# EDGAR Filing Document

**Accession Number:** 0001023994
**File Stem:** 0001213900-23-023790
**Filing Date:** 2023-3
**Character Count:** 6226
**Document Hash:** ca297bfedff31cb8c2213f9d568e39db
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001213900-23-023790.hdr.sgml**: 20230328

**ACCESSION NUMBER**: 0001213900-23-023790

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20221128

**FILED AS OF DATE**: 20230328

**DATE AS OF CHANGE**: 20230328

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Shaw John William
- **CENTRAL INDEX KEY:** 0001969685

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-38037
- **FILM NUMBER:** 23771330

**MAIL ADDRESS:**
- **STREET 1:** 1005 E. LAS TUNAS DR.
- **STREET 2:** #116
- **CITY:** SAN GABRIEL
- **STATE:** CA
- **ZIP:** 91776
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** SAFE & GREEN HOLDINGS CORP.
- **CENTRAL INDEX KEY:** 0001023994
- **STANDARD INDUSTRIAL CLASSIFICATION:** WHOLESALE-LUMBER & OTHER CONSTRUCTION MATERIALS [5030]
- **IRS NUMBER:** 954463937
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 195 MONTAGUE STREET, 14TH FLOOR
- **CITY:** BROOKLYN
- **STATE:** NY
- **ZIP:** 11201
- **BUSINESS PHONE:** (646) 240-4235

**MAIL ADDRESS:**
- **STREET 1:** 195 MONTAGUE STREET, 14TH FLOOR
- **CITY:** BROOKLYN
- **STATE:** NY
- **ZIP:** 11201

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** SG BLOCKS, INC.
- **DATE OF NAME CHANGE:** 20111122

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** CDSI HOLDINGS INC
- **DATE OF NAME CHANGE:** 19990114

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** PC411 INC
- **DATE OF NAME CHANGE:** 19961001

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

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Shaw John William<br><sub>(Last) (First) (Middle)</sub><br>1005 E. LAS TUNAS DR. #116<br><sub>(Street)</sub><br>SAN GABRIEL, CA 91776<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>SAFE & GREEN HOLDINGS CORP. [ SGBX ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2022-11-28 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director   [X] 10% Owner<br>[ ] Officer (give title below)   [ ] Other (specify below)<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 Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |
| Common Stock | 2414000 | D |  |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Call Option Contract (right to purchase) | <sup>(1)</sup> | 2023-05-19 | Common Stock | 110000 | $1 | D |  |
| Call Option Contract (right to purchase) | <sup>(1)</sup> | 2023-05-19 | Common Stock | 60000 | $2 | D |  |
| Call Option Contract (right to purchase) | <sup>(1)</sup> | 2023-05-19 | Common Stock | 30000 | $3 | D |  |
| Call Option Contract (right to purchase) | <sup>(1)</sup> | 2023-08-18 | Common Stock | 427000 | $1 | D |  |
| Call Option Contract (right to purchase) | <sup>(1)</sup> | 2023-08-18 | Common Stock | 107500 | $2 | D |  |
| Put Option Contract (obligation to purchase) | <sup>(1)</sup> | 2023-05-19 | Common Stock | 185800 | $1 | D |  |
| Put Option Contract (obligation to purchase) | <sup>(1)</sup> | 2023-05-19 | Common Stock | 533300 | $2 | D |  |
| Put Option Contract (obligation to purchase) | <sup>(1)</sup> | 2023-08-18 | Common Stock | 577000 | $1 | D |  |
| Put Option Contract (obligation to purchase) | <sup>(1)</sup> | 2023-08-18 | Common Stock | 10000 | $2 | D |  |
| Call Option Contract (obligation to sell) | <sup>(1)</sup> | 2023-08-18 | Common Stock | 90000 | $3 | D |  |
| Call Option Contract (obligation to sell) | <sup>(1)</sup> | 2023-08-18 | Common Stock | 10000 | $4 | D |  |

---

### Footnotes:

(1) Denotes option exercisable at any time prior to the expiration date.

**Remarks:**
Additionally, Reporting Person has a family member named Leo Shaw that Reporting Person believes owns approximately 382,500 shares of common stock, or approximately 3.174% of the Issuer (SGBX). Reporting Person has no ability to verify the actual ownership of Leo Shaw in SGBX. Reporting Person has no pecuniary interest in the securities owned by Leo Shaw and disclaims beneficial ownership in any of the shares owned by Leo Shaw. Reporting Person and his family member do not jointly vote their shares.

**Signature:** /s/ John William Shaw  
**Date:** 2023-03-28

### 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.**