Annual Statement of Changes in Beneficial Ownership (5)
June 09 2021 - 2:14PM
Edgar (US Regulatory)
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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Form 3 Holdings Reported
[X]
Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0362
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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
*
Balaouras Paris | 2. Issuer Name and Ticker or Trading SymbolMJ Holdings, Inc. [MJNE] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
Chief Cultivation Officer |
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(Last)
(First)
(Middle)
212 DESERT VIEW | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY)
12/31/2020 |
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(Street)
LAS VEGAS, NV 89107
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
(Instr. 3) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. 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) |
| Amount | (A) or (D) | Price |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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/YYYY) | 7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4) | 8. Price of Derivative Security
(Instr. 5) | 9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year
(Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4) | 11. Nature of Indirect Beneficial Ownership
(Instr. 4) |
| (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Stock option (1) | $0.75 | 9/15/2020 | | A4
| 500000 | | 9/15/2020 | 9/15/2023 | Common stock | 500000 | $0.75 | 500000 | D | |
| Explanation of Responses: |
| (1) | Explanation of Responses: (1) On September 15, 2020, Mr. Balaouras was granted an option to purchase 500,000 shares of the Company's common stock as per the terms of his Employment Agreement (the "Agreement"). The option has an exercise price of $0.75 and expires on the three-year anniversary date of the Agreement. 250,000 shares vested upon execution of the Agreement and 250,000 shares vest at the one-year anniversary of the Agreement. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Balaouras Paris
212 DESERT VIEW
LAS VEGAS, NV 89107 | X | X | Chief Cultivation Officer |
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Signatures
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| /s/ Paris Balaouras | | 6/9/2021 |
| **Signature of Reporting Person | Date |
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