0000899243-20-021314.txt : 20200804 0000899243-20-021314.hdr.sgml : 20200804 20200804211557 ACCESSION NUMBER: 0000899243-20-021314 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20200731 FILED AS OF DATE: 20200804 DATE AS OF CHANGE: 20200804 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BRATTON DOUGLAS K CENTRAL INDEX KEY: 0001281933 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10685 FILM NUMBER: 201075363 MAIL ADDRESS: STREET 1: 201 MAIN STREET STREET 2: SUITE 1900 CITY: FORT WORTH STATE: TX ZIP: 76102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: CRESTLINE ASSURANCE HOLDINGS LLC CENTRAL INDEX KEY: 0001810802 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10685 FILM NUMBER: 201075364 BUSINESS ADDRESS: STREET 1: 201 MAIN STREET STREET 2: SUITE 1900 CITY: FORT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: (817) 339-7600 MAIL ADDRESS: STREET 1: 201 MAIN STREET STREET 2: SUITE 1900 CITY: FORT WORTH STATE: TX ZIP: 76102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Crestline Management, LP CENTRAL INDEX KEY: 0001536054 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10685 FILM NUMBER: 201075365 BUSINESS ADDRESS: STREET 1: 201 MAIN STREET STREET 2: SUITE 1900 CITY: FORT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: 817.339.7483 MAIL ADDRESS: STREET 1: 201 MAIN STREET STREET 2: SUITE 1900 CITY: FORT WORTH STATE: TX ZIP: 76102 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Crestline Investors, Inc. CENTRAL INDEX KEY: 0001626596 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-10685 FILM NUMBER: 201075366 BUSINESS ADDRESS: STREET 1: 201 MAIN STREET, SUITE 1900 CITY: FORT WORTH STATE: TX ZIP: 76102 BUSINESS PHONE: 817-339-7600 MAIL ADDRESS: STREET 1: 201 MAIN STREET, SUITE 1900 CITY: FORT WORTH STATE: TX ZIP: 76102 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: 2900 SOUTH 70TH STREET STREET 2: SUITE 400 CITY: LINCOLN STATE: NE ZIP: 68506 BUSINESS PHONE: 402-489-8266 MAIL ADDRESS: STREET 1: 2900 SOUTH 70TH STREET STREET 2: SUITE 400 CITY: LINCOLN STATE: NE ZIP: 68506 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 doc4.xml FORM 4 SUBMISSION X0306 4 2020-07-31 0 0000355379 MIDWEST HOLDING INC. MDWT 0001281933 BRATTON DOUGLAS K 201 MAIN STREET, SUITE 1900 FORT WORTH TX 76102 1 0 1 0 0001810802 CRESTLINE ASSURANCE HOLDINGS LLC 201 MAIN STREET, SUITE 1900 FORT WORTH TX 76102 1 0 1 0 0001536054 Crestline Management, LP 201 MAIN STREET, SUITE 1900 FORT WORTH TX 76102 1 0 1 0 0001626596 Crestline Investors, Inc. 201 MAIN STREET, SUITE 1900 FORT WORTH TX 76102 1 0 1 0 Stock Option (right to buy) 0.05 2020-07-31 4 A 0 50000 0.00 A 2020-07-31 Voting Common Stock 50000 50000 I See Footnotes Non-Qualified Stock Options granted under the Midwest Holding Inc. 2019 Long-Term Incentive Plan to Douglas K. Bratton for his service on the Board of Directors (the "Board") of Midwest Holding Inc. (the "Issuer"). The Non-Qualified Stock Options vest as follows: (i) 25,000 Options shall vest on July 31, 2022; and (ii) 25,000 Options shall vest on July 31, 2024, in each case subject to Mr. Bratton's continued service on the Issuer's Board. Mr. Bratton serves on the Issuer's Board as a representative of Crestline Assurance Holdings LLC ("Crestline Assurance") and its affiliates. Mr. Bratton holds the Options reported herein for the benefit of Crestline Assurance and as a result does not have any direct pecuniary interest in such Options. Mr. Bratton may be deemed to have an indirect pecuniary interest in a portion of the Options through indirect membership interests in Crestline Assurance. The Manager of Crestline Assurance is Mr. Bratton and the Sole Member of Crestline Assurance is Crestline Management, L.P. ("Crestline Management"). Crestline Investors, Inc. ("Crestline") is the general partner of Crestline Management. Mr. Bratton is the sole director of Crestline. Crestline Management, Crestline and Mr. Bratton may each be deemed to beneficially own the securities beneficially owned by Crestline Assurance. (Continued from Footnote 2) Each such entity and Mr. Bratton disclaims beneficial ownership of such securities except to the extent of its or his respective pecuniary interest therein. Douglas K. Bratton is a member of the Board of Directors of Midwest Holding Inc. (the "Issuer"). For purposes of Section 16 of the Securities Exchange Act of 1934, as amended, Crestline Assurance Holdings LLC, Crestline Management, L.P. and Crestline Investors, Inc. may be deemed to be directors by deputization of the Issuer due to their relationship with Mr. Bratton. DOUGLAS K. BRATTON, /s/ Douglas K. Bratton 2020-08-04 CRESTLINE ASSURANCE HOLDINGS LLC, /s/ Douglas K. Bratton, Title: Manager 2020-08-04 CRESTLINE MANAGEMENT, L.P., By: Crestline Investors, Inc., its general partner, /s/ Douglas K. Bratton, Title: Sole Director 2020-08-04 CRESTLINE INVESTORS, INC., /s/ Douglas K. Bratton, Title: Sole Director 2020-08-04 EX-99.1 2 attachment1.htm EX-99.1 DOCUMENT

                                                                    Exhibit 99.1


                         Form 4 Joint Filer Information


Name:                                  Crestline Assurance Holdings LLC


Address:                               201 Main Street, Suite 1900
                                       Fort Worth, TX 75102

Date of Event Requiring Statement:     07/31/2020


Name:                                  Crestline Management, L.P.


Address:                               201 Main Street, Suite 1900
                                       Fort Worth, TX 75102

Date of Event Requiring Statement:     07/31/2020


Name:                                  Crestline Investors, Inc.


Address:                               201 Main Street, Suite 1900
                                       Fort Worth, TX 75102

Date of Event Requiring Statement:     07/31/2020