FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
MIDWEST HOLDING INC. [ MDWT ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Date of Earliest Transaction
(Month/Day/Year) 10/10/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
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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. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction 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) | |||
Code | V | Amount | (A) or (D) | Price |
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 Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) | 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: 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 | ||||||||
SENIOR SECURED CONVERTIBLE PROMISSORY NOTE | (1) | 10/10/2018 | P | $1,000,000 | (1) | (1) | Common Stock | 48,569,650 | $1,000,000 | 150,565,914 | I | See footnote(2) | |||
SENIOR SECURED CONVERTIBLE PROMISSORY NOTE | (1) | 12/07/2018 | P | $17,500,000 | (1) | (1) | Common Stock | 849,968,875 | $17,500,000 | 1,000,534,789 | I | See footnote(2) |
Explanation of Responses: |
1. Each of the Senior Secured Convertible Notes (the "Notes" and each a "Note") is convertible at any time prior to its maturity date on April 20, 2028 into shares of Common Stock of the Issuer on a basis of 48.569649333 shares of Common Stock for $1.00 of outstanding principal amount of Notes. |
2. This report is filed jointly by Vespoint LLC ("Vespoint"), Xenith Holdings LLC ("Xenith"), A. Michael Salem ("Salem") and Michael W. Minnich ("Minnich"), all of whom share beneficial ownership of more than 10% of the capital stock of the Issuer. Vespoint as managing member of Xenith may be deemed to have shared voting, investment and dispositive power over the shares held by Xenith. Salem and Minnich are each Co-Chief Executive Officers of Vespoint and in their capacity as such, may be deemed to exercise shared voting and investment power over the shares held by Reporting Persons. Each of Vespoint, Salem and Minnich disclaims beneficial ownership of such shares except to the extent of its or his pecuniary interest therein. |
Remarks: |
VESPOINT LLC BY: MICHAEL W. MINNICH, CO-CHIEF EXECUTIVE OFFICER |
/s/ Michael W. Minnich | 04/22/2019 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |