0001683168-22-004385.txt : 20220615 0001683168-22-004385.hdr.sgml : 20220615 20220615194239 ACCESSION NUMBER: 0001683168-22-004385 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220614 FILED AS OF DATE: 20220615 DATE AS OF CHANGE: 20220615 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mukharji Pratap Chandra CENTRAL INDEX KEY: 0001858854 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-55450 FILM NUMBER: 221019072 MAIL ADDRESS: STREET 1: 4880 HAVANA STREET STREET 2: SUITE 201 CITY: DENVER STATE: CO ZIP: 80239 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Medicine Man Technologies, Inc. CENTRAL INDEX KEY: 0001622879 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MANAGEMENT CONSULTING SERVICES [8742] IRS NUMBER: 465289499 STATE OF INCORPORATION: NV FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4880 HAVANA STREET STREET 2: SUITE 201 SOUTH CITY: DENVER STATE: CO ZIP: 80239 BUSINESS PHONE: 303-371-0387 MAIL ADDRESS: STREET 1: 4880 HAVANA STREET STREET 2: SUITE 201 SOUTH CITY: DENVER STATE: CO ZIP: 80239 4 1 ownership.xml X0306 4 2022-06-14 0 0001622879 Medicine Man Technologies, Inc. SHWZ 0001858854 Mukharji Pratap Chandra C/O MEDICINE MAN TECHNOLOGIES, INC. 4880 HAVANA ST., STE. 201 DENVER CO 80239 1 0 0 0 Common Stock 2022-06-14 4 A 0 22728 A 87701 D Common Stock 39683 I See Footnote Employee Stock Option (Right to Buy) 1.72 2022-06-14 4 D 0 20349 D 2022-05-04 2029-05-03 Common Stock 20349 0 D On May 4, 2022, the issuer granted to the reporting person options to purchase shares of Common Stock with an aggregate value of $35,000 as compensation for service on its board of directors. On June 14, 2022, the issuer and the reporting person agreed to cancel these options in exchange for shares of Common Stock with an aggregate value of $35,000. Magnolia Hall Enterprises, LLC (the "Holder") is the record holder of the reported shares. Mr. Mukharji is the manager and 100% owner of the Holder and has voting and investment control of the shares held by the Holder. The cancelled option vested 100% on the grant date. /s/Daniel R. Pabon, attorney-in-fact for Pratap C. Mukharji 2022-06-15