FORM 5 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 ANNUAL 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). | |||||||||||||||||
Form 3 Holdings Reported. | |||||||||||||||||
Form 4 Transactions Reported. |
1. Name and Address of Reporting Person*
(Street)
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2. Issuer Name and Ticker or Trading Symbol
Mitesco, Inc. [ MITI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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3. Statement for Issuer's Fiscal Year Ended
(Month/Day/Year) 12/31/2020 | ||||||||||||||||||||||||||
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 at end of Issuer's Fiscal Year (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||||||
Amount | (A) or (D) | Price | |||||||||||||
Common Stock(1) | 12/31/2018 | A | 25,000 | A | (1) | 25,000 | D | ||||||||
Common Stock(1) | 03/01/2019 | A | 100,000 | A | (1) | 125,000 | D | ||||||||
Common Stock(1) | 09/04/2019 | A | 775,000 | A | (1) | 900,000 | D | ||||||||
Common Stock(1) | 12/28/2020 | P | 98,431 | A | $0.03 | 998,431 | D | ||||||||
Preferred X Stock(2) | 12/31/2019 | P | 2,000 | A | $25 | 2,000 | D |
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) | |||
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | |||||||||
Stock Options | $0.03 | 02/27/2019 | A | 1,000,000 | 12/27/2020 | 02/27/2030 | Stock Options | 1,000,000 | $0.00 | 1,000,000 | D | |||
Stock Options | $0.03 | 12/28/2020 | A | 100,000 | 12/27/2020 | 12/27/2030 | Stock Options | 1,100,000 | $0.00 | 1,100,000 | D |
Explanation of Responses: |
1. On the dates set forth above, Ron Riewold, the Issuer's directors received shares of the Issuer's common stock as payment for services rendered. The Issuer valued the shares at the price of $0.03 per share. |
2. The amounts reflected as beneficially held by Issuer's Director, Ron Riewold includes an aggregate of 1,098,431 shares of the Issuer's common stock and 2,000 shares of its Series X Preferred Stock. Each one (1) share of the Series X Preferred Stock is entitled to 20,000 votes on all matters submitted to a vote of the Issuer's Common Stockholders. As a result, Mr. Riewold holds 1,098,431 votes as a result of his ownership of the Issuer's common stock, 1,100,000 stock options, and 24,000,0000 as a result of the Series X Preferred Stock. The 26198,431 votes held by Mr. Riewold represent 14.61% of the votes on matters submitted to a vote of the Issuer's common stockholders. |
/s/ Ron Riewold | 01/26/2021 | |
** 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. |