# EDGAR Filing Document

**Accession Number:** 0001455939
**File Stem:** 0001628280-23-001920
**Filing Date:** 2023-2
**Character Count:** 8689
**Document Hash:** e1359570cfa7495d4e594a852ec4bd9a
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001628280-23-001920.hdr.sgml**: 20230201

**ACCESSION NUMBER**: 0001628280-23-001920

**CONFORMED SUBMISSION TYPE**: 3/A

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20220812

**FILED AS OF DATE**: 20230201

**DATE AS OF CHANGE**: 20230201

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Cacioppo James
- **CENTRAL INDEX KEY:** 0001455939

**FILING VALUES:**
- **FORM TYPE:** 3/A
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 000-56468
- **FILM NUMBER:** 23577319

**MAIL ADDRESS:**
- **STREET 1:** 551 MADISON AVENUE
- **STREET 2:** 10TH FLOOR
- **CITY:** NEW YORK
- **STATE:** NY
- **ZIP:** 10022
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Jushi Holdings Inc.
- **CENTRAL INDEX KEY:** 0001909747
- **STANDARD INDUSTRIAL CLASSIFICATION:** MEDICINAL CHEMICALS & BOTANICAL PRODUCTS [2833]
- **IRS NUMBER:** 981547061
- **STATE OF INCORPORATION:** A1
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 301 YAMATO ROAD
- **STREET 2:** SUITE 3250
- **CITY:** BOCA RATON
- **STATE:** FL
- **ZIP:** 33431
- **BUSINESS PHONE:** 5616179100

**MAIL ADDRESS:**
- **STREET 1:** 301 YAMATO ROAD
- **STREET 2:** SUITE 3250
- **CITY:** BOCA RATON
- **STATE:** FL
- **ZIP:** 33431

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

## FORM 3/A

### 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>Cacioppo James<br><sub>(Last) (First) (Middle)</sub><br>C/O JUSHI HOLDINGS INC.<br>301 YAMATO ROAD, SUITE 3250<br><sub>(Street)</sub><br>BOCA RATON, FL 33431<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2022-08-12 | **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>Jushi Holdings Inc. [ JUSH/JUSHF ] | **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 |
| Subordinate Voting Shares |  |  |  |  |  |  |  | 4519627<sup>(1)</sup> | D |  |
| Subordinate Voting Shares |  |  |  |  |  |  |  | 2500000 | I | OEP Opportunities, L.P. |
| Subordinate Voting Shares |  |  |  |  |  |  |  | 1400000 | I | One East Capital Advisors, L.P. |
| Subordinate Voting Shares |  |  |  |  |  |  |  | 2703350<sup>(1)</sup> | I | One East Partners L.P. |
| Subordinate Voting Shares |  |  |  |  |  |  |  | 795488 | I | ST2 LLC |

---

## 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 |
| Stock Option (right to buy) | $3.91 |  |  |  |  |  |  | <sup>(2)</sup> | 2031-10-27 | Subordinate Voting Shares | 80000.0 |  |  | D |  |
| Stock Option (right to buy) | $2.0 |  |  |  |  |  |  | 2022-04-17 | 2029-04-17 | Subordinate Voting Shares | 2385000.0 |  |  | D |  |
| Stock Option (right to buy) | $1.93 |  |  |  |  |  |  | <sup>(3)</sup> | 2032-07-28 | Subordinate Voting Shares | 3000000.0 |  |  | D |  |
| Warrant (right to buy) | $1.0 |  |  |  |  |  |  | 2019-06-10 | 2029-06-10 | Subordinate Voting Shares | 2500000.0 |  |  | I | OEP Opportunities, L.P. |
| Warrant (right to buy) | $1.0 |  |  |  |  |  |  | 2019-06-10 | 2029-06-10 | Subordinate Voting Shares | 2500000.0 |  |  | I | One East Partners L.P. |
| Warrant (right to buy) | $1.0 |  |  |  |  |  |  | 2019-06-10 | 2029-06-10 | Subordinate Voting Shares | 5000000.0 |  |  | D |  |
| Warrant (right to buy) | $0.5 |  |  |  |  |  |  | 2019-06-10 | 2029-06-10 | Subordinate Voting Shares | 1375000.0 |  |  | I | One East Capital Advisors LP |
| Warrant (right to buy) | $1.0 |  |  |  |  |  |  | 2019-06-10 | 2029-06-10 | Subordinate Voting Shares | 1400000.0 |  |  | I | One East Capital Advisors LP |
| Warrant (right to buy) | $1.25 |  |  |  |  |  |  | 2020-07-11 | 2024-12-23 | Subordinate Voting Shares | 1500000.0 |  |  | I | OEP Opportunities, L.P. |
| Warrant (right to buy) | $1.5 |  |  |  |  |  |  | 2018-09-27 | 2023-09-27 | Subordinate Voting Shares | 175000.0 |  |  | I | One East Partners L.P. |
| Warrant (right to buy) | $1.25 |  |  |  |  |  |  | 2020-07-11 | 2024-12-23 | Subordinate Voting Shares | 1500000.0 |  |  | I | One East Partners L.P. |
| Warrant (right to buy) | $1.35 |  |  |  |  |  |  | 2019-06-10 | 2029-06-10 | Subordinate Voting Shares | 150000.0 |  |  | I | One East Management Services, LLC |
| Warrant (right to buy) | $2.0 |  |  |  |  |  |  | 2019-06-10 | 2029-06-10 | Subordinate Voting Shares | 10000.0 |  |  | I | One East Management Services, LLC |
| Warrant (right to buy) | $1.25 |  |  |  |  |  |  | 2020-07-11 | 2024-12-23 | Subordinate Voting Shares | 3000000.0 |  |  | I | Serpentine Capital Management II LLC |
| Warrant (right to buy) | $1.25 |  |  |  |  |  |  | 2020-07-11 | 2024-12-23 | Subordinate Voting Shares | 900000.0 |  |  | I | JAC Serpentine, LLC |

---

### Footnotes:

(1) 100,000 shares previously reported as owned directly should have been reported as owned indirectly by One East Partners L.P.

(2) One-third of the Option will vest on each of the first, second and third anniversaries of the Vesting Commencement Date (5/1/2021), subject to continuous service.

(3) 33.33% of the total number of Shares subject to the Option shall be vested as of the Date of Grant (7/28/2022) and 33.33% of the total number of Shares subject to the Option will vest on each January 1 thereafter, subject to continuous service.

**Signature:** /s/ Louis Jon Barack, attorney-in-fact  
**Date:** 2023-02-01

### 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.**