Sec Form 4 Filing - HOFFMAN Robert Thurston Sr @ ClearSign Technologies Corp - 2021-08-24

Insider filing report for Changes in Beneficial Ownership
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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
HOFFMAN Robert Thurston Sr
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)
08/24/2021
(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
Restricted Stock Units ( 1 ) 08/24/2021 A 6,896 ( 2 ) ( 2 ) Common Stock 6,896 $ 0 6,896 D
Restricted Stock Units ( 3 ) 08/24/2021 A 6,896 ( 2 ) ( 2 ) Common Stock 6,896 $ 0 6,896 D
Option to Purchase Common Stock $ 3.97 04/01/2021 01/21/2031 Common Stock 20,000 20,000 D
Option to Purchase Common Stock $ 2.38 11/19/2020 11/18/2030 Common Stock 20,000 20,000 D
Option to Purchase Common Stock $ 2.3 08/18/2020 08/17/2030 Common Stock 20,000 20,000 D
Option to Purchase Common Stock $ 0.49 05/19/2020 05/19/2030 Common Stock 20,000 20,000 D
Option to Purchase Common Stock $ 0.72 04/01/2020 04/01/2030 Common Stock 20,000 20,000 D
Option to Purchase Common Stock $ 1 ( 4 ) 04/01/2029 Common Stock 86,500 86,500 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
HOFFMAN Robert Thurston Sr
12870 INTERURBAN AVENUE SOUTH
SEATTLE, WA98168
X
Signatures
/s/ Robert T. Hoffman 08/26/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )As compensation for services as a non-executive director during the quarter ended June 30, 2021, the reporting person was granted restricted stock units ("RSUs") under the ClearSign Technologies Corporation 2021 Equity Incentive Plan and each RSU represents a right to receive one share of common stock or the cash equivalent thereof.
( 2 )The RSUs will vest upon the first to occur of: (1) a Change in Control (as defined in the applicable RSU award agreement), (2) the reporting person's Disability (as defined in the applicable RSU award agreement); (3) the reporting peron's death; or (4) the reporting person's separation from service.
( 3 )As compensation for services as a non-executive director during the quarter ending September 30, 2021, the reporting person was granted RSUs under the ClearSign Technologies Corporation 2021 Equity Incentive Plan and each RSU represents a right to receive one share of common stock or the cash equivalent thereof.
( 4 )The right to exercise the option and purchase the option shares vested in equal increments as follows: the right to purchase 21,625 shares vested on May 9, 2019 and the right to purchase the remaining 64,875 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).

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