Ohio Medical Marijuana Dispensary Application CRESCO LABS OHIO LLC Application ID 617
Demographic Information(Business Contact)
A-1.1 Business Name, as it appears on the Applicant’s certificate of incorporation, charter, bylaws, partnership agreement or other legal business formation documents
Cresco Labs Ohio LLC
A-1.2 Other trade names and DBA (doing business as) names
No response provided by applicant
A-1.3 Business Street Address
6545 Market Avenue North, STE 100
A-1.4 City
North Canton
A-1.5 State
OH
A-1.6 Zip Code
44721
A-1.7 Phone
6144408589
A-1.8 Email [email protected] Demographic Information(Primary Contact/Registered Agent)
A-2.1 Please select: Primary Contact, or Registered Agent for this Application
PRIMARY CONTACT
A-2.2 First Name
Christopher
A-2.3 Middle Name
Thomas
A-2.4 Last Name
Schrimpf
A-2.5 Street Address
113 South Ardmore
A-2.6 City
Bexley
A-2.7 State
OH
A-2.8 Zip Code
43209
A-2.9 Phone
6144408589
A-2.10 Email [email protected] Demographic Information(Applicant Organization and Tax Status)
A-3.1 Select One
Limited Liability Company
A-3.1A If other, explain
No response provided by applicant
A-3.2 State of Incorporation or Registration
OH
A-3.3 Date of Formation
05/22/2017
A-3.4 Business Name on Formation Documents
Cresco Labs Ohio, LLC
A-3.5 Federal Employer ID number
This response has been entirely redacted
A-3.6 Ohio Unemployment Compensation Account Number
No response provided by applicant
A-3.7 Ohio Department of Taxation Number (if Applicant is currently doing business in Ohio)
No response provided by applicant
A-3.8 Ohio Workers’ Compensation Policy Number (if Applicant is currently doing business in Ohio)
No response provided by applicant
A-3.9 The Applicant attests that workers’ compensation insurance will be obtained by the time the State of Ohio Board of Pharmacy determines the Applicant to be operational under the Act and regulations.
YES
A-3.10 Has the Applicant operated and conducted business in any jurisdiction other than Ohio in the past three years? If you select "Yes", answer question A-3.10.1 below.
NO
A-3.10.1 If "Yes" to question A-3.10, for each instance relevant to question A-3.10, provide the following: -Legal Business Name -Business Address -Federal Employee ID Number No response provided by applicant Demographic Information(Economically Disadvantaged Business)
A-4.1 The Applicant attests that at least fifty-one percent of the business, including corporate stock if a corporation, is owned by persons who belong to one or more of the groups set forth in this division, and that those owners have control over the management and day-to-day operations of the business and an interest in the capital, assets, and profits and losses of the business proportionate to their percentage of ownership. ORC 3796.10
NO Demographic Information(District Information )
A-5.1 Please select to indicate the medical marijuana dispensary Ohio district for which you are applying for a dispensary license
SOUTHEAST-3
A-5.2 Please select to indicate the medical marijuana dispensary Ohio county for which you are applying for a dispensary license
Franklin Demographic Information(Prospective Associated Key Employees Details)
Item 1 of 49
A-6.1 First Name
Charles
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Bachtell
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Attorney/CEO Cresco Labs
A-6.6 Title in the Applicant’s business
Chief Operations Officer / Owner
A-6.7 Applicant's business related compensation
$100,000 (Anticipated)
A-6.8 Number of shares owned
832,700
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
7.57
A-6.11 Voting percentage
7.57
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1830 N. Winchester Ave Apt 104
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60622
A-6.20 Phone
3123995471
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
This response has been entirely redacted Demographic Information(Prospective Associated Key Employees Details)
Item 2 of 49
A-6.1 First Name
Robert
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Sampson
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
COO Cresco Labs
A-6.6 Title in the Applicant’s business
Board Member / Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
832,700
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
7.57
A-6.11 Voting percentage
7.57
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
4605 Prospect Ave
A-6.17 City
Downers Grove
A-6.18 State
IL
A-6.19 Zip Code
60515
A-6.20 Phone
6306600291
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 3 of 49
A-6.1 First Name
Joseph
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Caltabiano
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - Cresco Labs
A-6.6 Title in the Applicant’s business
Director of Business Development/ Board Member
A-6.7 Applicant's business related compensation
$100,000 (Anticipated)
A-6.8 Number of shares owned
832,700
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
7.57
A-6.11 Voting percentage
7.57
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1720 N. Cleveland Ave
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60614
A-6.20 Phone
7738185807
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 4 of 49
A-6.1 First Name
Brian
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
McCormack
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - Cresco Labs
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
832,700
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
7.57
A-6.11 Voting percentage
7.57
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
6843 N. Loron Ave
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60646
A-6.20 Phone
3127198208
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 5 of 49
A-6.1 First Name
Dominic
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Sergi
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - Cresco Labs
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
832,700
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
7.57
A-6.11 Voting percentage
7.57
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1063 N. Paulina St Unit 1
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60622
A-6.20 Phone
6306883832
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 6 of 49
A-6.1 First Name
Lawrence
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Laurello
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
President Delta Railroad
A-6.6 Title in the Applicant’s business
Board Member / Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
666,600
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
6.06
A-6.11 Voting percentage
6.06
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
4712 Manchester Ct
A-6.17 City
Austinburg
A-6.18 State
OH
A-6.19 Zip Code
44010
A-6.20 Phone
4405360325
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
53 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 7 of 49
A-6.1 First Name
Michael
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Laurello
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Vice President - Delta Railroad
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
666,600
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
6.06
A-6.11 Voting percentage
6.06
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
284 Pepperidge Dr
A-6.17 City
Geneva
A-6.18 State
OH
A-6.19 Zip Code
44041
A-6.20 Phone
4405360376
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
51 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 8 of 49
A-6.1 First Name
Rick
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Ryel
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Vice President - Delta Railroad
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
666,600
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
6.06
A-6.11 Voting percentage
6.06
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
4359 Ivy Place
A-6.17 City
Ashtabula
A-6.18 State
OH
A-6.19 Zip Code
44004
A-6.20 Phone
4405360357
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
58 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 9 of 49
A-6.1 First Name
Annette
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Weber
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Homemaker
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
550,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
5
A-6.11 Voting percentage
5
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
73 West River Rd
A-6.17 City
Valley City
A-6.18 State
OH
A-6.19 Zip Code
44280
A-6.20 Phone
2169737523
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
51 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 10 of 49
A-6.1 First Name
Patrice
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Alberty
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
CEO - Catan Fashions
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
Common
A-6.9 Types of shares owned
550,000
A-6.10 Percent interest in Applicant's business
5
A-6.11 Voting percentage
5
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
19492 Kensington Ct
A-6.17 City
Strongsville
A-6.18 State
OH
A-6.19 Zip Code
44136
A-6.20 Phone
4405705011
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
68 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 11 of 49
A-6.1 First Name
Roger
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Riachi
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Owner - RFC Contracting, INC
A-6.6 Title in the Applicant’s business
Board Member / Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
572,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
5.20
A-6.11 Voting percentage
5.20
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
19600 Idlewood Trl
A-6.17 City
Strongsville
A-6.18 State
OH
A-6.19 Zip Code
44149
A-6.20 Phone
4405729444
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
30 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 12 of 49
A-6.1 First Name
David
A-6.2 Middle Name
Michael
A-6.3 Last Name
Balnave
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Development MGR - Boston Scientific
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
220,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
2
A-6.11 Voting percentage
2
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
2134 Rock Creek South
A-6.17 City
Akron
A-6.18 State
OH
A-6.19 Zip Code
44333
A-6.20 Phone
3303887877
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
25 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 13 of 49
A-6.1 First Name
Christina
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Englander
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Homemaker
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
110,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
1
A-6.11 Voting percentage
1
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1428 W. George St
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60657
A-6.20 Phone
6198940297
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 14 of 49
A-6.1 First Name
Dean
A-6.2 Middle Name
Gregory
A-6.3 Last Name
Steliotes
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Partner - Innovative Benefits Consulting
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
110,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
1
A-6.11 Voting percentage
1
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
332 Macintosh Dr
A-6.17 City
Mars
A-6.18 State
PA
A-6.19 Zip Code
16046
A-6.20 Phone
4123912020
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 15 of 49
A-6.1 First Name
Michael
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Pompeani
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Territory MGR - Boston Scientific
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
110,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
1
A-6.11 Voting percentage
1
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
3391 Burgundy Cir
A-6.17 City
Avon
A-6.18 State
OH
A-6.19 Zip Code
44011
A-6.20 Phone
2165091322
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
45 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 16 of 49
A-6.1 First Name
Craig
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Della Valle
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Orthopedic Surgeon
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
110,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
1
A-6.11 Voting percentage
1
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
453 W. Deming Place
A-6.17 City
Chicago
A-6.18 State
ID
A-6.19 Zip Code
60614
A-6.20 Phone
3124322350
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 17 of 49
A-6.1 First Name
John
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Planes
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
CEO - Planes Companies
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
110,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
1
A-6.11 Voting percentage
1
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
8676 Emerald Isle
A-6.17 City
Mason
A-6.18 State
OH
A-6.19 Zip Code
45040
A-6.20 Phone
5132956975
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
68 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
This response has been entirely redacted Demographic Information(Prospective Associated Key Employees Details)
Item 18 of 49
A-6.1 First Name
Kenneth
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Amann
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
CFO - Cresco Labs
A-6.6 Title in the Applicant’s business
CFO / Owner
A-6.7 Applicant's business related compensation
$100,000 (Anticipated)
A-6.8 Number of shares owned
110,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
1
A-6.11 Voting percentage
1
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
2523 N. Southport #1N
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60614
