0001213900-23-041953.txt : 20230522 0001213900-23-041953.hdr.sgml : 20230522 20230522155846 ACCESSION NUMBER: 0001213900-23-041953 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230518 FILED AS OF DATE: 20230522 DATE AS OF CHANGE: 20230522 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Shaw John William CENTRAL INDEX KEY: 0001969685 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38037 FILM NUMBER: 23944306 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 4 1 ownership.xml X0407 4 2023-05-18 0 0001023994 SAFE & GREEN HOLDINGS CORP. SGBX 0001969685 Shaw John William 1005 E. LAS TUNAS DR. #116 SAN GABRIEL CA 91776 0 0 1 0 0 Common Stock 2023-05-18 4 X 0 22100 1 A 4454600 D Common Stock 2023-05-19 4 X 0 368700 2 A 4454600 D Common Stock 2023-05-19 4 X 0 163700 1 A 4454600 D Put Option (obligation to buy) 1 2023-05-18 4 X 0 221 0 D 2023-05-19 Common Stock 22100 0 D Put Option (obligation to buy) 2 2023-05-19 4 X 0 3687 0 D 2023-05-19 Common Stock 368700 0 D Put Option (obligation to buy) 1 2023-05-19 4 X 0 1637 0 D 2023-05-19 Common Stock 163700 0 D The counterparty to certain of the Reporting Person's outstanding short put options exercised such options and the Reporting Person was obligated to purchase these shares at an exercise price of $1.00 per share. The counterparty to certain of the Reporting Person's outstanding short put options exercised such options and the Reporting Person was obligated to purchase these shares at an exercise price of $2.00 per share. The counterparty to certain of the Reporting Person's outstanding short put options exercised such options and the Reporting Person was obligated to purchase these shares at an exercise price of $1.00 per share. As of 05/19/2023 this amount includes the rights and/or the obligations to purchase 1,111,900 shares in the aggregate that are exercisable subject to various call and put option contracts. Denotes option exercisable at any time prior to the expiration date. /s/ John William Shaw 2023-05-22