SEC Info - Bearden Jeffery Dwight - ‘3’ for 6/12/20 re: Acacia Diversified Holdings, Inc.

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^*

Bearden Jeffery Dwight

(Last)

(First)

(Middle)

704 FOREST GLEN ROAD

(Street)

SILVER SPRING

20901

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
6/12/20

3. Issuer Name and Ticker or Trading Symbol
Acacia Diversified Holdings, Inc. [ ACCA ]

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

X	Director	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)

X	Form filed by One Reporting Person
	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)

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 B Convertible Preferred Stock	⁽¹⁾	⁽²⁾	Common Stock ⁽³⁾	73,750,000	0	I ⁽⁴⁾	Through ownership of ORCIM Financial Holdings, LLC

Explanation of Responses:

(1) There is no exercise date for the Series B Convertible Preferred Stock, as it is convertible at the discretion of the reporting person's limited liability company.

(2) There is no expiration date for the Series B Convertible Preferred Stock.

(3) Each share of Series B Convertible Preferred Stock is convertible into 50 shares of the issuer's Common Stock.

(4) The 1,475,000 shares of Series B Convertible Preferred Stock is owned by ORCIM Financial Holdings, LLC, a Maryland limited liability company that is wholly-owned by the reporting person.

	Jeffery D. Bearden	7/29/20
	by Clifford J. Hunt, Esquire, PoA	7/29/20
	** 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.
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Bearden Jeffery Dwight – ‘3’ for 6/12/20 re: Acacia Diversified Holdings, Inc.

On: Wednesday, 7/29/20, at 5:39pm ET · For: 6/12/20 · Accession #: 1380389-20-6 · File #: 1-14088

Initial Statement of Beneficial Ownership of Securities by an Insider — Form 3 — SEA’34
Filing Table of Contents

This ‘3’ Document is an XML Data File that may be rendered in various formats:

Bearden Jeffery Dwight – ‘3’ for 6/12/20 re: Acacia Diversified Holdings, Inc.

On: Wednesday, 7/29/20, at 5:39pm ET · For: 6/12/20 · Accession #: 1380389-20-6 · File #: 1-14088

Initial Statement of Beneficial Ownership of Securities by an Insider — Form 3 — SEA’34Filing Table of Contents

This ‘3’ Document is an XML Data File that may be rendered in various formats:

Initial Statement of Beneficial Ownership of Securities by an Insider — Form 3 — SEA’34
Filing Table of Contents