Statement of Changes in Beneficial Ownership (4)
October 27 2021 - 10:23AM
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
*
Lindstrom Ingrid Jenny |
2. Issuer Name and Ticker or Trading Symbol
Mitesco, Inc.
[
MITI
]
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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) Chief Legal Officer |
(Last)
(First)
(Middle)
C/O MITESCO, INC., 1660 HWY 100 SOUTH, SUITE 432 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
10/18/2021 |
(Street)
ST. LOUIS PARK, MN 55416
(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 |
Series D Convertible Preferred Stock (1) | (2)(3) | 10/18/2021 | | P | | 25000 | | (2) | (2) | Common Stock | 105000 (2) | (3) | 25000 | D | |
Series A Warrant to purchase Common Stock (4) | $0.50 (3)(4) | 10/18/2021 | | P | | 25000 | | 4/18/2022 | 10/18/2026 | Common Stock | 52500 | (3) | 52500 | D | |
Series B Warrant to purchase Common Stock (5) | $0.75 (3)(5) | 10/18/2021 | | P | | 25000 | | 4/18/2022 | 10/18/2026 | Common Stock | 52500 | (3) | 52500 | D | |
Explanation of Responses: |
(1) | The Series D Convertible Preferred Stock (the "Series D Preferred") ranks senior to all other preferred stock of the Issuer except in relation to the Issuer's Series X Cumulative Redeemable Perpetual Preferred Stock and the Series C Convertible Preferred Stock, which ranks pari passu to the Series D Preferred, with respect to the preferences as to dividends, distributions and payments upon the liquidation, dissolution and winding up of the Issuer. The Series D Preferred accrues dividends on a quarterly basis in arrears, at the rate of 6% per annum plus accrued and unpaid dividends. |
(2) | The number of shares of common Stock of the Issuer, par value $0.01 per share (the "Common Stock") issuable upon the conversion of each share of Series D Preferred Stock is calculated by dividing the Conversion Amount (defined in the COD as the Stated Value, $1.05 per share, plus accrued and unpaid dividends) by the $0.25 conversion price (the "Conversion Price"). The shares of Series D Preferred Stock may, at any time, at the option of the holder, be converted into fully paid and non-assessable shares of Common Stock. |
(3) | The securities were issued to Ms. Lindstrom in a private placement offering (the "Offering") pursuant to a securities purchase agreement, dated October 18, 2021, by and between the Issuer and Ms. Lindstrom, whereby the Issuer sold to Ms. Lindstrom, for a purchase price of $25,000.00, 25,000 units (the "Units"), with each Unit consisting of (a) one share of Series D Preferred Stock, (b) one warrant (the "Series A Warrants") to purchase 2.1 shares of Common Stock at a purchase price of $0.50 per whole share of Common Stock, and (c) one warrant (the "Series B Warrants") to purchase 2.1 shares of Common Stock at a purchase price of $0.75 per whole share. |
(4) | Each Series A Warrant represents the right to purchase 2.1 shares of Common Stock at an exercise price of $0.50 per share and was issued as part of the Offering by the Issuer. The Series A Warrants are exercisable only for whole numbers of shares of Common Stock. |
(5) | Each Series B Warrant represents the right to purchase 2.1 shares of Common Stock at an exercise price of $0.75 per share and was issued as part of the Offering by the Issuer. The Series B Warrants are exercisable only for whole numbers of shares of Common Stock. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Lindstrom Ingrid Jenny C/O MITESCO, INC. 1660 HWY 100 SOUTH, SUITE 432 ST. LOUIS PARK, MN 55416 |
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| Chief Legal Officer |
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Signatures
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/s/ Ingrid Jenny Lindstrom | | 10/26/2021 |
**Signature of Reporting Person | Date |
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