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