Sec Form 4 Filing - Cozad Jeffrey Alley @ Medicine Man Technologies, Inc. - 2021-12-07

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Cozad Jeffrey Alley
2. Issuer Name and Ticker or Trading Symbol
Medicine Man Technologies, Inc. [ SHWZ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O MEDICINE MAN TECHNOLOGIES, INC., 4880 HAVANA ST., STE. 201
3. Date of Earliest Transaction (MM/DD/YY)
12/07/2021
(Street)
DENVER, CO80239
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
13% Senior Convertible Note Due 2026 $ 2.24( 1 ) 12/07/2021 A 250,000 12/07/2021 12/07/2026 Common Stock 111,608( 1 ) $ 250,000 250,000 I See Footnote( 2 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Cozad Jeffrey Alley
C/O MEDICINE MAN TECHNOLOGIES, INC.
4880 HAVANA ST., STE. 201
DENVER, CO80239
X X
Signatures
/s/ Daniel R. Pabon, attorney-in-fact for Jeffrey A. Cozad 12/09/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On December 7, 2021, the Issuer completed an offering of its 13% Senior Secured Convertible Notes due December 7, 2026 (the "Notes"). The Notes are convertible at any time at the option of theholder into shares of the Issuer's common stock. The foregoing description of the Notes does not purport to be complete and is subject to and qualified in its entirety by reference to the Form ofConvertible Note included as Exhibit 4.2 and the indenture included as Exhibit 4.1 in the Issuer's Current Report on Form 8-K filed on December 9, 2021, which is incorporated by reference.
( 2 )Cozad Investments, L.P. (the "Holder") is the record holder of the reported shares. Mr. Cozad is the General Partner the Holder. Mr. Cozad disclaims beneficial ownership of the reported shares exceptto the extent of his pecuniary interest therein.

Remarks:
Exhibit 24 - Power of Attorney

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