A-6.20 Phone
3126562160
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 19 of 49
A-6.1 First Name
Joshua
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Rubin
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - CJR Group
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
74,800
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
0.68
A-6.11 Voting percentage
0.68
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
6604 Westpoint Dr
A-6.17 City
Hudson
A-6.18 State
OH
A-6.19 Zip Code
44236
A-6.20 Phone
2164102502
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
45 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 20 of 49
A-6.1 First Name
Matthew
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Palumbo
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Principal - The Omada Group
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
205,700
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
1.87
A-6.11 Voting percentage
1.87
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
34 N. Hayden Parkway
A-6.17 City
Hudson
A-6.18 State
OH
A-6.19 Zip Code
44236
A-6.20 Phone
6149298090
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
48 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 21 of 49
A-6.1 First Name
Christopher
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Schrimpf
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - Red Track Strategy
A-6.6 Title in the Applicant’s business
CEO / Owner
A-6.7 Applicant's business related compensation
$100,000 (Anticipated)
A-6.8 Number of shares owned
489,500
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
4.45
A-6.11 Voting percentage
4.45
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
113 South Ardmore
A-6.17 City
Bexley
A-6.18 State
OH
A-6.19 Zip Code
43209
A-6.20 Phone
6144408589
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
4 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 22 of 49
A-6.1 First Name
Troy
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Judy
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - The Batchelder Company
A-6.6 Title in the Applicant’s business
Government Relations / Compliance Adviser / Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
484,000
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
4.40
A-6.11 Voting percentage
4.40
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
5587 Mesa Falls
A-6.17 City
Dublin
A-6.18 State
OH
A-6.19 Zip Code
53016
A-6.20 Phone
6144033914
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
34 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 23 of 49
A-6.1 First Name
Chad
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Hawley
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - The Batchelder Company
A-6.6 Title in the Applicant’s business
Government Relations / Compliance Adviser / Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
434,500
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
3.95
A-6.11 Voting percentage
3.95
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
111 W. 3rd Ave #314
A-6.17 City
Columbus
A-6.18 State
OH
A-6.19 Zip Code
43201
A-6.20 Phone
7402521543
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
34 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 24 of 49
A-6.1 First Name
Michael
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Schrimpf
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - Red Track Strategy
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
434,500
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
3.95
A-6.11 Voting percentage
3.95
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1839 N. Howe Unit B
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60614
A-6.20 Phone
3127201111
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 25 of 49
A-6.1 First Name
Melissa
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Durkee
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Homemaker
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
37,400
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
0.34
A-6.11 Voting percentage
0.34
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
7615 Oxgate Ct
A-6.17 City
Hudson
A-6.18 State
OH
A-6.19 Zip Code
44236
A-6.20 Phone
2165705556
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
17 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 26 of 49
A-6.1 First Name
James
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Peel
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Regional Sales Director - Service Now
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
37,400
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
0.34
A-6.11 Voting percentage
0.34
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1718 Royal Oaks Circle
A-6.17 City
Hudson
A-6.18 State
OH
A-6.19 Zip Code
44236
A-6.20 Phone
4407596661
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
25 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 27 of 49
A-6.1 First Name
William
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Vidmar
A-6.4 Suffix
Jr
A-6.5 Occupation
Sales Leader - Oracle
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
37,400
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
0.34
A-6.11 Voting percentage
0.34
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
7618 Woodspring Ln
A-6.17 City
Hudson
A-6.18 State
OH
A-6.19 Zip Code
44236
A-6.20 Phone
3306552440
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
48 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 28 of 49
A-6.1 First Name
John
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Sabatalo
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
President - Planes Companies
A-6.6 Title in the Applicant’s business
Passive Owner
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
49,500
A-6.9 Types of shares owned
Common
A-6.10 Percent interest in Applicant's business
0.45
A-6.11 Voting percentage
0.45
A-6.12 Proposed Role
OWNER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
7390 Avenel Ct
A-6.17 City
Westchester
A-6.18 State
OH
A-6.19 Zip Code
45069
A-6.20 Phone
5132956874
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
38 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 29 of 49
A-6.1 First Name
Lucas
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Baker
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
President/CEO - Brookside Laboratories
A-6.6 Title in the Applicant’s business
Quality Control Assurance Advisor
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
200 White Mountain Dr
A-6.17 City
New Bremen
A-6.18 State
OH
A-6.19 Zip Code
45869
A-6.20 Phone
4199772766
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
37 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 30 of 49
A-6.1 First Name
Thomas
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Menke
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
President/Owner - Menke Consulting
A-6.6 Title in the Applicant’s business
Quality Control Assurance Advisor
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
6070 Routzong Rd
A-6.17 City
Greenville
A-6.18 State
OH
A-6.19 Zip Code
45331
A-6.20 Phone
9374170155
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
64 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 31 of 49
A-6.1 First Name
Arnold
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Schropp
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Retired Highway Patrol Commander
A-6.6 Title in the Applicant’s business
Director Of Security
A-6.7 Applicant's business related compensation
$60,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
464 Crossings Drive
A-6.17 City
Westerville
A-6.18 State
OH
A-6.19 Zip Code
43082
A-6.20 Phone
6145954759
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
68 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 32 of 49
A-6.1 First Name
Duard
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Headley
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Director Data Warehousing - Care Source
A-6.6 Title in the Applicant’s business
Environmental & Sustainability Advisor
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
535 Fairfield Pike
A-6.17 City
Yellow Springs
A-6.18 State
OH
A-6.19 Zip Code
45307
A-6.20 Phone
9372395837
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
25 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 33 of 49
A-6.1 First Name
Kathryn
A-6.2 Middle Name
Holly
A-6.3 Last Name
Walter
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Founder - Yellow Springs Resilience Netowrk
A-6.6 Title in the Applicant’s business
Environmental & Sustainability Advisor
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
535 Fairfield Pike
A-6.17 City
Yellow Springs
A-6.18 State
OH
A-6.19 Zip Code
45307
A-6.20 Phone
9374759207
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
28 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 34 of 49
A-6.1 First Name
Malte
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Von Matthiessen
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Consultant - Roaring Judy Management Services
A-6.6 Title in the Applicant’s business
Manufacturing Adviser
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1234 Livermore St
A-6.17 City
Yellow Springs
A-6.18 State
OH
A-6.19 Zip Code
45387
A-6.20 Phone
9376573676
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
1 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 35 of 49
A-6.1 First Name
Kathryn
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Hichcock
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Special Project MGR - Yellow Springs News
A-6.6 Title in the Applicant’s business
Substance Abuse Adviser
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
223 N. High St
A-6.17 City
Yellow Springs
A-6.18 State
OH
A-6.19 Zip Code
45387
A-6.20 Phone
9374083678
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
47 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 36 of 49
A-6.1 First Name
Craig
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Mesure
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Realtor
A-6.6 Title in the Applicant’s business
Patient and Community Outreach Advisor
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
322 Allen Street
A-6.17 City
Yellow Springs
A-6.18 State
OH
A-6.19 Zip Code
45387
A-6.20 Phone
9377080559
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
10 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 37 of 49
A-6.1 First Name
Erin
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Alexander
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Attorney
A-6.6 Title in the Applicant’s business
Director Of Compliance
A-6.7 Applicant's business related compensation
$60,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1645 W. School St #211
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60657
A-6.20 Phone
3123424475
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 38 of 49
A-6.1 First Name
David
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Ellis
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
EVP Of Operations - Cresco Labs
A-6.6 Title in the Applicant’s business
EVP Of Operations
A-6.7 Applicant's business related compensation
$60,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
910 W. Huron St #814
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60642
A-6.20 Phone
4043177716
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 39 of 49
A-6.1 First Name
Kelli
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Impola
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Facility Compliance & Inventory Supervisor - Cresco Labs
A-6.6 Title in the Applicant’s business
Human Resource Director
A-6.7 Applicant's business related compensation
$50,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
2793 Carlsbad Cr
A-6.17 City
Aurora
A-6.18 State
IL
A-6.19 Zip Code
60503
A-6.20 Phone
6302295624
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 40 of 49
A-6.1 First Name
Alyssa
A-6.2 Middle Name
Lynn
A-6.3 Last Name
Kruse
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Quality Assurance Director - Cresco Labs
A-6.6 Title in the Applicant’s business
Director of Quality Assurance
A-6.7 Applicant's business related compensation
$45,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
6077 N. Elston Ave
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60646
A-6.20 Phone
6308739984
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 41 of 49
A-6.1 First Name
Jennifer
A-6.2 Middle Name
Rae
A-6.3 Last Name
Haynes
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Inventory MGR - Cresco Labs
A-6.6 Title in the Applicant’s business
Inventory Manager
A-6.7 Applicant's business related compensation
$45,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
766 Double Jack St
A-6.17 City
Bourbonnais
A-6.18 State
IL
A-6.19 Zip Code
60914
A-6.20 Phone
3093380251
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 42 of 49
A-6.1 First Name
Rebecca
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Horwitz
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Packaging MGR - Cresco Labs
A-6.6 Title in the Applicant’s business
Packaging Compliance Manager
A-6.7 Applicant's business related compensation
$45,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
6722 Cedar Ln
A-6.17 City
Westmont
A-6.18 State
IL
A-6.19 Zip Code
60559
A-6.20 Phone
8474004741
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 43 of 49
A-6.1 First Name
Bryan
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Weber
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Managing Director - Corning Advisors
A-6.6 Title in the Applicant’s business
Board Member
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
BOARD MEMBER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
73 West River Rd
A-6.17 City
Valley City
A-6.18 State
