into any financing agreement with a third party on terms more favorable than the per-share price or discount set forth therein, the Company will, at Adnant's request, amend and restate the Debt Conversion Agreement to reflect economics at least equal to those of such third-party financing. The shares were issued at a per-share price of $0.98.

**Signature:** /s/ Sabas Carrillo  
**Date:** 2025-11-17

### Remarks:

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 4 (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.**