SEC Form 4 · accession 0001385150-18-000001
Acacia Diversified Holdings, Inc. · ACCA
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Steven L Sample
Other
Period of report
Mar 5, 2018
Accepted (ET)
Apr 16, 2018 · 2:55 pm EDT
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 | Mar 5, 2018 | G | 100,000 | $0.00 | D | 1,559,290 | D |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The Reporting Person owns less than 10% of the issued and outstanding Common shares of Issuer. Reporting Person disclaims any beneficial ownership in shares held by others, and disclaims beneficial ownership of any other person in his securities. However, the Issuer has elected to aggregate the shares of the Reporting Person with that of his spouse, thereby rendering the collective aggregated total to be greater than 10% of the issued and outstanding shares of the Issuer. As such, the Reporting Person and his spouse are considered by the Issuer to collectively be "Affiliates" of Issuer, thus requiring this disclosure report.
Remarks
Reporting Person disclaims any beneficial ownership in shares held by others, and disclaims beneficial ownership of any other person in his securities.