Rhode Island Department of Business Regulation, Office of Cannabis Regulation Renewal Application for Medical Marijuana Cultivator License FORM 2* Disclosure of Owners and Other Interest Holders Name of Applicant/Licensee: ci, tic d/b/a The Work Part i: Owners and Other interest Holders List (A. all persons and/or entities with any ownership interest with respect to the applicantlicenseo, and (B.) all Officers, directors, members, managers or agents ofthe applicantficenses, and (C.} all persons or entities with ‘managing or operational control with respect to the applicartlicensce, ts operations, the license andlor Kcensed facities whether they have an ownership interest or not, and (D.) al Investors or other persons or entities with any financial interest whether they have ownership interest or not, and (E-) ail persons or entities that hold interest(s) atising under shared management companies, management agreements, or other agreements that afford third-party ‘management or operational control with respect tothe applicantiicensee, ts operations, the license andlor the licensed facilities (a persons and entitles described in (A)-(E) being hereinafter individually referred to as an “Interest Holder" and collectively referred to as ‘interest Holders"), Tothe extent that any Interest Holder is an entity (corporation, partnership, LLC, etc.) list all Interest Holders in thet entity unt all such Interest Hoiders are identified and disclosed down to the individual person level. Attach a separate sheets) if necessary, (A) LIST ALL PERSONS ANDIOR ENTITIES WITH ANY OWNERSHIP INTEREST IN THE APPLICANTILICENSEE (including corporation stockholders; LLC members; and partners if a partnership: this includes parent companies if the applicantlicensee Is a subsidiary of another entity). To the extent that any Interest Holder is an entty (corporation, partnership, LLC, etc.) list all Interest Holders in that entity until all such Interest Holders are identified and disclosed down to the individual person level ae Te a i i “Lamnest cannatorem, Sale Member a. a a fae ae _ | meee — erty [| lArgicart Re apc nt a _.. ai ee 1 Ef |CEO/Director/Otficer/Shareholder ives Ne ao es See aera ama wt: A “2454 TN ee _, ns —- CEO, Applicant; |CEO/Director/Officer/Shareholder, CannaLorem, | its ri aa Boa forsaap yan smith Presideny/orector/shareholder | “eae Page 10 of 28Rhode Island Department of Business Regulation, Office of Cannabis Regulation Renewal Application for Medical Marijuana Cultivator License = a7 —f#§ —$ prs eee eer en a ar fines President/Director/Shareholder, CannaLorem, is = mre — pa is left ‘Shareholder/Officer elem? asin eo a a | ee ee pssst sr Bi rrvstrem, ne ier See em oat linperium, inc. (CannaLorem, Inc. Shareholder) ee = ane pax pea Jennifer Gassen Director/Officer/Shareholder ee: ore ere << o_o Cnc | eer ee ee feet ar [cannatorem, Inc. Director/Secretary/Shareholder, CannaLorem, Inc.; Secretary, Inperium, Inc. (Cannatorem, Inc. |Shareholder) = = ae ieee Shareholder Ld ee ——— sa — He [Reaine [room ill Se aa a ea ‘Shareholder, CannaLorem, Inc. [Inperium is a not-for-profit; it has no shareholders} a = ‘ato General Manoger/shateholder |i [city [state \ziP ft — ani er Par farciowr ne General Manager, Applicant; Shareholder, |cannatorem, inc, Parent (8) LIST ALL OFFICERS, DIRECTORS, MANAGERS, MEMBERS OR AGENTS OF THE APPLICANTILICENSEE AND ANY OTHER ENTITIES DESCRIBED IN SECTION A. To the extent that any such Interest Holder is an entity (corporation, parinership, LLC, ete.) list all Interest Holders in that entity until all such Interest Holders are identified and disclosed down to the individual person level Page 11 of 28Rhode Island Department of Business Regulation, Office