SEC Form 4 · accession 0001385150-16-000012
Acacia Diversified Holdings, Inc. · ACCA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Richard K Pertile
Officer — CEO, President, Chairman · Director · 10% Owner
Period of report
Dec 12, 2016
Accepted (ET)
Dec 16, 2016 · 11:43 am EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001001463
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common stockF1,F2,F3,F4 | Dec 12, 2016 | P | 1,200,000 | $0.50 | A | 2,234,000 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Reporting Person acquired 1,200,000 shares of the Common stock of Issuer in a transaction relating to the exchange of equity shares of Issuer for cancellation of $500,000 in debt and for an additional injection of $100,000 into Issuer for operating capital.
- F2Price was fixed by the board of directors as an incentive for Reporting Person to exchange equity shares for debt and to infuse additional operating capital into the Company.
- F3In conjunction with the acquisition of these shares, Reporting Person became a shareholder of greater than 10% the issued and outstanding shares of Issuer.
- F4In addition to the shares beneficially held by Reporting Person, he also holds: (1) a Proxy to vote 2,500,000 shares of another affiliate of the Company; and, (ii) holds those shares in trust under a Right of First Refusal to acquire them from the other affiliated person at any time between April 4th and May 4th of 2019. This Proxy brings the total sole dispositive voting power of 4,734,000 votes.
Remarks
In addition to the 2,234,000 Common shares beneficially held by Reporting Person, he also holds: (1) a Proxy to vote 2,500,000 shares of another affiliate of the Company; and, (ii) holds those shares in trust under a Right of First Refusal to acquire them from the other affiliated person at any time between April 4th and May 4th of 2019. This Proxy brings the total sole dispositive voting power of 4,734,000 votes.