SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Shimpa Amber Holly

(Last) (First) (Middle)
207 SOUTH 9TH STREET

(Street)
MINNEAPOLIS MN 55402

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/04/2021
3. Issuer Name and Ticker or Trading Symbol
Vireo Health International, Inc. [ VREOF ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Administrative Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Multiple Voting Shares(1) 8,521 D
Subordinate Voting Shares 23,530 D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options (2) (2) Subordinate Voting Shares 750,120 $0.19 D
Stock Options (3) (3) Subordinate Voting Shares 300,048 $0.19 D
Stock Options (4) (4) Subordinate Voting Shares 1,860,300 $0.33 D
Explanation of Responses:
1. Each Multiple Voting Share carries the right to 100 votes per share on all matters to be voted on by the Company's shareholders.
2. The stock options were granted on January 1, 2018, are 100% vested and and expire on January 2, 2028.
3. The stock options were granted on January 1, 2018, are 100% vested and and expire on January 2, 2028.
4. The stock options were granted on May 1, 2018. 1,278,956 of the options vested and 232,537 vest each of the next three calendar quarters. The options expire on January 2, 2028.
Remarks:
Exhibit List: Exhibit 24 - Power of Attorney
/s/ J. Michael Schroeder attorney-in-fact 01/04/2021
** Signature of Reporting Person Date
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 5 (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.
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