OH
A-6.19 Zip Code
44280
A-6.20 Phone
2169737523
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
52 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 44 of 49
A-6.1 First Name
Joseph
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Friedman
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Pharmacist/Chief Operations Officer - PDI Medical
A-6.6 Title in the Applicant’s business
Pharmacy Advisor
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
10 Queens Way
A-6.17 City
Lincolnshire
A-6.18 State
IL
A-6.19 Zip Code
60069
A-6.20 Phone
2244361634
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 45 of 49
A-6.1 First Name
Zach
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Marburger
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
CIO - Cresco Labs
A-6.6 Title in the Applicant’s business
Director of Marketing
A-6.7 Applicant's business related compensation
$60,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
2404 Railroad St. #317
A-6.17 City
Pittsburgh
A-6.18 State
PA
A-6.19 Zip Code
15222
A-6.20 Phone
3173797917
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 46 of 49
A-6.1 First Name
Lisa
A-6.2 Middle Name
No response provided by applicant
A-6.3 Last Name
Kamerad
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Edibles GM - Cresco Labs
A-6.6 Title in the Applicant’s business
Director of Retail
A-6.7 Applicant's business related compensation
$60,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1340 N. Artesian Ave
A-6.17 City
Chicago
A-6.18 State
IL
A-6.19 Zip Code
60622
A-6.20 Phone
3122098135
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 47 of 49
A-6.1 First Name
Elizabeth
A-6.2 Middle Name
Jo
A-6.3 Last Name
Greusel
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Laboratory MGR - Cresco Labs
A-6.6 Title in the Applicant’s business
Manufacturing Compliance Manager
A-6.7 Applicant's business related compensation
$50,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
1340 Pioneer Rd. Apt 201
A-6.17 City
Crest Hill
A-6.18 State
IL
A-6.19 Zip Code
60403
A-6.20 Phone
2245586299
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 48 of 49
A-6.1 First Name
Maria
A-6.2 Middle Name
Concetta
A-6.3 Last Name
Schiavoni
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Paradym Healthcare Consultant Pharmacist
A-6.6 Title in the Applicant’s business
Director of Patient Wellness
A-6.7 Applicant's business related compensation
$75,000 (Anticipated)
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
3273 Chaucer Dr
A-6.17 City
Columbus
A-6.18 State
OH
A-6.19 Zip Code
43221
A-6.20 Phone
2159173626
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
1.5 Years
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Demographic Information(Prospective Associated Key Employees Details)
Item 49 of 49
A-6.1 First Name
Charles
A-6.2 Middle Name
Bakert
A-6.3 Last Name
Bachtell
A-6.4 Suffix
No response provided by applicant
A-6.5 Occupation
Sr. Investment Executive - Private Client Group
A-6.6 Title in the Applicant’s business
Veterans Affairs Adviser
A-6.7 Applicant's business related compensation
0
A-6.8 Number of shares owned
0
A-6.9 Types of shares owned
N/A
A-6.10 Percent interest in Applicant's business
0
A-6.11 Voting percentage
0
A-6.12 Proposed Role
OTHER
A-6.13 Please include any contributions of money, equipment, real estate and expertise
No response provided by applicant A-6.14 Date of birth
This response has been entirely redacted
A-6.15 Social Security Number (use "N/A" if unavailable)
This response has been entirely redacted
A-6.16 Street Address
15446 Sherman Way Apt 302
A-6.17 City
Van Nuys
A-6.18 State
CA
A-6.19 Zip Code
91406
A-6.20 Phone
8184482575
A-6.21 Email [email protected]
A-6.22 Race/Ethnicity: (Only answer if applying as an Economically Disadvantaged Business)
No response provided by applicant
A-6.23 If the Prospective Associated Key Employee maintains an Ohio residence, please provide the length of time for which Ohio residency has been established:
No response provided by applicant
A-6.24 Attach verification of identity. The following are acceptable forms of verification of identity: -Unexpired, valid state-issued driver's license. -Unexpired, valid photographic identification issued by the Ohio Bureau of Motor Vehicles or the equivalent from another state. -Unexpired, valid United States passport.
This response has been entirely redacted
A-6.25 Tax Authorization: Each Prospective Associated Key Employee with an aggregate ownership interest of ten percent or more in the Applicant, must print, manually sign and attach a copy of the Tax Authorization Form. The State Board of Pharmacy may, in its discretion, require an owner or person who exercises substantial control over a proposed dispensary, but who has less than a ten percent ownership interest, to comply with statutory and regulatory ownership requirements. ORC 3796.10, OAC 3796:6-2-02
No response provided by applicant Compliance(Compliance with Applicable Laws and Regulations)
B-1.1 By selecting “Yes”, the Applicant, as well as all individually identified Prospective Associated Key Employees listed in this provisional license application, agree to comply with all applicable Ohio laws and regulations relating to the operation of a medical marijuana dispensary.
YES
B-1.2 By selecting “Yes”, the Applicant understands and attests that it must establish and maintain an escrow account or surety bond in the amount of $50,000 as a condition precedent to receiving a medical marijuana certificate of operation. OAC 3796:6-2-11
YES Compliance(Civil and Administrative Action)
B-2.1 Has the Applicant been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties or fines being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-2.2 Has the Applicant been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-2.3 Has criminal, civil, or administrative action been taken against the Applicant for obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-2.4 Has criminal, civil or administrative action been taken against the Applicant under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to any of the Applicant's Prospective Associated Key Employees' profession or occupation?
NO
B-2.4.1 If "Yes" to any question in B-2, provide the following: Respondent / Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and the Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant Compliance(Prospective Associated Key Employee Compliance)
Item 1 of 49
B-3.1 First Name
Charles
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Bachtell
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Chief Operations Officer / Owner
B-3.6 Brief description of role
Officer&Owner overseeing all operations
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Labs Puerto Rico, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Labs Puerto Rico, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing. YES Compliance(Prospective Associated Key Employee Compliance)
Item 2 of 49
B-3.1 First Name
Robert
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Sampson
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Board Member/ Owner
B-3.6 Brief description of role
Will serve on the board of directors
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address. Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 3 of 49
B-3.1 First Name
Joseph
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Caltabiano
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Director of Business Development/ Board Member
B-3.6 Brief description of role
Will develop a strategic vision for Cresco Labs Ohio, LLC
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address. Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 4 of 49
B-3.1 First Name
Brian
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
McCormack
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Labs Puerto Rico, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Labs Puerto Rico, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing. YES Compliance(Prospective Associated Key Employee Compliance)
Item 5 of 49
B-3.1 First Name
Dominic
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Sergi
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 6 of 49
B-3.1 First Name
Lawrence
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Laurello
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Board Member / Owner
B-3.6 Brief description of role
Will serve on the board of directors
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 7 of 49
B-3.1 First Name
Michael
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Laurello
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 8 of 49
B-3.1 First Name
Rick
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Ryel
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 9 of 49
B-3.1 First Name
Annette
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Weber
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 10 of 49
B-3.1 First Name
Patrice
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Alberty
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 11 of 49
B-3.1 First Name
Roger
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Riachi
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Board Member / Owner
B-3.6 Brief description of role
Will serve on the board of directors
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 12 of 49
B-3.1 First Name
David
B-3.2 Middle Name
Michael
B-3.3 Last Name
Balnave
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 13 of 49
B-3.1 First Name
Christina
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Englander
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 14 of 49
B-3.1 First Name
Dean
B-3.2 Middle Name
Gregory
B-3.3 Last Name
Steliotes
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 15 of 49
B-3.1 First Name
Michael
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Pompeani
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 16 of 49
B-3.1 First Name
Craig
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Della Valle
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654 Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 17 of 49
B-3.1 First Name
John
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Planes
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 18 of 49
B-3.1 First Name
Kenneth
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Amann
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
CFO / Owner
B-3.6 Brief description of role
Will oversee all financial aspects of Cresco Labs Ohio, LLC
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address. Cresco Labs Illinois, LLC 520 W. Erie Suite 220 Chicago IL 60654
Cresco Yeltrah, LLC 150 Timberline Lane Butler PA 16001
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 19 of 49
B-3.1 First Name
Joshua
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Rubin
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 20 of 49
B-3.1 First Name
Matthew
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Palumbo
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 21 of 49
B-3.1 First Name
Christopher
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Schrimpf
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
CEO / Owner
B-3.6 Brief description of role
Oversee all operations of Cresco Labs Ohio, LLC
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 22 of 49
B-3.1 First Name
Troy
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Judy
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Government Relations / Compliance Advisor / Owner
B-3.6 Brief description of role
Advise on Government Relations and compliance
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 23 of 49
B-3.1 First Name
Chad
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Hawley
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Government Relations / Compliance Adviser / Owner
B-3.6 Brief description of role
Advise on Government Relations and compliance
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 24 of 49
B-3.1 First Name
Michael
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Schrimpf
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
YES
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 25 of 49
B-3.1 First Name
Melissa
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Durkee
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 26 of 49
B-3.1 First Name
James
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Peel
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 27 of 49
B-3.1 First Name
William
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Vidmar
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 28 of 49
B-3.1 First Name
John
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Sabatalo
B-3.4 Proposed Role
OWNER
B-3.5 Position/Title
Passive Owner
B-3.6 Brief description of role
Inactive Owner
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below. No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 29 of 49
B-3.1 First Name
Lucas
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Baker
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Quality Control Assurance Advisor
B-3.6 Brief description of role
Advise on all aspects of Quality
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 30 of 49
B-3.1 First Name
Thomas
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Menke
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Quality Control Assurance Advisor
B-3.6 Brief description of role
Advise on all aspects of Quality
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 31 of 49
B-3.1 First Name
Arnold
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Schropp
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Director Of Security
B-3.6 Brief description of role
Oversee all aspects of security.
