Statement of Changes in Beneficial Ownership (4)
January 05 2021 - 04:59PM
Edgar (US Regulatory)
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 OF SECURITIES
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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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1. Name and Address of Reporting Person
*
Fike Brian Grant |
2. Issuer Name and Ticker or Trading Symbol
ClearSign Technologies Corp
[
CLIR
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) Chief Financial Officer |
(Last)
(First)
(Middle)
12870 INTERURBAN AVENUE SOUTH |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/3/2021 |
(Street)
SEATTLE, WA 98168
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 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 | $2.93 | 1/3/2021 | | A | | 30000 | | (1) | 1/2/2031 | Common Stock | 30000 | $0.00 | 30000 | D | |
Option to Purchase Common Stock | $0.89 | | | | | | | (2) | 1/9/2030 | Common Stock | 40000 | | 40000 | D | |
Option to Purchase Common Stock | $1.21 | | | | | | | (3) | 12/31/2028 | Common Stock | 50000 | | 50000 | D | |
Option to Purchase Common Stock | $1.21 | | | | | | | (4) | 12/31/2028 | Common Stock | 50000 | | 50000 | D | |
Option to Purchase Common Stock | $2.25 | | | | | | | (4) | 12/31/2028 | Common Stock | 50000 | | 50000 | D | |
Option to Purchase Common Stock | $1.90 | | | | | | | (5) | 3/31/2028 | Common Stock | 25000 | | 25000 | D | |
Option to Purchase Common Stock | $3.80 | | | | | | | (6) | 3/31/2027 | Common Stock | 10000 | | 10000 | D | |
Option to Purchase Common Stock | $4.21 | | | | | | | (7) | 3/31/2026 | Common Stock | 5000 | | 5000 | D | |
Explanation of Responses: |
(1) | The right to purchase the option shares vests upon the achievement of certain performance goals during the fiscal year ending December 31, 2021. As each of these various performance goals is met, a portion of the award will vest and will be available for purchase from that date. |
(2) | The right to purchase the option shares vested on the date of award. |
(3) | The right to purchase the option shares vested on the date of award. |
(4) | The right to purchase one-third of the shares subject to the options vested as of January 1, 2019. The right to purchase the remainder of the shares will vest as follows: one-third on January 1, 2020 and one third on January 1, 2021. |
(5) | The right to purchase the option shares vests at the rate of 6.25% commencing on July 1, 2018 and continuing thereafter on the last day of each quarter, until the right to purchase all of the option shares has vested. |
(6) | The right to purchase the option shares vests at the rate of 6.25% commencing on June 30, 2017 and continuing thereafter on the last day of each quarter, until the right to purchase all of the option shares has vested. |
(7) | The right to purchase the option shares vests 40% on 4/1/2017 and continues at the rate of 5% per quarter thereafter on the last day of each quarter, until the right to purchase all of the option shares has vested. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Fike Brian Grant 12870 INTERURBAN AVENUE SOUTH SEATTLE, WA 98168 |
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| Chief Financial Officer |
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Signatures
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/s/ Brian G. Fike | | 1/5/2021 |
**Signature of Reporting Person | Date |
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