Statement of Changes in Beneficial Ownership (4)
April 21 2021 - 04:27PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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
*
Havranek Debra |
2. Issuer Name and Ticker or Trading Symbol
MIDWEST HOLDING INC.
[
mdwt
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) VP & CFO |
(Last)
(First)
(Middle)
2900 SOUTH 70TH STREET, SUITE 400 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/11/2021 |
(Street)
LINCOLN, NE 68506
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities 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 | 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 Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (right to buy) | $55.02 | 3/11/2021 | | A | | 1500 | | 3/11/2023 (1) | 3/11/2031 | Voting Common Stock | 1500 | $0 | 1500 | D | |
Stock Option (right to buy) | $25 | | | | | | | 7/17/2021 (2) | 7/17/2029 | Voting Common Stock | 3000 | | 3000 | D | |
Explanation of Responses: |
(1) | Options vest as follows: (i) 750 shares vest on March 11, 2023 and (ii) 750 shares vest on March 11, 2025, subject to the Reporting Peron's continued service as an employee of the Company. Vesting is also subject to acceleration under certain circumstances. |
(2) | Options vest as follows: (i) 1,000 shares vest on July 17, 2021 and (ii) 2,000 shares vest on July 17, 2023, subject to the Reporting Peron's continued service as an employee of the Company. Vesting is also subject to acceleration under certain circumstances. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Havranek Debra 2900 SOUTH 70TH STREET SUITE 400 LINCOLN, NE 68506 |
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| VP & CFO |
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Signatures
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Debra Havranek | | 4/21/2021 |
**Signature of Reporting Person | Date |
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