0001213900-22-056729.txt : 20220916
0001213900-22-056729.hdr.sgml : 20220916
20220916214128
ACCESSION NUMBER: 0001213900-22-056729
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220915
FILED AS OF DATE: 20220916
DATE AS OF CHANGE: 20220916
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Potashnick Robert
CENTRAL INDEX KEY: 0001939454
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39783
FILM NUMBER: 221249274
MAIL ADDRESS:
STREET 1: 220 SOUTH SIXTH STREET
STREET 2: SUITE 1200
CITY: MINNEAPOLIS
STATE: MN
ZIP: 55402
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: FOXO TECHNOLOGIES INC.
CENTRAL INDEX KEY: 0001812360
STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311]
IRS NUMBER: 851050265
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 729 WASHINGTON AVE. N
STREET 2: SUITE 600
CITY: MINNEAPOLIS
STATE: MN
ZIP: 55401
BUSINESS PHONE: (612) 562-9447
MAIL ADDRESS:
STREET 1: 729 WASHINGTON AVE. N
STREET 2: SUITE 600
CITY: MINNEAPOLIS
STATE: MN
ZIP: 55401
FORMER COMPANY:
FORMER CONFORMED NAME: Delwinds Insurance Acquisition Corp.
DATE OF NAME CHANGE: 20200518
4
1
ownership.xml
X0306
4
2022-09-15
0
0001812360
FOXO TECHNOLOGIES INC.
FOXO
0001939454
Potashnick Robert
C/O ROBERT POTASHNICK
729 WASHINGTON AVE. N., SUITE 600
MINNEAPOLIS
MN
55401
0
1
0
0
Chief Financial Officer
Common Stock
2022-09-15
4
A
0
510000
A
510000
D
Stock Option (right to buy)
6.51
2022-09-15
4
A
0
78413
0
A
2026-04-02
Class A Common Stock
78413
78413
D
Stock Option (right to buy)
6.51
2022-09-15
4
A
0
3571
0
A
2026-08-09
Class A Common Stock
3571
3571
D
Stock Option (right to buy)
15.76
2022-09-15
4
A
0
2
0
A
2027-01-27
Class A Common Stock
2
2
D
In connection with the Merger (as defined below), the reporting person received a restricted share award equal to 510,000 shares of Class A common stock of the Issuer pursuant to the terms and conditions of the FOXO Technologies Inc. Management Contingent Share Plan (the "MIP"). The restricted share award is subject to the following three service-based vesting conditions (i) 60% of the award will become vested on the 3rd anniversary of the Closing Date (as defined below) if the reporting person is still employed by the Issuer on such date, (ii) ) 20% of the award will become vested on the 4th anniversary of the Closing Date if the reporting person is still employed by the Issuer on such date, and (iii) the final 20% of the award will become vested on the 5th anniversary of the Closing Date if the reporting person is still employed by the Issuer on such date. In addition, 1/3 of the restricted share award will become vested upon the satisfaction of certain performance-based conditions as further described in the MIP.
The stock options were received in exchange for stock options to purchase 135,000 shares of Class A common stock of FOXO Technologies Operating Company ("FOXO") in connection with the merger of FOXO with and into a wholly owned subsidiary of the Issuer (the "Merger"), which closed on 9/15/2022 (the "Closing Date"). As of the Closing Date, 43,562.78 of the shares of Class A common stock of the Issuer subject to the stock options were vested, and, thereafter, the remaining number of shares subject to the stock options shall vest in equal monthly installments until fully vested on 12/31/2023.
The stock options were received in exchange for stock options to purchase 6,148 shares of Class A common stock of FOXO in connection with the Merger. As of the Closing Date, 1,289.54 of the shares of Class A common stock of the Issuer subject to the stock options were vested, and, thereafter, the remaining number of shares subject to the stock options shall vest in equal monthly installments until fully vested on 8/9/2024.
The stock options were received in exchange for stock options to purchase 5 shares of Class A common stock of FOXO in connection with the Merger. As of the Closing Date, 0.39 of the shares of Class A common stock of the Issuer subject to the stock options were vested, and, thereafter, the remaining number of shares subject to the stock options shall vest in equal monthly installments until fully vested on 1/27/2025.
/s/ Robert Potashnick
2022-09-16