0001104659-20-021937.txt : 20200214
0001104659-20-021937.hdr.sgml : 20200214
20200214163926
ACCESSION NUMBER: 0001104659-20-021937
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200212
FILED AS OF DATE: 20200214
DATE AS OF CHANGE: 20200214
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Deller Colin James
CENTRAL INDEX KEY: 0001766480
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35521
FILM NUMBER: 20621065
MAIL ADDRESS:
STREET 1: C/O CLEARSIGN COMBUSTION CORP.
STREET 2: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: ClearSign Technologies Corp
CENTRAL INDEX KEY: 0001434524
STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823]
IRS NUMBER: 000000000
STATE OF INCORPORATION: WA
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
BUSINESS PHONE: (206) 673-4848
MAIL ADDRESS:
STREET 1: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
FORMER COMPANY:
FORMER CONFORMED NAME: CLEARSIGN COMBUSTION CORP
DATE OF NAME CHANGE: 20080507
4
1
tm208054-1_4.xml
OWNERSHIP DOCUMENT
X0306
4
2020-02-12
0
0001434524
ClearSign Technologies Corp
CLIR
0001766480
Deller Colin James
12870 INTERURBAN AVENUE SOUTH
SEATTLE
WA
98168
0
1
0
0
Chief Executive Officer
Option to Purchase Common Stock
0.94
2020-02-12
4
A
0
182730
0.00
A
2030-01-01
Common Stock
182730
782730
D
Option to Purchase Common Stock
1.16
2029-01-01
Common Stock
400000
600000
D
Option to Purchase Common Stock
2.25
2029-01-01
Common Stock
200000
200000
D
The right to purchase the option shares vested on the date of grant.
The right to purchase the option shares vests in 3 equal portions in January of 2019, 2020, 2021
/s/ Colin J. Deller
2020-02-14