of Cannabis Regulation Renewal Application for Medical Marijuana Cultivator License rans ie yah Seheiman Pd |CEO/Director/Officer/Shareholder | Ian esa Pa nian Toy sate ae North Wales PA ‘tase Bree Ret hee fabs oa i argo) ee Officer/Director/Shareholder ]CEO, Applicant; |CEO/Director/Otficer/Shareholder, Cannatorem, inc. ame Te Ryan Smith [Sse rresidenypiecorsretoer | [poe [Key Ste Ape ‘ausmited? Yes No LAddross (residence itan individual eity [state jziF [Phone Number 4 Teh nd se _[toas Re een ae SaaS RRS jerdiy) Officer/Director/Shareholder_ Officer/Director/Shareholder, Cannatorern, inc., Parent; Officer/Director inperium, Inc. |(Cannatorem, Inc. Shareholder) ir a Ss rear Jeff Govino: Shareholder/Officer ‘submitted? ee reas iamemraracaat — oy =e Toten a oe Seren eae AR ht oo [er iF) jertity) ‘Shareholder Sherhoer,Caraorem ne eet Oi, |Inperiun, inc. (CannaLorem, inc., |Shareholder) a = a in a : aon ser x Sectay/Oket/Shrhader (oe waaay om — iii Reade os [Business Associated wih (Applicant, parent business or sub- [Tia (officer, drectr, marager, ec) jortty) ‘Secretary/Director/Shareholder Secretary/Ditector/Sharehoider Cannatorem, Ine, Parent; Officer, Inperium, Inc. (Cannatorem, Inc. Shareholder) lio ‘General Manager/shareholder | iii ay [Ker Sait Aep ‘submited? COND Name Tite Lazzarini iad [Oy Warwick [sate ja RI 02886 [Prone Nore Businees Ansciated wih (Appar, parent baniness oF ub erty General Manager, Applicant; Shareholder, Icannatorem, ine., [Tite ics, dredior, maneaer oa) ‘General Manager/Shareholder Parent ame Tie Issue [Key Sait app ‘sosmited yes No Page 12 of 28Rhode Island Department of Business Regulation, Office of Cannabis Regulation Renewal Application for Medical Marijuana Cultivator License Tennifer Shareholder/Compliance aczarni Manager ess a Dai [oy ie Be i Mari {os —_—e Buss Assented i (PS fro choos | (em, Sadly Pao ay Shareholder/compliance Manager ‘Compliance Manager, Applicant; Shareholder, ee ns cannatorem, in, Parent fare Te ae sae Ways Kenneth Brian Stofac Shoreholder/Oftcer zz | wmode ies conan Tasman | fame Ee Crested Butte co 81224 Fausiness Assovated wih (Apclical,parzl buaness or sub a (fier, cvocor, manager, Re) exe Officer/Shareholder Shareholder/COO, Cannatorem, Ine., Parent (C) LIST ALL PERSONS OR ENTITIES WHO HAVE MANAGING OR OPERATIONAL CONTROL WITH RESPECT TO THE APPLICANTILICENSEE, ANY OTHER ENTITIES DESCRIBED IN SECTIONS AORB, ITS OPERATIONS, THE LICENSE, AND/OR LICENSED FACILITIES (WHETHER THEY HAVE AN ‘OWNERSHIP INTEREST OR NOT). To the extent that any such Interest Holder is an entity (corporation, partnership, LLC, etc), stall interest Holders in that entty unt all such Interest Holders are identified and disclosed down to the Individual person. weve hae rs sauce i = Eliyahu Scheiman_ ‘submited : |CEO/Director/Officer/Shareholder| vee ON a ow See sine [iy woes ea use ies ened wi aS roars oa RSS aa jerky) ‘CEO, Applicant: CEO, Applicant; |CEO/Director/Officer/Shareholder, CannaLorem, ine rm ona Tae ae Julio Lazzarini General Manager/Shareholder ome ra icra — oe sa = a mu fle | [Business Associated with (Applicant, parent business or sub- oo San ‘General Manager, Applicant; Shareholdet, connaoeeny ne ro o sa arma Tena taza ["Shareholder/compltance | ii ‘toned? | Manager eee! Wie ain eat jo sae a Warvice ‘ Czaae Page 13 of 28Rhode Island Department of Business Regulation, Office of Cannabis Regulation Renewal Application for Medical Marijuana Cultivator License Biinoss Aa ents) Compliance Manager, Applicant; Shareholder, [cannaLorem, tne. with (Applicant, parent business or ub- [cool ‘Compliance Manager, Applicant Name ite [seuren [poe Key Sta AS uated? vee oN [aaaress (idence an vidoe [Cy [Sale a Prone tamer eo) Bucinces Assocuted wit (Applicant, paren business or au [Rlo Iriel Jetty) Name Tite [SSNrEN [poe ey Sta Ae dares Gosden on nadia [Oy facto la > Bcinoss Assocated wit (Appcan, parent basness or sub [Reo ivoe erty) | ame Te sewren [pos Kay tat Ap "saamited? Byes "OMe [adress sidoncsi an nidua [ly [eto ae hora Naber > Businass Assocated wit (Applicat, parent buses or ub [Roo tren, ortiyy ame Tite [Ssnren [adarecs(osidoncoif an waviaue [Gly sate ia ts, ero Businass Assocated wb (ApDICa, parent bunnoss of eu erty) (D) _LIST ALL INVESTORS OR OTHER PERSONS OR ENTITIES WHO HAVE ANY FINANCIAL INTEREST WITH RESPECT TO THE APPLICANT/LICENSEE, ANY OTHER ENTITIES DESCRIBED IN SECTIONS A, 8 OR G, ITS OPERATIONS, THE LICENSE, AND/OR LICENSED FACILITIES (WHETHER THEY HAVE AN OWNERSHIP INTEREST OR NOT). ‘To the extent that any such Interest Holder is an entity (corporation, partnership, LLC, etc.) list all Interest Holleren thet ory ul el suok Interest Holds ee eri and lsclosed down othe hdl person revel Tame Tie 58 arse ‘aperum, In. Shareholder iis Py, [Cer em ae ee Fed —« Business Associates wh (Appicant. parent bisiness or sub- erty) Cannatorem, Inc. Debt Financing Page 14 of 28Rhode Island Department of Business Regulation, Office of Cannabis Regulation Renewal Application for Medical Marijuana Cultivator License ame Te [seven jpoe [Key Stat app “Sbrited? vee CNe ears esidonce Wan waaay (Cy Baie ae [Prone Nomar kd Business Associated wih Appiont, parent Business or sub [neest enti Name Free [ssurenT [poe hadros (osidonce Fan iaivdva) [Oy sae lar [Prone Nniar > Business Assocated wih (Appian, part business or sub [toast ect) Rome is SSNrEN adres (oadance on iahidcay | Ry an lee > Buapes Aevocted wh (ont pen bashes rai [ert ame ree SsurEN [por [Key sta Aap ‘casted? Dives" CNe ica Gealdonce Fan aida) [Oy Sia ae [Brone Number kd [Business Associated with (Applicant, parent business or sub- [Interest erty) ame [Tie jesureN edress (ecidanco an inavua) (Oy sate jee kd Business Assocated wih (Apeicort, part busness or ub [neest lent) ame Free [senren joo [Ker Sta Ane “waited? vee DN [aadross(exidoncs Wan naan [hy [sat ar [Phone Nomar > Business Associated wih (Apeizant, paren business or sub [tort Jen) = LIST ALL PERSONS OR ENTITIES THAT HOLD INTEREST(S) ARISING UNDER SHARED MANAGEMENT COMPANIES, MANAGEMENT AGREEMENTS, OR OTHER AGREEMENTS THAT AFFORD THIRD-PARTY MANAGEMENT OR OPERATIONAL CONTROL WITH RESPECT TO THE APPLICANTILICENSEE, ITS OPERATIONS, THE LICENSE ANDOR THE LICENSED FACILITIES. To the extent that any such Interest Holder is an entity (corporation, partnership, LLC, etc) ist all interest Holders in that entity until all such Interest Holders ere identified and disclosed down to the individual person level Page 15 of 28Rhode Island Department of Business Regulation, Office of Cannabis Regulation Renewal Application for Medical Marijuana Cultivator License [SSNFEN [oe Key Sa Ane } ‘ubmiiod? ves CN cares (osiiorce Fan ast) [oa [sie ae [Prone Naber > Busioss Assocaiod wih (Applicat parent business of sub enn) [arose ame Tie [sSNren pos Key aA ‘baited? De Acie Gosidorce Wan ina) civ [sate aie [Phone Nomar i) Business Associated wih (Appian, porentbusnaae or sub ony) itreat "Te [pSNrEN Joos Key Stat Ape ‘ubmitieg? Yee Ole haar Gosidance Fan naivdiad) iow [site ae [Phone Narmboe i) Biciness Associated wih (ApaiCar, paren bucnass oF subeniy) [ileest Tite Swren [oo [key Sait App ‘aemiteg? es No [Aaarece(aiaonce Won iniduay iw [Sao TF [Prone Numbar > Business Acsoclsed win Applicant, poren/buninass or aubeontyy)—[itorst Fite IseNFEN Address (residence fn indi |oty [state ai Business Assocted wih (Applicant, parent busiest or sub-onty) —[iterest ame Tie [ssaren [oor [kay San App submited? Byes "ON [actrees (sidoran Fan eva iow tate a [Phono Nomar i) sinoos Assocated wih (Applicant parent busless or cub nb) [reat Fie [ssuren joo Rey Stat Ap “hbmtioe? ves OMe Across (esicorce an ih ioe sae Ta [Prone Naber Ky Business Assovialed wih (Appllcant, parent business orsub-endiy) [interest Page 16 of 28Rhode Island Department of Business Regulation, Office of Cannabis Regulation Renewal Application for Medical Marijuana Cultivator License Part il: Who, besides the owners and other Interest Holders listed in this Form 2 (including persons, firms, Partnershins, corporations, inited liability companies, trusts), wil loan, give or otherwise provide money. property Interests, equipment, inventory furiture, icensing or other proprietary rights to or for use inthis business, or hold 2 security interest therein; orwho will receive money, profits, proprietary rights or other interests from this business. Attach a separate shest if necessary. If any such person's an enti, ist all persons with any ownership in or control ofthat entity, Name Date of Birth ‘SSNIFEIN Interest/Dollar Amount Part lit Attach an organizational char that clearly depicts all Interest Holdars identified in this Form 2. ‘Attach a lst ofall Interest Holders identified in Part I(A) and Part I(0) that are individual persons and include the effective ownership percentage and dollar amount of each Interest Holders interest with respect to the applicantlicensee, its operations, the license and/or licensed facilties. List them In order of their effective ‘ownership percentage, ‘Attach a Ist ofall Interest Holders identitied in Part ((A), Part I(B), Part (G) and Part i(E) and include the dollar ‘amount of annual compensation/temuneration paidito be paid to such Interest Holders with respect to the _applicanticensee, its operations, the license and/or licensed facies for the last five years, ‘The organizational chart and accompanying lists should follow the form and structure ofthe sample charts and lists included with this form, Sample Org Chart: ee [ Page 17 of 28Rhode island Department of Business Regulation, Office of Cannabis Regulation Renewal Apptication for Medical Marijuana Cultivator License CERUFICATION S810 FORM 2 The undersivned duly authorized officer of the appliewvticensce, i Bi for and on behall of the applieantticensce, ater due inquiry, hereby Regulation of the Department of Business Regelation (the “Dsportny dhisclosed to the Department m this Form > her capacity a8 such officer and ries to the Office of Cannabis wt of “DBR") thot ittie/she has (A) With sespect te applisanticensee ll persons and entities tha: () Aveowners, meinbots,oflccs,dscctors. managers ar agents af he applic andlor (ii) Havers nave managing or operational contol with zespct tothe applicantiense Xts operations the lccuse and/or licensed foelites whether they hase a ownership anterest or not. andor Gi Are mnvestors orhave eres herein, andor Go) Hold amerestis) ansing under shared management companies. management ayrstoonts, oF other agrevments thar alford thiedpauty management oF operational control with respect to the applicantilicensee. its operations. the proposed heense aunbr the theensed facilives (any person or ence m dhe foregoing 1), (i) ani being herein ndividually referred t9 as an “antaest bolder” and all sch persons ancl emites inthe foregoing (, (i, fai) and fis) beng collectively cefered 10 as the ‘anerest holders") and 1B) To theestemt thet any interest hoker descmbed an (A) above i a ent inotest holders in that ity un all such terest holders ane identified and disclosed dow to the in idual person level other financial ‘The undersigned, after due inquiry. further cortifis