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*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol ClearSign Technologies Corp [ CLIR ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 01/22/2021 | ||||||||||||||||||||||||||
| 4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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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) | 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) | |||||||||||||||
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| 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 | ||||||||
| Options to Purchase Common Stock(1) | $3.97 | 01/22/2021 | A | 19,750 | 04/01/2021(1) | 01/21/2031 | Common Stock | 19,750 | $0.00 | 19,750 | D | ||||
| Options to Purchase Common Stock | $2.38 | 11/19/2020 | 11/18/2030 | Common Stock | 19,750 | 19,750 | D | ||||||||
| Options to Purchase Common Stock | $2.3 | 08/18/2020 | 08/17/2030 | Common Stock | 19,750 | 19,750 | D | ||||||||
| Options to Purchase Common Stock | $0.49 | 05/19/2020 | 05/19/2030 | Common Stock | 19,750 | 19,750 | D | ||||||||
| Option to Purchase Common Stock | $0.72 | 04/01/2020 | 04/01/2030 | Common Stock | 19,750 | 19,750 | D | ||||||||
| Option to Purchase Common Stock | $1 | (2) | 04/01/2029 | Common Stock | 70,500 | 70,500 | D | ||||||||
| 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 17,625 shares vested on May 9, 2019 and the right to purchase the remaining 52,875 shares vested in equal increments on the last day of each calendar quarter during 2019. |
| /s/ Bruce A. Pate | 01/25/2021 | |
| ** 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). | ||
| 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. | ||