SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

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).
1. Name and Address of Reporting Person*
Lindstrom Ingrid Jenny

(Last) (First) (Middle)
C/O MITESCO, INC.
1660 HWY 100 SOUTH, SUITE 432

(Street)
ST. LOUIS PARK MN 55416

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Mitesco, Inc. [ MITI ]
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
3. Date of Earliest Transaction (Month/Day/Year)
10/18/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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 Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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)
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 25,000 (2) (2) Common Stock 105,000(2) (3) 25,000 D
Series A Warrant to purchase Common Stock(4) $0.5(3)(4) 10/18/2021 P 25,000 04/18/2022 10/18/2026 Common Stock 52,500 (3) 52,500 D
Series B Warrant to purchase Common Stock(5) $0.75(3)(5) 10/18/2021 P 25,000 04/18/2022 10/18/2026 Common Stock 52,500 (3) 52,500 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.
/s/ Ingrid Jenny Lindstrom 10/26/2021
** 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).
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