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 32 of 49
B-3.1 First Name
Duard
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Headley
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Environmental & Sustainability Advisor
B-3.6 Brief description of role
Advise on environmental and sustainability efficiency
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 33 of 49
B-3.1 First Name
Kathryn
B-3.2 Middle Name
Holly
B-3.3 Last Name
Walter
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Environmental & Sustainability Advisor
B-3.6 Brief description of role
Advise on environmental and sustainability efficiency
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 34 of 49
B-3.1 First Name
Malte
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Von Matthiessen
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Manufacturing Adviser
B-3.6 Brief description of role
Advise on all aspects of quality manufacturing.
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 35 of 49
B-3.1 First Name
Kathryn
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Hichcock
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Substance Abuse Adviser
B-3.6 Brief description of role
Advise on all aspects of Substance Abuse and Patient Wellness
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 36 of 49
B-3.1 First Name
Craig
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Mesure
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Patient and Community Outreach Advisor
B-3.6 Brief description of role
Advise on Patient and Community Outreach
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 37 of 49
B-3.1 First Name
Erin
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Alexander
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Director Of Compliance
B-3.6 Brief description of role
Ensure compliance is maintained throughout all operations of Cresco Labs Ohio, LLC
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 38 of 49
B-3.1 First Name
David
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Ellis
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
EVP Of Operations
B-3.6 Brief description of role
Oversee general operations of Cresco Labs Ohio, LLC
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 39 of 49
B-3.1 First Name
Elizabeth
B-3.2 Middle Name
Jo
B-3.3 Last Name
Greusel
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Manufacturing Compliance Manager
B-3.6 Brief description of role
Ensure compliance is maintained on all manufactured products
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 40 of 49
B-3.1 First Name
Kelli
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Impola
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Human Resource Director
B-3.6 Brief description of role
Manage the initial startup process until a permanent HR Director is sourced and trained.
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 41 of 49
B-3.1 First Name
Alyssa
B-3.2 Middle Name
Lynn
B-3.3 Last Name
Kruse
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Director of Quality Assurance
B-3.6 Brief description of role
Manage the training of initial employees and SOP's to ensure consistent quality products
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 42 of 49
B-3.1 First Name
Jennifer
B-3.2 Middle Name
Rae
B-3.3 Last Name
Haynes
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Inventory Manager
B-3.6 Brief description of role
Oversee inventory management and training of initial employees
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 43 of 49
B-3.1 First Name
Rebecca
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Horwitz
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Packaging Compliance Manager
B-3.6 Brief description of role
Oversee packaging processes and training of initial packaging employees
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 44 of 49
B-3.1 First Name
Bryan
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Weber
B-3.4 Proposed Role
BOARD MEMBER
B-3.5 Position/Title
Board Member
B-3.6 Brief description of role
Will serve on the board of directors
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
Cresco Labs Ohio, LLC 6545 Market Ave North North Canton, OH 44721 (Cultivation application submitted)
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction. NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 45 of 49
B-3.1 First Name
Joseph
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Friedman
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Pharmacy Advisor
B-3.6 Brief description of role
Advise on all aspects of dispensary operations and patient services
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
YES
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
PDI Medical 1623 Barclay Blvd Buffalo Grove, IL. 60089
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
YES
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
PDI Medical 1623 Barclay Blvd Buffalo Grove, IL. 60089
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO
B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO
B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation?
NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 46 of 49
B-3.1 First Name
Zach
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Marburger
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Director of Marketing
B-3.6 Brief description of role
Oversee all marketing and collateral to ensure compliance with regulations
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 47 of 49
B-3.1 First Name
Lisa
B-3.2 Middle Name
No response provided by applicant
B-3.3 Last Name
Kamerad
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Director of Retail
B-3.6 Brief description of role
Oversee retail operations and training of initial employees
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 48 of 49
B-3.1 First Name
Maria
B-3.2 Middle Name
Concetta
B-3.3 Last Name
Schiavoni
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Director of Patient Wellness
B-3.6 Brief description of role
Oversee all aspects of dispensary operations and patient services
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Compliance(Prospective Associated Key Employee Compliance)
Item 49 of 49
B-3.1 First Name
Charles
B-3.2 Middle Name
Baker
B-3.3 Last Name
Bachtell
B-3.4 Proposed Role
OTHER
B-3.5 Position/Title
Veterans Affairs Adviser
B-3.6 Brief description of role
Advise on Veteran Affairs to ensure employment opportunities for veterans
B-3.7 Has this individual served, or are they currently serving as an owner, officer, or board member of another medical marijuana entity in Ohio or the United States?
NO
B-3.7.1 If "Yes" to B-3.7, please provide the entity Name and Address.
No response provided by applicant
B-3.8 Has this individual had ownership or financial interest, or do they currently have ownership or financial interest of another medical marijuana entity in Ohio or the United States?
NO
B-3.8.1 If "Yes" to B-3.8, please provide the entity Name and Address.
No response provided by applicant
B-3.9 Has this individual ever been convicted of, or are charges pending for, a disqualifying offense? Include instances in which a court granted intervention in lieu of treatment (also known as treatment in lieu of conviction, ILC, or TLC), or other diversion programs. Offenses must be reported regardless of whether the case has been sealed, as described in section 2953.32 of the Revised Code, or the equivalent thereof in another jurisdiction.
NO B-3.9.1 If "Yes" to B-3.9, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.10 Has the individual ever been convicted of, or are charges pending for, any other felony offense under state or federal law?
NO
B-3.10.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.11 Has the individual ever been convicted of, or are charges pending for, a crime (felony or misdemeanor) involving an act of moral turpitude?
NO
B-3.11.1 If "Yes", please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.12 Has this individual ever been disciplined by the State of Ohio Board of Pharmacy or any other licensing body.
NO
B-3.12.1 If "Yes", please provide the following: Name, Name and Address of Licensing Board, License Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved
No response provided by applicant
B-3.13 Has the individual ever been denied a license by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction, or is such action pending?
NO
B-3.13.1 If "Yes" to B-3.13, the reason for doing so must be provided below.
No response provided by applicant
B-3.14 Has the individual ever been the subject of an investigation or disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state or jurisdiction that resulted in the surrender, suspension, revocation, or probation of the individual's license or registration?
NO B-3.14.1 If "Yes" to B-3.14, the reason for doing so must be provided below.
No response provided by applicant
B-3.15 Has the individual ever been the subject of a disciplinary action by the Drug Enforcement Administration or appropriate issuing body of any state jurisdiction that was based in whole or in part, on the Applicant's prescribing, dispensing, diverting, administering, storing, personally furnishing, compounding, supplying, or selling a controlled substance or other dangerous drug (i.e. prescription drug), or is any such action pending?
NO
B-3.15.1 If "Yes" to B-3.15, the reason for doing so must be provided below.
No response provided by applicant
B-3.16 By selecting "Yes", this individual agrees to be enrolled in the Retained Applicant Fingerprint Database (Rapback) should the Applicant be awarded a provisional license.
YES
B-3.17 Has the individual been the subject of an action resulting in sanctions, disciplinary actions or civil monetary penalties being imposed relating to a registration, license, provisional license or any other authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.17.1 If "Yes" to B-3.17, the reason for doing so must be provided below.
No response provided by applicant
B-3.18 Has the individual been the subject of a civil or administrative action relating to a registration, license, provisional license or authorization to cultivate, process, or dispense medical marijuana in any state?
NO
B-3.18.1 If "Yes" to B-3.18, the reason for doing so must be provided below.
No response provided by applicant
B-3.19 Has the individual been accused of obtaining a registration, license, provisional license or other authorization to operate as a cultivator, processor, or dispensary of medical marijuana in any jurisdiction by fraud, misrepresentation, or the submission of false information?
NO
B-3.19.1 If "Yes" to B-3.19, the reason for doing so must be provided below.
No response provided by applicant
B-3.20 Has civil or administrative action been taken against the individual under the laws of Ohio or any other state, the United States or a military, territorial or tribal authority, relating to the individual's profession or occupation? NO
B-3.20.1 If "Yes" to B-3.20, please provide the following: Defendant, Name of Case and Docket Number, Nature of Charge or Complaint, Date of Charge or Complaint, Disposition, Name and Address of the Administrative Agency Involved, and Jurisdictional Court (Specify Federal, State and/or Local Jurisdictions)
No response provided by applicant
B-3.21 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees are a physician who has a certificate to recommend medical marijuana or who has applied for a certificate to recommend medical marijuana under section 4731.30 of the Revised Code.
