0001206774-19-002087.txt : 20190719 0001206774-19-002087.hdr.sgml : 20190719 20190719171314 ACCESSION NUMBER: 0001206774-19-002087 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190717 FILED AS OF DATE: 20190719 DATE AS OF CHANGE: 20190719 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Havranek Debra CENTRAL INDEX KEY: 0001658529 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10685 FILM NUMBER: 19964103 MAIL ADDRESS: STREET 1: 2900 SOUTH 70TH STREET STREET 2: SUITE 400 CITY: LINCOLN STATE: NE ZIP: 68506 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: MIDWEST HOLDING INC. CENTRAL INDEX KEY: 0000355379 STANDARD INDUSTRIAL CLASSIFICATION: LIFE INSURANCE [6311] IRS NUMBER: 200362426 STATE OF INCORPORATION: NE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 8101 O STREET STREET 2: SUITE S111 CITY: LINCOLN STATE: NE ZIP: 68510 BUSINESS PHONE: 402-489-8266 MAIL ADDRESS: STREET 1: 8101 O STREET STREET 2: SUITE S111 CITY: LINCOLN STATE: NE ZIP: 68510 FORMER COMPANY: FORMER CONFORMED NAME: MIDWEST HOLDING INC DATE OF NAME CHANGE: 20000101 FORMER COMPANY: FORMER CONFORMED NAME: MIDWEST NATIONAL CORP DATE OF NAME CHANGE: 19860123 4 1 havranek3485282-form4.xml STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES X0306 4 2019-07-17 0 0000355379 MIDWEST HOLDING INC. MDWT 0001658529 Havranek Debra 2900 SOUTH 70TH STREET SUITE 400 LINCOLN NE 68506 0 1 0 0 VP Options 0.05 2019-07-17 4 A 0 500000 0 A 2021-07-17 2029-07-17 Common Stock 500000 500000 D Options 0.05 2019-07-17 4 A 0 1000000 0 A 2023-07-17 2029-07-17 Common Stock 1000000 1500000 D Options granted under the Company's 2019 Long-Term Incentive Plan. Shares vest as follows: (i) 500,000 shares shall vest on July 17, 2021; and (ii) 1,000,000 shares shall vest on July 17, 2023; in each case subject to the Reporting Person's continued service as an employee of the Company. /s/ Debra Havranek 2019-07-19