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Sec Form 4 Filing - Meline Susanne @ ClearSign Technologies Corp - 2021-01-22

  1. About Form 4 Filing: Every director, officer or owner of more than ten percent of a class of equity securities registered under Section 12 of the '34 Act must file with the U.S. Securities and Exchange Commission (SEC) a statement of ownership regarding such security. The initial filing is on Form 3 and changes are reported on Form 4. The Annual Statement of beneficial ownership of securities is on Form 5. The forms contain information on the reporting person's relationship to the company and on purchases and sales of such equity securities.
  2. Form 4 is stored in SEC's EDGAR database. EDGAR is Electronic Data Gathering, Analysis and Retrieval System. It is a registered trademark of the SEC.

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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person *
Meline Susanne
2. Issuer Name and Ticker or Trading Symbol
ClearSign Technologies Corp [ CLIR]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last)
(First)
(Middle)
12870 INTERURBAN AVENUE SOUTH
3. Date of Earliest Transaction (MM/DD/YY)
01/22/2021
(Street)
SEATTLE, WA98168
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City)
(State)
(Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Option to Purchase Common Stock ( 1 ) $ 3.97 01/22/2021 A 22,750 04/01/2021( 1 ) 01/21/2031 Common Stock 22,750 $ 0 22,750 D
Option to Purchase Common Stock $ 2.38 11/19/2020 11/18/2030 Common Stock 22,750 22,750 D
Option to Purchase Common Stock $ 2.3 08/18/2020 05/17/2030 Common Stock 22,750 22,750 D
Option to Purchase Common Stock $ 0.49 05/19/2020 05/19/2030 Common Stock 22,750 22,750 D
Option to Purchase Common Stock $ 0.72 04/01/2020 04/01/2030 Common Stock 22,750 22,750 D
Option to Purchase Common Stock $ 1 ( 2 ) 04/01/2029 Common Stock 91,000 91,000 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Meline Susanne
12870 INTERURBAN AVENUE SOUTH
SEATTLE, WA98168
X
Signatures
/s/ Susanne Meline 01/25/2021
** Signature of Reporting Person Date
Explanation of Responses:
( 1 )On January 22, 2021, the Issuer's board of directors approved compensation to be paid to the Issuer's non-executive directors for services provided to the Issuer during the period from January 1, 2021 to March 31, 2021. The reporting person is a non-executive director. As compensation for their services, each non-executive director was awarded options for shares of common stock having an exercise price of $3.97. The options fully vest on April 1, 2021, subject to the reporting person's continued service as a non-executive director to the Issuer. The total numbers of option shares awarded was based on the services provided by the director. These services include Board participation, committee participation, committee chair responsibilities and lead director responsibilities, if any. The award was recommended to the Issuer's board of directors by its compensation committee and issued from the Issuer's 2011 Equity Incentive Plan.
( 2 )The right to exercise the option and purchase the option shares vested in equal increments as follows: the right to purchase 22,750 shares vested on May 9, 2019 and the right to purchase the remaining 68,250 shares vested in equal increments on the last day of each calendar quarter during 2019.

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.