0001104659-20-128455.txt : 20201123 0001104659-20-128455.hdr.sgml : 20201123 20201123160340 ACCESSION NUMBER: 0001104659-20-128455 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201119 FILED AS OF DATE: 20201123 DATE AS OF CHANGE: 20201123 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Meline Susanne CENTRAL INDEX KEY: 0001731684 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35521 FILM NUMBER: 201337246 MAIL ADDRESS: STREET 1: P.O. BOX 515381 STREET 2: #86506 CITY: LOS ANGELES STATE: CA ZIP: 90051 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 tm2036637d3_4.xml OWNERSHIP DOCUMENT X0306 4 2020-11-19 0 0001434524 ClearSign Technologies Corp CLIR 0001731684 Meline Susanne 12870 INTERURBAN AVENUE SOUTH SEATTLE WA 98168 1 0 0 0 Option to Purchase Common Stock 2.38 2020-11-19 4 A 0 22750 0.00 A 2020-11-19 2020-11-18 Common Stock 22750 22750 D Option to Purchase Common Stock 2.30 2020-08-18 2030-08-17 Common Stock 22750 22750 D Option to Purchase Common Stock 0.49 2020-05-19 2030-05-19 Common Stock 22750 22750 D Option to Purchase Common Stock 0.72 2020-04-01 2030-04-01 Common Stock 22750 22750 D Option to Purchase Common Stock 1.00 2029-04-01 Common Stock 91000 91000 D On November 19, 2020 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 October 1, 2020 to December 31, 2020. 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 $2.38. 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 issued from the Issuer's 2011 Equity Incentive Plan. The right to exercise the option and purchase the option shares vested in equal increments as follows: the right to purchase 22,750 shares vested on May 9, 2019 and the right to purchase the remaining 68,250 shares vested in equal increments on the last day of each calendar quarter during 2019. /s/ Susanne Meline 2020-11-23