SEC Info - Rohrer Douglas S - ‘3’ for 11/22/22 re: Bloomios, 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^*

Rohrer Douglas S

(Last)

(First)

(Middle)

701 ANACAPA

SUITE C

(Street)

SANTA BARBARA

93101

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
11/22/22

3. Issuer Name and Ticker or Trading Symbol
BLOOMIOS, INC. [ BLMS ]

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

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
Chief Business 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)
Common Stock ⁽¹⁾	1,697	D

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)
Stock Option Grant	⁽²⁾	5/4/27	Common stock	550,000	1.69	D

Explanation of Responses:

(1) Common shares acquired through market trades occurring 11/22/22 to 12/2/22.

(2) 50,000 shares exercisable on the Date of Grant of 5/4/22; 200,000 shares on the date that the Company is approved for up-listing on Nasdaq; and the balance of 300,000 shall vest equally over 24 months commencing on the one-year anniversary of the Date of Grant and become exercisable on the 18th day of each month thereafter (and if there is no corresponding day, the last day of the month).

Remarks:

	/s/ Douglas S Rohrer	12/2/22
	** 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.

Rohrer Douglas S – ‘3’ for 11/22/22 re: Bloomios, Inc.

On: Friday, 12/2/22, at 6:15pm ET · For: 11/22/22 · As: Officer · Accession #: 1477932-22-9059 · File #: 0-50026

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:

Rohrer Douglas S – ‘3’ for 11/22/22 re: Bloomios, Inc.

On: Friday, 12/2/22, at 6:15pm ET · For: 11/22/22 · As: Officer · Accession #: 1477932-22-9059 · File #: 0-50026

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