YES
B-3.22 By selecting “Yes”, you attest to the following statement: None of the Applicant's Prospective Associated Key Employees have ownership, investment interest, or a compensation arrangement with a laboratory licensed under Chapter 3796 of the Revised Code or an Applicant for a license to conduct laboratory testing.
YES Business Plan(Property Title, Lease, or Option to Acquire Property Location)
C-1.1 Attach one of the following: -Evidence of the Applicant’s clear legal title to or option to purchase the proposed site and facility. -A fully-executed copy of the Applicant’s unexpired lease for the proposed site and facility and a written statement from the property owner that the Applicant may operate a medical marijuana organization on the proposed site for, at a minimum, the term of the initial provisional license. -Other evidence that shows that the Applicant has a location to operate its medical marijuana organization.
Uploaded Document Name: C-1.1_Executed Property Docs.pdf NOTE: This applicant uploaded document is the next 14 page(s) of this document.
C-1.2 Business Name, as it appears on the Applicant’s certificate of incorporation, charter, bylaws, partnership agreement or other official documents.
Cresco Labs Ohio, LLC
C-1.3 Trade names and DBA (doing business as) names
No response provided by applicant
C-1.4 Business Address
3280 East Main
C-1.5 City
Columbus
C-1.6 State
OH
C-1.7 Zip Code
43213
C-1.8 Phone
6144408589
C-1.9 Email [email protected] Business Plan(Site and Facility Plan)
C-2.1 Applicants must show that they can expeditiously use a site and facility to meet the activities described in the provisional license by attaching one of the following: -If the facility is in existence at the time that the provisional license application is submitted, submit plans and specifications drawn to scale for the interior of the facility. -If the facility is in existence at the time that the provisional license application is submitted, and the Applicant plans to make alterations to the facility, submit renovation plans and specifications for the interior and exterior of the facility. -If the facility does not exist at the time that the provisional license application is submitted, submit a plot plan that shows the proposed location of the facility and an architectural drawing of the facility, including a detailed drawing, to scale, of the interior of the facility.
Uploaded Document Name: C-2.1_Facility Plan.pdf NOTE: This applicant uploaded document is the next 11 page(s) of this document.
C-2.2 The Applicant also must submit evidence that it is in compliance with any local ordinances, rules, or regulations adopted by the locality in which the Applicant's property is located, which are in effect at the time of the application. Include copies of any required local registration, license or permit. If no relevant zoning restrictions have been enacted, provide a professionally prepared survey which demonstrates that the Applicant is not in violation of restrictions pertaining to prohibited facilities and is not located within 500 feet of a community addiction services provider as defined under section 5119.01 of the Revised Code. OAC 3796:5-5-01
Uploaded Document Name: C-2.2_Zoning Confirmation.pdf NOTE: This applicant uploaded document is the next 2 page(s) of this document.
C-2.3 Provide a location map of the area surrounding the proposed facility that establishes the facility is at least 500 feet from a prohibited facility or a community addiction services provider as defined under section 5119.01 of the Revised Code. In establishing the distance between a proposed dispensary and such a facility, the distance shall be measured linearly and shall be the shortest distance between the closest point of the property lines of the proposed dispensary and the prohibited facility or community addiction services provider. The map must be clearly legible and labeled and may be divided into 8.5*11 inch sections. OAC 3796:5-5-01
Uploaded Document Name: C-2.3_Location Area Map.pdf NOTE: This applicant uploaded document is the next 1 page(s) of this document.
Business Plan(Description of Employee Duties and Roles)
C-4.1 Please provide a description of the duties, responsibilities, and roles of each Prospective Associated Key Employee. Please attach a Table of Organization and Control for the business. Include all individuals listed in question A-6.
TRADE SECRET
Chief Executive Officer: Responsible for the direct management of the Executive team; primary liaison with Board and other regulators; responsible for approving and updating policies and procedures; approval of financial projections; develop a strategic plan to advance the mission and objectives; promote revenue, profitability, and growth as an organization.
Chief Operations Officer: Responsible for all operations to ensure production efficiency, quality, service, and cost-effective management of resources; planning, developing, and implementing strategies for generating resources and/or revenues, in conjunction with the CFO; develop, update, and maintain operational procedures, policies, and standards that exceed Board requirements.
Chief Financial Officer: Responsible for auditing medical marijuana inventories and supervising external third-party bookkeeper; oversight of financial accounting records and filings; ensuring proper financial accounting and asset management; tracking retail location sales; and guidance of financial projections and goals.
Director of Compliance: Responsible for establishing standard operating procedures, and operational strategy to ensure compliance programs throughout the organization are instrumental in identifying, analyzing and preventing noncompliance with State rules and regulations.
Director of Business Development: Responsible for developing a strategic vision for increasing, obtaining, and managing all business relationships. Planning will be focused on establishing business opportunities within the Ohio. Involved in setting benchmarks, diversity goals, and measurable organization growth standards.
Executive Vice President of Operations: Responsible for ensuring the day-to-day operations are effective, efficient, and adequate to support and meet the patient population demand. Develop the strategic planning, policies and procedures, and methodologies to direct the retail operations.
Director of Quality Assurance: Responsible for developing, establishing, and enforcing quality control standards, testing materials, and product analysis for all staff and create product inspection standards by implementing federal, Board and industry standards; and enforce product quality documentation systems.
Director of Marketing: Responsible for developing a competitive market strategy, identifying risks in the market, and implementing a sales program centered around medical marijuana as an alternative medicine to traditional pharmaceuticals.
Director of Security: Responsible for the management of our security provider; implementing security policies and protocols; working with the COO on all security-related facility matters and systems; manage security training and ongoing education; oversee security audits; collaborate with State, county and local law enforcement.
Security Agent: Responsible for monitoring and securing the premise of the dispensary facility by utilizing security, surveillance, and safety equipment throughout the building and property boundaries to ensure the facility, staff and patients are secure always.
Human Resources Director: Responsible for providing on-site safety coordination to ensure operations are performed according to Board requirements without incidents. Additionally, responsible for reporting all claims, accidents, injuries, or other document incidents in compliance with worker compensation policies.
Director of Retail: Responsible for all local retail operations, staff, and sales for the retail department to ensure product inventory, merchandise, and other medical marijuana items are in stock and readily available for qualified patients.
Director of Patient Wellness: Responsible for assisting in community planning and executing programs promoting health, safety and patient education. Responsible for developing and overseeing training and patient care and education.
Inventory Manager: Responsible for the inventory management strategy with the aim of controlling costs and rationalizing inventory; execution of inventory control measures to minimize inventory holding and maximizes stock system and paperwork accuracy; ensuring that incoming product is received and managed appropriately.
Packaging Compliance Manager: Responsible for implementing policies and procedures for inspection of medical marijuana from cultivators and processors prior to accepting any delivery.
Manufacturing Compliance Manager: Responsible for implementing policies and procedures for quality assurance for all manufactured products to ensure only compliant medication is sold at each facility.
Designated Representative: Responsible for managing retail operations of assigned dispensary facility location by overseeing all employees, training, policies and procedure updates, maintaining facility and regulatory compliance; and all functions set forth in 6-3-05; and reporting of any compliance violations to the Director of Compliance and the Board.
Assistant Dispensary Manager: Responsible for assisting in implementing retail operational standard operating procedures, and quality measures throughout retail transactions.
Patient Care Manager: Responsible for patient customer service, maintaining confidential and HIPAA- compliant paperwork, and overall upkeep. Maintains accurate patient records, manage scheduling patient traffic flow, and respond to patient inquiries.
Patient Care specialist (x3): Responsible for customer orientation, data, paperwork, and management; maintaining accurate records of customers’ identification and registration documents; recording patient orders; and maintaining an organized environment and facility appearance.
Dispensary Agent: Responsible for customer service and educational guidance to registered patients and caregivers; assembling patient orders, recording sales in our (“ADP/POS”) system; handling transactions including cash, check, and credit card payments.
Board of Directors (x7): Includes a wide range of subject matter experts and Ohioans who will provide informed decision making and recommendations for the leadership team.
Passive Owners (x19): Include those who are owners but have other obligations in their professional lives that make them unable to participate in day-to-day operations. Engage in owner’s meetings and provide recommendations for the leadership on operations based on their respective disciplines.
Patient & Community Outreach Advisor: Responsible for advising on the development and implementation of all community engagement, public communications, and patient education and outreach.
Substance Abuse Advisor: Responsible for advising on continuing education for employees emphasizing condition specific treatment options, patient support and recognizing the symptoms of possible substance abuse.
Pharmacy Advisor: Responsible for advising on industry best practices for dispensing of medical marijuana and patient education. With Director of Patient Wellness, will oversee training and continuing education to ensure compliance with State requirements.
Quality Assurance Advisors (x2): Responsible for advising on improving quality control standards, continuing education for employees and oversight on all aspects of internal processes.
Environmental & Sustainability Advisory Committee (x2) : Responsible for advising on continuous improvements to our policies and procedures to maximize efficiencies while reducing any impact on the environment and guide sustainability.
Government Relations & Compliance Advisors (x2): Responsible for maintaining an open relationship with the Board to provide transparency of our operations and ensure compliance is maintained.
Veteran Affairs Advisor: Responsible for advising on Veteran Affairs to ensure opportunities for employment and additional services are provided to veterans.