to the Deparment that, e\eopt far de hecnse that isthe subject of this Form 2 and except as permittsd under RT Gen, Laws § 21-28.6-1246)(10), no “interest roller” disclosed herein is an “interest holder” with respect 10 any other Leense isswed by, oF license jon made to, the Department as ba Tmariqyam oe" as defined in RI. Gen 28 6-317) Tams $2 The undersigned hereby acknowledues al agrees thatthe applicancilicenses has «continu ebligawn te Uisclose any changes and shall provide writen novice to the Deparment within duty (30) dave of any change of the persons‘entitis“interest holders described and the certifications made inthis Form 2 and chat each such notice shall inclxie an wjdated Form Linder penalty of peg. Thereby declare and verify that al sagements on and information submited wb this Fom 2 are complete. mie. comeet and accurate Authorized Signatory iz Dare ‘sliyalw Scheiman Primed Name Print Name of ApplicantiLicensee: Print Officer Title Page 19 of 28EXHIBIT L Use for Part A Supplemental = ri area = oe t 1 [Sete ra onan Ta ay oy sae fran ombe a j f ff Wen 1 ea TN TE Tim TE — [RAO Hr q aoe i aga i 7a \Seeraverconptanc ila il Ber Ee [Manager| fae ee Pane ff) Pees lm 1 Sagrene arsed GVEA parse, aos haan en GST entity) Bia rretorem, ine. Te) cn ange Apa Sor, CemeLeen, ine. Parent | nae Tite orm kenneth Brien Stotac {Sarenoteroficer "aves Eo [Business Associated wih (Appicant, parent business or 6ub- erty) = eee Sees ine hoe 1 [ShareholderG00, Camatorem, ine, Parent ame Tite [ | Aderess (esidence Fen ndvicual) oy ane F aires (ecaerce Fan india oly ; L J [Business Associated with (Applicant, parent business Gr sub- om ‘9 Business Associated with i ‘Own. % in Appicant ey) i Name i SenFeEn POS. Ampito [ 1 bot 1 | Bre Be ices (esiceres Wan nvidia iow pate BP Phone Narber it df Lien 1 [eusiness Ascoclated wih (Applicant, parent business or sub fect [Eftective Own, % in Applicant entity) { ame 7 Sra seo t t iif i (i ity: i [Adsress (wsidence an naivicual) State iP Phone Nambar d tt ft Llc ![Business Associated with (Applicant, parent business or sub- Own. % Business Associated vith ir ‘Own, % in Applicant entty) { Use for Part B Supplemental: frame rte Seo ep sabritoa || Theresa c. witson [Director |i Teves. [-No Sa = ——a Ramee | 1fPPsees | Gillies ce [Business Associated vith (Applicant, parent business or sub- | Te (officer, dreoter, manager, to) sty) Pe Srecor ‘inperim, in. i Rane Fie eure a or. vincent J. Lasorsa P ovector || ill |“FEsees Fo = eae el Fa [Pn Fm Jesanes Fe ee arses anager.) [i tnperim, in. ane ie Pe sinned? I cave cuer T Director i ee Ac Fan individual) cay ‘i f [Business Associated with (Applicant, parent business or sub- | Tae (fice, recto, manager, te) Director 3 c jentity) q Inpertum, tne. he TE aERRS i, Michael Herr {Director yes: 7 : a an . -s i Peso] coo (ili ae [Business Associated with (Applicant, parent business or sub- | Tite (officer, director, manager, etc.) entity) {Director IL Inperium, tne. fs 2 ame I ‘Cynthia Pachuta i tes jividual) City aha he [Beach _ 1 Jentity) oe a 7 po ams amp ove lima =" TS se ‘il Feoare [PP if 10606 | (lillie Spring with (Applicant, parent business or sub- [Tie (ocr, drector, manager, ets) T Director inane Associa ent) peru, inc. pp submited? fe a || Gary Twardowski ] if Director Taives [No — es TP er ‘ill ioe eo[Bisiness Associated with (Applicant, parent business or sub- ently) L Imperium, ne. Fite (oficer,crector, manager, els) [Director ane [Frederick J. Lokuta, Jr. | a re cw Sisto ZIP IT Avoca [TPA] |f teeet Business Assocated with (Applcnt, parent business oF Sib erty) N Inperium, tne. ie (oMicer, dvector, manager, eto) Director [Business Assoctated with (Applicant, parent business or