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^*

Carrillo Sabas D

(Last)

(First)

(Middle)

3242 SOUTH HALLADAY STREET

SUITE 202

(Street)

SANTA ANA

92705

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
01/12/2024

3. Issuer Name and Ticker or Trading Symbol
BLUM HOLDINGS, INC. [ BLMH ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	X	10% Owner
X	Officer (give title below)		Other (specify below)
Chief Executive Officer

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

	Form filed by One Reporting Person
X	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)
Common Stock	1,123,596	I⁽¹⁾	By Adnant LLC

**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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Series V Preferred Stock	01/03/2024	⁽²⁾	Common Stock	357,143	0.0000	I⁽¹⁾	By Adnant LLC
Warrants	01/03/2023	12/31/2025	Common Stock	178,571	2.8	I⁽¹⁾	By Adnant LLC

1. Name and Address of Reporting Person^*

Carrillo Sabas D

(Last)

(First)

(Middle)

3242 SOUTH HALLADAY STREET

SUITE 202

(Street)

SANTA ANA

92705

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

Adnant LLC

(Last)

(First)

(Middle)

3242 SOUTH HALLADAY STREET

SUITE 202

(Street)

SANTA ANA

92705

(City)

(State)

(Zip)

Explanation of Responses:

1. All securities reported herein are held by Adnant LLC of which Reporting Person is the sole member.

2. Each share of Series V Preferred Stock is convertible at the option of the holder into ten (10) shares of Common Stock at any time from and after the first anniversary of the issuance date. Each share of Series V Preferred Stock automatically converts into ten (10) fully paid and non-assessable shares of Common Stock on the second anniversary of the issuance date.

	/s/ Sabas Carrillo	01/22/2024
	** 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.

Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.