Manufacturing Advisor: Responsible for advising on Manufacturing and Supply Chain Management to ensure maximum efficiency of all operations.
C-4.2 Please attach a Table of Organization and Control for the business. Include all individuals listed in question A-6.
Uploaded Document Name: C-4.2_Dispensary Organizational Charts.pdf NOTE: This applicant uploaded document is the next 4 page(s) of this document.
Business Plan(Capital Requirements)
Item 1 of 1
C-5.1 Type of Capital
Equity
C-5.2 Source of Capital
Private funds of Applicant on deposit at the financial institution described in 3-5.3
C-5.3 Name and Address of financial institution
This response has been entirely redacted
C-5.4 Account Number
This response has been entirely redacted
C-5.5 Illustrate that the Applicant has adequate liquid assets to cover all expenses and costs for the first year of operation as indicated in the dispensary's proposed Business Startup Plan (Question C-3). The total amount of liquid assets must be no less than $250,000. Provide unredacted documentation from the Applicant's financial institution to support these capital requirements. (ORC 3796:6-2-02)
This response has been entirely redacted
C-5.5.1 Please attach a redacted copy of documentation from the Applicant's financial institution to support the capital requirements. (ORC 3796:6-2-02)
Uploaded Document Name: C-5.5_Redacted Asset Confirmation.pdf NOTE: This applicant uploaded document is the next 1 page(s) of this document.
Business Plan(Business History and Experience)
Item 1 of 1
C-6.1 First Name
No response provided by applicant
C-6.2 Middle Name
No response provided by applicant
C-6.3 Last Name
No response provided by applicant
C-6.4 Previous Role (e.g. Owner, Officer, Board Member, Person with Financial Interest, Person Exercising Substantial Control, Support Employee)
No response provided by applicant
C-6.5 Business Name
No response provided by applicant
C-6.6 Business Address
No response provided by applicant
C-6.7 Position of management or ownership of a controlling interest
No response provided by applicant
C-6.8 Dates
No response provided by applicant Business Plan(Business History and Experience Narrative)
C-6.9 Provide a narrative description not to exceed 1500 words demonstrating any previous experience at operating other businesses or non-profit organizations and any demonstrated knowledge or expertise with regard to the medical use of marijuana to treat qualifying conditions (for all Prospective Associated Key Employees with an ownership interest of ten percent or more in the prospective dispensary). Include the number of years of experience, the type of business, and any administrative discipline history associated with each business.
TRADE SECRET
Our executive team includes the leadership team of Cresco Labs, a highly-regarded, compliance- focused Medical Marijuana (MM) operator that currently holds seven (7) licenses across three (3) modern, hyper-regulated state MM programs. Patient care and education is a critical component of the Ohio program. We intend to operate our dispensary like a pharmacy – providing patient access to healthcare professionals with a deep understanding of what it means to dispense marijuana-based medicine. In addition, our group includes two pharmacists – an Ohio pharmacist (Director of Patient Wellness) and an Illinois-based pharmacist who owns and operates an Illinois MM dispensary (Advisor). The depth and breadth of our ownership, leadership and advisory committee exceeds that of most others operating in this industry. No PAKE has >10% ownership interest. • Cresco Labs Ohio was formed by successful professionals together with Cresco Labs. Cresco Labs is a significant and truly vested owner in Cresco Labs Ohio and has designed this operation accordingly; this is not a limited or consultant-based relationship. Cresco Labs’ knowledge, experience and operational know-how will be immediately implemented on behalf of Cresco Labs Ohio and leveraged for its success and the success of the Ohio program. Cresco Labs has a track record of success in hyper-regulated markets east of the Mississippi – receiving the top three scores from all applicants in Illinois, establishing three cultivation facilities in the state within 6 months of licensure and subsequently becoming the largest operator by market share in the state (averaging 25%+ each month). Most recently, Cresco Labs was one of only five (5) operators awarded both cultivation/processing and a dispensary license in Pennsylvania (awarded the second highest score of all applicants) and subsequently became the first licensee to be deemed operational by the state (within 4 months from receiving license). We put a unique emphasis on patient awareness and education – the cornerstone of our marketing/sales efforts is based on creating an educated, fully- informed and comforted patient population. We have established an operational model that allows us to perform and excel in a manner that these highly-regulated state programs require.
Cresco Labs has been involved in two lawsuits:
1. PM RX LLC v. IL Dept. of Agriculture, et al. 2015 CH 3226 (Circuit Court of Cook County). A losing applicant for a MM license sued the IL Department of Agriculture and Cresco Labs, LLC and alleged that plaintiff should have been awarded license. Voluntarily dismissed with prejudice on 5/18/2015.
2. WhiteOak Growers, LLC v. IL Dept. of Agriculture, et al. 2015 CH 4161 (Circuit Court of Cook County). A losing applicant for a MM license sued the IL Department of Agriculture and Cresco Labs, LLC alleging plaintiff should have been awarded license. Voluntarily dismissed with prejudice on 11/18/2015.
• Charles Bachtell (Owner/COO): Bachtell is the CEO of Cresco Labs, LLC. Bachtell is responsible for designing the business model and the direction for Cresco Labs and Cresco Labs Ohio, has overseen the development of $35M+ worth of MM facilities, and has led efforts raising $65M+ in private capital and traditional-bank debt financing. Bachtell also serves as an adjunct Professor at the Northwestern Pritzker School of Law teaching classes on the legal and regulatory matters existing in the emerging cannabis industry. He is the former General Counsel and Executive Vice President of a leading national mortgage bank in the U.S. Bachtell is an Executive Committee board member for MM industry associations in Illinois and Pennsylvania.
• Joseph Friedman (Advisor): Friedman, R.Ph. MBA, is founding member at Professional Dispensaries of Illinois, (PDI) Medical LLC. Friedman has a pharmacy degree from the University of Illinois College of Pharmacy, and an MBA. Through Friedman’s efforts, PDI Medical will become the first accredited dispensary in the nation through Ohio based NMMAO (National MM Accreditation Organization). Dispensaries meeting the NMMAO accreditation criteria prove a heightened awareness of general healthcare industry standards and quality measurements through documented policies, procedures, processes, and attestations. Friedman has also orchestrated the first ever pharmacy student “clinical” rotation at a medical cannabis dispensary, with Chicago’s Roosevelt University College of Pharmacy. Friedman has been published in the Chicago Tribune, Pharmacy Practice News, Marijuana Business Daily and Crain’s Chicago Business. Friedman has presented on MM matters at the NASP (National Association of Specialty Pharmacy), was the keynote speaker at the “Marijuana for Medical Professionals” convention in 2016, and, most recently, presented “Hitting the High Points of MM” at the National Community Pharmacist Association (NCPA) meeting.
• Maria Schiavoni (Director of Patient Wellness): Schiavoni previously served as a Staff Pharmacist and Pharmacy Manager for CVS. She is currently a pharmacist consultant for skilled nursing facilities in Ohio. She assists Directors of Nursing and physicians in making clinical recommendations based on the individual needs of their patients. She also participates in Quarterly Continuing Quality Improvement (CQI) meetings for long term care facilities to outline prescribing trends and assists nurses with narcotic destruction, med cart audits and med pass observations. In 2014 she was the recipient of a CVS Pharmacy Manager District Paragon Award which is the highest honor presented to the top 1% of pharmacy employees who demonstrate company values and consistently strive to deliver the best level of care to their patients. She was also the recipient of The Outstanding Preceptor Award for providing positive mentorship and training to pharmacy students in both internship and externship programs. Schiavoni has a Pharmacy degree from Temple University School of Pharmacy and is a licensed pharmacist in the state of Ohio.
• Arnold Schropp (Director of Security): Schropp is a public safety professional with over 45 years of experience in law enforcement, compliance, and security. After serving at three (3) different State Highway Patrol field locations, he spent 11 years as a criminal investigator. He retired as a Commander, where he oversaw all aspects of security at a Statehouse and a Governor’s Residence. He developed building policies and rules governing political rallies and demonstrations including all security elements for that state’s State Fair. As Ohio’s First Assistant Inspector General, he investigated fraud and helped state agencies develop stronger security policies. He attended the Association of Inspectors General Institute and earned a Certified Inspector General accreditation.
• Kathryn Hitchcock (Advisor): Hitchcock has over 30 years of experience as a Clinical Psychologist and Substance Abuse Counselor providing therapy and guidance services for individuals and groups. After graduating with a B.S in psychology (Magna Cum Laude) she obtained a Doctorate in Clinical Psychology. She recently managed a team of eight (8) health practitioners providing psychological testing as well as inpatient/outpatient alcohol and drug counseling.
• Larry Laurello (Owner): Laurello is the current President and CEO of a 3rd-generation family owned, multimillion dollar national railroad contractor with over 40 years of experience. His innovative approach to the railroad construction and rehab industry allows this company to be the most state of the art, competitive, safe and efficient contractor in the nation. He is also the owner/operator of a family owned winery that has existed for more than 15 years producing 12,000 gallons of wine annually. He has overseen expansion to over 18 acres of vines that he manages and maintains. He employs more than 200 employees annually.
• Roger Riachi (Owner): Riachi is the founder of a well-respected construction and contracting company with a verifiable record of success in driving projects from concept to fruition, on-time, and within budget all over the country. He holds an MBA in finance, a M.S in construction management as well as a B.S in Civil Engineering. Under his leadership his construction company has averaged 18% sales growth annually. He has extensive knowledge of regulatory compliance, comprehensive project management and budget development.