eub- Jentty) Te (oficer, director, manager, ec.) i 7 ry | br Lisa asie McCauley | Bic |i ime | EER er a cy [Soe i | leeeren |! (|i Nothampton f [Business Associated with (Applicant, parent bushess or sub- entty) f Inperium, ine. [Tle (officer, drecir, manager, etc) [Director Business Associated with (Applicant, parent buslness or aub- erty) [ile (oticer, decir, manager, to) Name {John Loyack —} irae Bos app ou Lit || S es No ipod? Aces Geaiiance Pan vicina) state FQ leay [Reeang [PA | |ft9e0s [Busness Associated with (Applicant, parent business or 6ub- Mile (ofcer, director, manager, ete) ent) (‘Director [_tnperium, ine. Name rite ing sitmioae | Jonathan Peter Swatsburg | t ver li lm [eves ENo lew sate ar ‘(Prone Number Biylrvite [PA] {17207 i ocr, deste, manager, ei) [Director Use for Part C Supplemental tame rie SSNFEIN pow [App sabres d } i |_| Bree Bre Rares (esidence an indvidva pe i , [Phone Number IL 1 1 Business Associated win (Applicant parent business oreub- Rd, miorest, et, erty) { H Rae in Tey (pe [Ane ube? | Acres residence fan indica ee sate zP : Business Assccated wih Appleant, arent business orsub- [cle tere, et entiy) Nlent) ane rie SSNrEN pos: ep aibied? IL ll | } Il |_| Bes Bhe Adres (esience Wan rainy fa ere i 1 Ses soci ean poner [Ae [ ti em poe Pagani [ al ) [Eves Actress (residence Wan ndiadua fa Pir ee | cL 1 sioss Assocaied wi (ppt, parent busines or sub” [Ril rivet entity) { J yee Fe p08 ep sibritec? 1 tt | | Be B pares sis on ny fe 7 ane i i Business Associated wth (Appicnt, parent bushes or ub entity) 1 ane Te p03 ep aieoedy I, | [ | | [Gres ine irons esi Fan ni cay Phone Number I i | ei 1 Busoss Resotated wih ApDIan, parent bushes or > Jeni) | Name Fe SSNFEN [pos [hep euomitor? i _ll ! 1 1 [Bre ie Actress rescence Wan individual) cy ato [BP hone Number I { fealae 1 cn i Bocresa Assodaied wih Vpplcat pave! business orwibs [lire ec erat) | lesen Use for Part D |Z] or EC] Supplemental (Specify by Checking the Box) ae rie SSNrEIN poe [hee auton? tt L yt Lod ] | ye Ee Adress Gesidence Fan aia cay Sie xP Phone Number . ll Loo Leu } Susans Associated wih Appican parent bose or sub [noret : enti) i Name rite SSNFEN pos [hep sbried? I 1 tt | Bie [Adress (eaidence Wan wid) iy fe (BP Phone Nambor i if rf Her } Sones Assodaled wih (Appicat parent bases or sub [terestName Fie SsNiFEN 508 ep soorites? t VI it |_| Pye Ete Adis Gesdence Wan nda) let Sate [ae Prone Nomber [ ti | fey 1 [Business Associated with (Applicant, parent business or sub- | Interest | Jenty) I | ta SSNFEN Too Dp soitod? joty. ZIP [Phone Number if 1 | jen } | Business Associated with (Applicant, parent business or sub- are | ent) Name rie SSNrEN BoB a eiorites? t _l ut Los Pe acess (elconce Wan diva cy [see [BP Phone Number I f ti i | feo 1 Business hasocktod wih (Apical, parent hess orsub- [rest entity) { ] aa fi = i esomiie? | Address (residence if an individual) Hs fia ia P” | 1 gee omen Vote panne oe jernity) ane rie SuFEN [poe Tp asec? 1 a ( EYRE Pee ross (esicence an vical) rf ane = ] ce i Business Ascot win Appian pare bushes orauby [rest i" i } Part It Supplemental: Name Date of Birth ‘SSNIFEIN Interest/Dollar Amount [ Tf [eee | rt i Ty y | ! ae I leet al T - leeEXHIBIT M Use for Part A Supplemental: are Tie SSNFEN DOS [App submiteas I I Li ) tt |_| Bree | Address (residence if an individual) Fag State Zp [Phone Number eee I IesecHlea | few i Sp RT et ro a Toon Ran a nem Haire ent ane Fite SaurEN a [hep sabi? d i Ht i 4 |_| Bes Bee Aree (residence Fan individ) oy sate [BP Phone Nomber i {iff je i aaa a aT jenitty) [Name rite [SSWFEIN jDOB |Anp submitted? f l | Jl | | res Bie Prone (esdance Wan hdvaua fa - 7 [meena | a i Business Associated with (Applicant, parent business