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