• Brian McCormack (Owner): McCormack is the founder of a publicly traded logistics company that he built into a successful global operation that employs more than 1,800 people and grosses over $1 billion in annual revenue. He oversaw management and operation of multiple sophisticated manufacturing facilities requiring clean room environments and International Organization of Standardization 9001 certifications, pioneering technology and data-based solutions to create efficiencies and disrupt traditional industries. He is currently the Vice Chair of the board of Cresco Labs.
Kenneth Amann (Owner/CFO): Amann serves as the CFO of Cresco Labs, with over 20 years of financial management and consulting experience. Acting as CFO for eight years at a $2B+ global BPO business based in Europe that specialized in corporate information solutions that re-engineer end-to- end business processes. He was responsible for over 170 employees located in seven (7) different countries. He is a CPA and has extensive experience with accounting matters specific to this industry, like I.R.C. 280(e).
Jennifer Haynes (Inventory Manager): Haynes is the Inventory Manager for Cresco Labs. Responsibilities include maintaining all inventory records generated by all 3 of Cresco’s Illinois facilities. This includes daily audits of saleable material, coordination with Sales Managers to ensure all inventory data is accurate, and implementing sampling procedures for independent laboratory testing. Previously, Haynes was a Dispensary Technician for Pharmacannis of Illinois where she educated patients on every aspect of MM including effects, dosages, and administration methods. Operations Plan(Dispensary Oversight)
D-1.1 By selecting "Yes", the Applicant attests that it will appoint a designated representative responsible for the oversight, supervision and control of operations of the medical marijuana dispensary. When there is a change in the appointed designated representative, the Applicant will notify the State Board of Pharmacy within 10 business days of appointment. OAC 3796:6-3-05
YES Operations Plan(Security and Surveillance )
D-2.1 By checking “Yes,” the Applicant attests that it is able to continuously maintain effective security, surveillance and accounting control measures to prevent diversion, abuse and other illegal conduct regarding medical marijuana and medical marijuana products.
YES
D-2.2 Please provide a summary of the Applicant's proposed security and surveillance equipment and measures that will be in place at the proposed facility and site. These measures should cover, but are not limited to, the following: 1. General overview of the equipment, measures and procedures to be used 2. Alarm systems 3. Surveillance system 4. Surveillance storage 5. Recording capability 6. Records retention 7. Premises accessibility 8. Inspection/servicing/alteration protocols Please reference OAC 3796:6-3-16 for more information.
This response has been entirely redacted
D-2.2.1 Applicants may include images or diagrams, in PDF format, demonstrating the measures described in D-2.2. The images or diagrams may contain a brief descriptive caption. Additional language responding to the question will not be considered.
Uploaded Document Name: D-2.2.1_Security Attachments.pdf NOTE: This applicant uploaded document is the next 9 page(s) of this document.
D-2.3 By selecting “Yes”, the Applicant attests that the answer provided in response to Question D-2.2 is voluntarily submitted to the State Board of Pharmacy in expectation of protection from disclosure as provided by section 149.433 of the Revised Code.
YES
Non-Compliant Non-Compliant Non-Compliant Compliant damaged label damaged label altered label legible label Compliant package – Non-compliant package – Non-compliant package – fully closed and tampered not tampered correctly not closed correctly
Implementation Guide ASAP Standard Version 4 • Release 2A for Prescription Drug Monitoring Programs
Table of Contents
Summary of Enhancements to Version 4.2 ...... 3 ASAP Technical Specifications ...... 4 Data Element Summary ...... 4 Data Element Separators and Segment Terminators ...... 4 Use of Escape Character ...... 5 Segment and Data Ordering...... 6 Privacy and Security...... 6 Rules-Based Standard ...... 6 Real-Time versus Batch Transmissions...... 6 Use of Qualifiers...... 6 Examples of Looping ...... 7 Core Reporting Segments ...... 9 Header Segments ...... 10 Segment: TH Transaction Header...... 11 Segment: IS Information Source ...... 13 Segment: PHA Pharmacy Header...... 14 Detail Segments ...... 15 Segment: PAT Patient Information ...... 17 Segment: DSP Dispensing Record ...... 19 Segment: PRE Prescriber Information ...... 24 Segment: CDI Compound Drug Ingredient Detail ...... 25 Segment: AIR Additional Information Reporting ...... 26 Summary Segments ...... 28 Segment: TP Pharmacy Trailer ...... 29 Segment: TT Transaction Trailer ...... 30 Acknowledgment/Response ...... 31 Segment: TP Transaction Header...... 32 Segment: IS Information Source ...... 34 Segment: PHA Pharmacy Header ...... 35 Segment: ACK Acknowledgment/Response ...... 36 Segment: TP Pharmacy Trailer ...... 37 Segment: TT Transaction Trailer ...... 38 Example Transmissions ...... 39 Appendix A List of Jurisdictions ...... 44 Appendix B Reporting Quantity Dispensed ...... 45 Appendix C Real-Time Transmission Reject Codes ...... 46 Appendix D Examples of the Correct Use of Codes in DSP01 ...... 48 Error Report Standard ...... 50 Zero Report Standard ...... 61
2 TRADE SECRET
Cultivator: Entity A Dispensary: Entity B Lic. #: XXX XXX Lic. #: XXX XXX mm/dd/yyyy 0000 Center St. Columbus, OH 00000 Cannabis - Flower Strain A Patient: John Doe NET WT X OZ (XXXg) Patient ID: XXX-XXXXX Harvested: mm/dd/yyyy Caregiver: Jane Doe POTENCY ANALYSIS: WARNING: This product may cause THC 0.00% THCA 0.00% impairment and may be habit- THCV 0.00% CBD 0.00% forming. CBDA 0.00% CBDV 0.00% This product may be unlawful CBN 0.00% CBG 0.00% outside of the State of Ohio. CBC 0.00% XXX 0.00% TOTAL: 00.0%
TERPENE PROFILE: Xxxxxx, xxxxxxxx, xxxxxxxxx TRADE SECRET
Cultivator: Entity A Dispensary: Entity B Lic. #: XXX XXX Lic. #: XXX XXX mm/dd/yyyy 0000 Center St. Columbus, OH 00000 Cannabis - Flower Strain A Patient: John Doe NET WT X OZ (XXXg) Patient ID: XXX-XXXXX Harvested: mm/dd/yyyy Caregiver: Jane Doe POTENCY ANALYSIS: WARNING: This product may cause THC 0.00% THCA 0.00% impairment and may be habit- THCV 0.00% CBD 0.00% forming. CBDA 0.00% CBDV 0.00% CBN 0.00% CBG 0.00% This product may be unlawful CBC 0.00% XXX 0.00% outside of the State of Ohio. TOTAL: 00.0% TERPENE PROFILE: Xxxxxx, xxxxxxxx, xxxxxxxxx Batch #
000000000000000 TRADE SECRET
WARNING: This product may cause Marijuana can impair impairment and may be habit- concentration, coordination forming. Smoking medical and judgment. Do not operate marijuana is not permitted in a vehicle or machinery under the State of Ohio. the influence of this drug. There may be health risks 24-Hour Toll Free Help Line: associated with consumption 1-800-XXX-XXXX of this product. If you have a concern that Should not be used by an error may have occurred women who are pregnant or in the dispensing of your breastfeeding. medical marijuana, you may contact the State of Ohio For use only by the person Board of Pharmacy, using the named on the label of the contact information found at dispensed product. Keep out medicalmarijuana.ohio.gov. of reach of children.
Uploaded Document Name: D- 10.1.1_Additional Services Attachment.pdf NOTE: This applicant uploaded document is the next 37 page(s) of this document.
Operations Plan(Security & Infrastructure Records )
D-11.1 By selecting "Yes", the Applicant attests that all responses identified as containing security and infrastructure are voluntarily submitted to the State Board of Pharmacy in expectation of a protection from disclosure as provided by section 149.433 of the Revised Code.
