# EDGAR Filing Document

**Accession Number:** 0001962676
**File Stem:** 0001213900-23-008049
**Filing Date:** 2023-2
**Character Count:** 7804
**Document Hash:** e80152de487d742e482d2f5c6daa2391
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001213900-23-008049.hdr.sgml**: 20230203

**ACCESSION NUMBER**: 0001213900-23-008049

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20230203

**FILED AS OF DATE**: 20230203

**DATE AS OF CHANGE**: 20230203

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Fay Taylor
- **CENTRAL INDEX KEY:** 0001962676

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-39783
- **FILM NUMBER:** 23587613

**MAIL ADDRESS:**
- **STREET 1:** 729 N. WASHINGTON AVE
- **STREET 2:** SUITE 600
- **CITY:** MINNEAPOLIS
- **STATE:** MN
- **ZIP:** 55401
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** FOXO TECHNOLOGIES INC.
- **CENTRAL INDEX KEY:** 0001812360
- **STANDARD INDUSTRIAL CLASSIFICATION:** LIFE INSURANCE [6311]
- **IRS NUMBER:** 851050265
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 729 WASHINGTON AVE. N
- **STREET 2:** SUITE 600
- **CITY:** MINNEAPOLIS
- **STATE:** MN
- **ZIP:** 55401
- **BUSINESS PHONE:** (612) 562-9447

**MAIL ADDRESS:**
- **STREET 1:** 729 WASHINGTON AVE. N
- **STREET 2:** SUITE 600
- **CITY:** MINNEAPOLIS
- **STATE:** MN
- **ZIP:** 55401

**FORMER COMPANY:**
- **FORMER CONFORMED NAME:** Delwinds Insurance Acquisition Corp.
- **DATE OF NAME CHANGE:** 20200518

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

[ ] 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**<sup>*</sup><br>Fay Taylor<br><sub>(Last) (First) (Middle)</sub><br>729 N. WASHINGTON ST.,<br>SUITE 600<br><sub>(Street)</sub><br>MINNEAPOLIS, MN 55402<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>FOXO TECHNOLOGIES INC. [ FOXO ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2023-02-03 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director   [ ] 10% Owner<br>[X] Officer (give title below)   [ ] Other (specify below)<br>_Chief Operating Officer_ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |
| Class A Common Stock | 150000<sup>(1)</sup> | D |  |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Stock Option (right to buy) | <sup>(2)</sup> | 2027-01-27 | Class A Common Stock | 2 | $15.75 | D |  |
| Stock Option (right to buy) | <sup>(3)</sup> | 2026-08-09 | Class A Common Stock | 2904 | $6.51 | D |  |
| Stock Option (right to buy) | <sup>(4)</sup> | 2026-08-09 | Class A Common Stock | 3208 | $6.51 | D |  |
| Stock Option (right to buy) | <sup>(5)</sup> | 2026-04-02 | Class A Common Stock | 29042 | $6.51 | D |  |
| Stock Option (right to buy) | <sup>(6)</sup> | 2026-04-02 | Class A Common Stock | 3276 | $6.51 | D |  |
| Stock Option (right to buy) | <sup>(7)</sup> | 2026-04-02 | Class A Common Stock | 2900 | $6.51 | D |  |

---

### Footnotes:

(1) At the closing of the business combination between the Issuer and FOXO Technologies Operating Company, the reporting person received a restricted share award equal to 150,000 shares pursuant to the terms and conditions of the FOXO Technologies Inc. Management Contingent Share Plan (the "MIP"). The award is subject to the following vesting conditions (i) 60% of the award will become vested on the 3rd anniversary of the closing of the business combination if the reporting person is still employed by the Issuer on such date, (ii) ) 20% of the award will become vested on the 4th anniversary of the closing date if the reporting person is still employed by the Issuer on such date, and (iii) the final 20% of the award will become vested on the 5th anniversary of the closing date if the reporting person is still employed by the Issuer on such date. In addition, 1/3 of the award will become vested upon the satisfaction of certain performance-based conditions as further described in the MIP.

(2) Stock option granted on January 27, 2022. As of February 3, 2023, the 2 shares of Class A Common Stock of the Issuer subject to the stock options were fully vested.

(3) Stock option granted on August 9, 2021. As of February 3, 2023, 1,377 shares of Class A Common Stock of the Issuer subject to the stock options were vested, and, thereafter, the remaining 1,527 shares of Class A Common Stock subject to the stock options shall vest on each subsequent month anniversary of the award date until fully vested on August 9, 2024.

(4) Stock option granted on August 9, 2021. As of February 3, 2023, 1,517 shares of Class A Common Stock of the Issuer subject to the stock options were vested, and, thereafter, the remaining 1,691 shares of Class A Common Stock subject to the stock options shall vest on each subsequent month anniversary of the award date until fully vested on August 9, 2024.

(5) Stock option granted on April 2, 2021. As of February 3, 2023, 20,175 shares of Class A Common Stock of the Issuer subject to the stock options were vested, and, thereafter, the remaining 8,867 shares of Class A Common Stock subject to the stock options shall vest in equal monthly installments until fully vested on December 31, 2023.

(6) Stock option granted on April 2, 2021. As of February 3, 2023, 2,275 shares of Class A Common Stock of the Issuer subject to the stock options were vested, and, thereafter, the remaining 1,001 shares of Class A Common Stock subject to the stock options shall vest in equal monthly installments until fully vested on December 31, 2023.

(7) Stock option granted on April 2, 2021. As of February 3, 2023, 2,500 shares of Class A Common Stock of the Issuer subject to the stock options were vested, and, thereafter, the remaining 400 shares of Class A Common Stock subject to the stock options shall vest in equal monthly installments until fully vested on June 30, 2023.

**Signature:** /s/ Taylor Fay  
**Date:** 2023-02-03

### Remarks:

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.**