Annual Statement of Changes in Beneficial Ownership (5)
January 26 2021 - 12:17PM
Edgar (US Regulatory)
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
RIEWOLD RON | 2. Issuer Name and Ticker or Trading SymbolMitesco, Inc. [MITI] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
601 CARLSON PARKWAY, SUITE 1050 | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2020 |
(Street)
MINNETONKA, MN 55305
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Amount | (A) or (D) | Price |
Common Stock (1) | 12/31/2018 | | A | 25000 | A | (1) | 25000 | D | |
Common Stock (1) | 3/1/2019 | | A | 100000 | A | (1) | 125000 | D | |
Common Stock (1) | 9/4/2019 | | A | 775000 | A | (1) | 900000 | D | |
Common Stock (1) | 12/28/2020 | | P | 98431 | A | $0.03 | 998431 | D | |
Preferred X Stock (2) | 12/31/2019 | | P | 2000 | A | $25.00 | 2000 | D | |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (MM/DD/YYYY) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Options | $0.03 | 2/27/2019 | | A | 1000000 | | 12/27/2020 | 2/27/2030 | Stock Options | 1000000 | $0.00 | 1000000 | D | |
Stock Options | $0.03 | 12/28/2020 | | A | 100000 | | 12/27/2020 | 12/27/2030 | Stock Options | 1100000 | $0.00 | 1100000 | D | |
Explanation of Responses: |
(1) | On the dates set forth above, Ron Riewold, the Issuer's directors received shares of the Issuer's common stock as payment for services rendered. The Issuer valued the shares at the price of $0.03 per share. |
(2) | The amounts reflected as beneficially held by Issuer's Director, Ron Riewold includes an aggregate of 1,098,431 shares of the Issuer's common stock and 2,000 shares of its Series X Preferred Stock. Each one (1) share of the Series X Preferred Stock is entitled to 20,000 votes on all matters submitted to a vote of the Issuer's Common Stockholders. As a result, Mr. Riewold holds 1,098,431 votes as a result of his ownership of the Issuer's common stock, 1,100,000 stock options, and 24,000,0000 as a result of the Series X Preferred Stock. The 26198,431 votes held by Mr. Riewold represent 14.61% of the votes on matters submitted to a vote of the Issuer's common stockholders. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
RIEWOLD RON 601 CARLSON PARKWAY, SUITE 1050 MINNETONKA, MN 55305 | X |
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Signatures
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/s/ Ron Riewold | | 1/26/2021 |
**Signature of Reporting Person | Date |
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