YES
Implementation Guide ASAP Standard Version 4 • Release 2A for Prescription Drug Monitoring Programs
Table of Contents
Summary of Enhancements to Version 4.2 ...... 3 ASAP Technical Specifications ...... 4 Data Element Summary ...... 4 Data Element Separators and Segment Terminators ...... 4 Use of Escape Character ...... 5 Segment and Data Ordering...... 6 Privacy and Security...... 6 Rules-Based Standard ...... 6 Real-Time versus Batch Transmissions...... 6 Use of Qualifiers...... 6 Examples of Looping ...... 7 Core Reporting Segments ...... 9 Header Segments ...... 10 Segment: TH Transaction Header...... 11 Segment: IS Information Source ...... 13 Segment: PHA Pharmacy Header...... 14 Detail Segments ...... 15 Segment: PAT Patient Information ...... 17 Segment: DSP Dispensing Record ...... 19 Segment: PRE Prescriber Information ...... 24 Segment: CDI Compound Drug Ingredient Detail ...... 25 Segment: AIR Additional Information Reporting ...... 26 Summary Segments ...... 28 Segment: TP Pharmacy Trailer ...... 29 Segment: TT Transaction Trailer ...... 30 Acknowledgment/Response ...... 31 Segment: TP Transaction Header...... 32 Segment: IS Information Source ...... 34 Segment: PHA Pharmacy Header ...... 35 Segment: ACK Acknowledgment/Response ...... 36 Segment: TP Pharmacy Trailer ...... 37 Segment: TT Transaction Trailer ...... 38 Example Transmissions ...... 39 Appendix A List of Jurisdictions ...... 44 Appendix B Reporting Quantity Dispensed ...... 45 Appendix C Real-Time Transmission Reject Codes ...... 46 Appendix D Examples of the Correct Use of Codes in DSP01 ...... 48 Error Report Standard ...... 50 Zero Report Standard ...... 61
2
Implementation Guide ASAP Standard Version 4 • Release 2A for Prescription Drug Monitoring Programs
Table of Contents
Summary of Enhancements to Version 4.2 ...... 3 ASAP Technical Specifications ...... 4 Data Element Summary ...... 4 Data Element Separators and Segment Terminators ...... 4 Use of Escape Character ...... 5 Segment and Data Ordering...... 6 Privacy and Security...... 6 Rules-Based Standard ...... 6 Real-Time versus Batch Transmissions...... 6 Use of Qualifiers...... 6 Examples of Looping ...... 7 Core Reporting Segments ...... 9 Header Segments ...... 10 Segment: TH Transaction Header...... 11 Segment: IS Information Source ...... 13 Segment: PHA Pharmacy Header...... 14 Detail Segments ...... 15 Segment: PAT Patient Information ...... 17 Segment: DSP Dispensing Record ...... 19 Segment: PRE Prescriber Information ...... 24 Segment: CDI Compound Drug Ingredient Detail ...... 25 Segment: AIR Additional Information Reporting ...... 26 Summary Segments ...... 28 Segment: TP Pharmacy Trailer ...... 29 Segment: TT Transaction Trailer ...... 30 Acknowledgment/Response ...... 31 Segment: TP Transaction Header...... 32 Segment: IS Information Source ...... 34 Segment: PHA Pharmacy Header ...... 35 Segment: ACK Acknowledgment/Response ...... 36 Segment: TP Pharmacy Trailer ...... 37 Segment: TT Transaction Trailer ...... 38 Example Transmissions ...... 39 Appendix A List of Jurisdictions ...... 44 Appendix B Reporting Quantity Dispensed ...... 45 Appendix C Real-Time Transmission Reject Codes ...... 46 Appendix D Examples of the Correct Use of Codes in DSP01 ...... 48 Error Report Standard ...... 50 Zero Report Standard ...... 61
2
Patient Care(Dispensary Operating Hours)
E-4.1 By selecting "Yes", the Applicant attests that it will make the dispensary available to patients and caregivers to purchase medical marijuana for a minimum of 35 hours per week, between the hours of 7 am and 9 pm, except as authorized by State Board of Pharmacy. OAC 3796:6-3-03
YES
E-4.2 Provide the proposed hours of operation during which the prospective dispensary will available to dispense medical marijuana to patients and caregivers. (Information only) OAC 3796:6-3-03
7am (EST) - 9pm (EST) Patient Care(Patient Information)
E-5.1 By selecting "Yes", the Applicant attests that it will post a sign directing patients and caregivers with medical marijuana inquiries or adverse reactions to the toll-free hotline established by the State Board of Pharmacy. OAC 3796:6-3-15
YES
E-5.2 By selecting "Yes", the Applicant attests that it will make information regarding the use and possession of medical marijuana available to patients and caregivers. The Applicant agrees to submit all such information to the State Board of Pharmacy prior to being provided to patients and caregivers. OAC 3796:6-3-15
YES Attestations and Acknowledgements(Attestations and Acknowledgements)
F-1.1 Fill out and attach the “Trade Secret Form” to Question F-1.1, specifying the question and / or attachment references of the application submission that are exempt from disclosure under Ohio public records law and articulate how the information meets the definition of “trade secret” under Ohio Revised Code section 1333.61(D). If no material is designated as trade secret information, a statement of “None” should be listed on the form.
Uploaded Document Name: F-1.1_Trade Secret Attachment.pdf NOTE: This applicant uploaded document is the next 5 page(s) of this document.
TRADE SECRET ADDENDUM
The pages marked TRADE SECRET C-2.1, C-3.1, C-3.2, C-4.1, C-5.5, C-6.9, D-2.2, D-3.3, D- 4.4, D-5.5, D-6.8, D-6.9, D-7.1, D-8.1, D-9.2, D-10.1, D-10.2, D-10.3, E-1.1, E-1.2, E-2.1, E-2.2 and E-3.1) contain highly confidential/trade secret information.
Pursuant to Ohio Revised Code 1333.61, a "Trade Secret" means information, including the whole or any portion or phase of any scientific or technical information, design, process, procedure, formula, pattern, compilation, program, device, method, technique, or improvement, or any business information or plans, financial information, or listing of names, addresses, or telephone numbers, that satisfies both of the following: (I) it derives economic value, actual potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from its disclosure or use; and (2) it is the subject of efforts that are reasonable under the circumstances to maintain its secrecy.
The pages marked TRADE SECRET of the subject application convey highly secret processes, formulae, methodologies, and techniques that give Applicant a competitive advantage. The marked pages contain information not known to the general public (even with respect to the selection, arrangement and Applicant's analyses of compilations of public facts (compilations not known to the public)). None of the information contained on the marked pages can be found in any public source. This information is guarded internally at Applicant's place of business, with only those people who have a need to know with access. Any person with access to this information vis-a-vis Applicant is subject to contractual non-disclosure obligations.
It would require significant resources (including significant time) for others to acquire and duplicate the information on Applicant's pages marked TRADE SECRET. In fact, Applicant spent three years developing its responses to questions C-2.1, C-3.1, C-3.2, C-4.1, C-5.5, C-6.9, D-2.2, D-3.3, D-4.4, D-5.5, D-6.8, D-6.9, D-7.1, D-8.1, D-9.2, D-10.1, D-10.2, D-10.3, E-1.1, E-1.2, E-2.1, E-2.2 and E- 3.1, i.e., all of the marked pages. Without protection from disclosure to the public, anyone could simply copy Applicant's plans with impunity and submit the copied plans in other state application processes, all to Applicant's detriment.
Applicant's interest to maintain the secrecy of its application is critical to Applicant's ability to obtain additional licenses, in lieu of Applicant's competitors, in markets with medical marijuana regulations and ancillary application efforts.
Ohio law clearly offers protection for trade secrets. See Id. However, to be eligible for the trade secret protection that Applicant enjoys under Ohio law, information on the marked pages must not be disclosed to the public.
Protecting Applicant's trade secrets as part of the subject application process comports with the Freedom of Information Act ("FOIA"). Exemption 4 of the FOIA protects "trade secrets and commercial or financial information obtained from a person [that is] privileged or confidential." 5 U.S.C. § 552(b)(4) (2006) (citations omitted). This exemption is intended to protect the interests of both the government and submitters of information. See, e.g., Nat 'I Parks & Conservation Ass 'n v. Morion, 498 F.2d 765, 767-70 (D.C. Cir. 1974).
10251256 v1 Thus, the information on the marked pages should also be exempt from FOIA requests.
For purposes of Exemption 4, the Court of Appeals for the District of Columbia Circuit in Public Citizen Health Research Group v. FDA, 704 F.2d 1280, 1288 (D.C. Cir. 1983), has adopted a "common law" definition of the term "trade secret" that is narrower than the broad definition used in the Restatement of Torts - that a "trade secret" encompasses virtually any information that provides a competitive advantage.
Trade secret protection has been recognized for product manufacturing and business methodology information of the type conveyed on Applicant's pages marked TRADE SECRET. See, e.g., Herrick v. Garvey, 200 F.Supp. 2d 1321, 1326 (D. Wyo. 2000) ("technical blueprints depicting the design, materials, components, dimensions and geometry of' aircraft) (citations omitted); Sako/ow v. FDA, No. l:97-CV-252, slip op. at 7 (E.D. Tex. Feb. 19, 1998) ( description of how drug is manufactured, including "analytical methods employed to assure quality and consistency") ( citations omitted).
Both Ohio and federal law support a regime that is supposed to safeguard submitters of trade secret/highly proprietary information from competitive disadvantages if the information became public.
Applicant's pages marked TRADE SECRET clearly contain privileged and confidential commercial information and scientific methodologies.
Under the test promulgated in National Parks, a commercial matter is "confidential" for purposes of being exempt from disclosure if the information is likely to have one or both of the following effects if produced: (1) production of the information would impair the Government's ability to obtain necessary information in the future; or (2) production of the information would cause substantial harm to the competitive position of the person from whom the information was obtained.
Clearly (2) applies here. So does (1). Production of Applicant's confidential information to the public would harm the Ohio Board of Pharmacy’s, i.e., the Government's, ability to receive compelling, well-researched, well-developed proposals in the future. The government serves the public. Nobody will invest resources in detailed proposals to the Ohio Board of Pharmacy if the work can be copied and used by others with impunity, and to the detriment of the public (who will not have the benefit of great programs such as Applicant's Medical Marijuana Control Program).
Applicant will suffer harm as to its competitive position if Applicant's competitors had access to this information. Applicant respectfully requests that the Ohio Board of Pharmacy not publish Applicant's trade secrets.
F-1.2 To be considered complete, each application must be submitted with an Attestation and Release Authorization. The form must be completed by a Prospective Associated Key Employee who may legally sign for the Applicant and who can verify the information provided in the application is true, correct, and complete.
This response has been entirely redacted