or sub- Own. % Business Associated with | Freee ee “% in Applicant entity) ame rie SeNrEN poe [app submited? | l ill I || Pires ros eetence Wan inaiidca oe site BP [Prone Nonor ft fesse ta 1 ex 1 Sap ORG set rae Toe. Rr ie Om incor entity) fame = a fone i i | ee rane since Fen vind fa rir laa ey 1 Buses Associated wih pica parent boas or sab Eft Gon in Appicant ey) ( | I Name rile SSNFEN [poe ep sirites? I [ il { |_| Gre Be dives veaaance Wen india) cay Sate [BP Phone Naber ! i iol ff J eu i [Spe Oras eee Tom Baniness Associated wih” 7 a eG inn jentiy) hae Fie sSNrEN poe [app bred I { if Lit |_| Bree Ere asia resdance an aoa low iF Phone Nonber q if ses -ta) | eb 1 Sep ae Care areata [oe a amar in Om Ci entity)Use for Part B Supplemental: name Tite | Joseph F, Leone, Jr. [Treasurer pos ‘Bives [App submits n individual iy sate [Monrevine } [PA ap. J ft9se1 Poope iin [Business Associated with (Applcant parent business or sub- [le (omicer,arector, manager, eto) ed ery) Tomer oat no Name Fre sited? | Christopher vatente [ Drecor ee] Eaves india icy Sete Tae Pons ham [Wyomissing |[Pa | {19610 Business Associated wih (ippcart, parent business or sib [Tie (fice, dretor manager et) entity) | Director Jrperim, te ame rie SSFEN bos [hep suites? I [ iI itt |_| Bie Be [Adsreos (eskdence en nada civ siete [a [Phone Number f L foi Len i Sp A a ree il i Se ao) I fare ti = > as a 1 1 iad Aakeas (residence Wan Individual low sets YzP Prone Number tt i tod } jes 1 age SR Fe oat (EN ta GNA) ents) ql me iP re ee Address (residence ifan individual) oity state [ze [Phone Number ii tL Ley 1 wih (Rppicank parent bushess or 8o>- f | Tame 7 [aap orien? q L | | | Bree Phe Adie (esac Wan iain i [Phone Number i eo \ [Business Associated with (Applicant, parent business or sub- [Title (officer, director, manager, atc.) entity) | | nare Fre [SSFEN pos [agp sabriteg? i tl iI ) yes Ne | Aatrece(ecldence an inaivduah ie es P [Pane Nomber[address (esidence Wan indwiavaly Bases eset inant panera te (Oe dec ane He) Use for Part C Supplemental: ame rite SSNFEN pos ap sated tt It } | (Gres Akreas residence Wa india) ey ~F a i i ass Ascodated wih Appicat. parent buses or sub Roe, ert, oe = ] Same rite SSNFEN pos app sibited? i i ] ee || Bre cress esicacs Wan ica omy sate [Phone Number 1 | 1 ey 1 See cee Per ro a se a i ane Tite [poe [App saritea t Ly [Bee Ea [Adcoss eslsance Fan naval chy [Phone Number I [ (a 1 | Business Associated with (Applicant, parent business or sub- ia | ame Tie [poe [hop sitive? l I L [EB Rares Genero Wan ndhiaua es [phone Number t i Ley i Buses Associate wih (Applicat parent busines or eub- esti I ane Tie poe repre ! 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Pat i Ownership Compensation + jOwners by a Ryan Smith Jeff Giovino Jennifer Ga: Julio Lazzari Jennifer Laz: fective Percentage of lEffective Percentage of Ownership |Capital Contributions, if any Inperium, Inc.** Eliyahu Scheiman Brian Stofac issen ini zarini [Directors, Officers, and Key Persons LRI, LLC is wholly-owned by CannaLorem, Inc. The following are the shareholders of CannaLorem, Inc. Inperium, Inc. is a not-for-profit corporation and does not have any shareholders. ***2022 | 2021 Comp] 2020 Comp comp 2019 Comp 2018 Comp 2017 Comp 2016 Compjulio Lazzarini jennifer Lazzarini liyahu Scheiman ***CLRI, LLC acquired Class A Cultivation License No. MMP CV 0109 via asset purchase agreement on March 31, 2022. Therefore, compensation information is being provided as of 2022.FORM 2 Disclosure of Owners and Other Interest Holders } Part Ill - Organizational Chart | ~“RPPLRANT ORE LEE | (a whoity onned subsidiary of Canaatorer {Eliyahu Schetman, Chief ts | Pero fe lazzrnt, Genera L ‘cempline 1 | EXHIBIT |