0001104659-21-003502.txt : 20210112 0001104659-21-003502.hdr.sgml : 20210112 20210112170049 ACCESSION NUMBER: 0001104659-21-003502 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210110 FILED AS OF DATE: 20210112 DATE AS OF CHANGE: 20210112 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Fike Brian Grant CENTRAL INDEX KEY: 0001706465 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35521 FILM NUMBER: 21524102 MAIL ADDRESS: STREET 1: 12755 SE 73RD PLACE CITY: NEWCASTLE STATE: WA ZIP: 98056-1315 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 tm212905-2_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-01-10 0 0001434524 ClearSign Technologies Corp CLIR 0001706465 Fike Brian Grant 12870 INTERURBAN AVENUE SOUTH SEATTLE WA 98168 0 1 0 0 Chief Financial Officer Common Stock 2021-01-10 4 A 0 14837 3.37 A 15837 D Common Stock 2021-01-10 4 F 0 5765 3.37 D 10071 D These shares were issued by ClearSign Technologies Corporation ("ClearSign") as payment for the reporting person's annual bonus compensation approved by the Compensation Committee of the Board of Directors of ClearSign on January 10, 2021. The number of shares was determined by dividing the bonus amount by the closing price of ClearSign's common stock on January 8, 2021. Represents shares of ClearSign common stock withheld to satisfy the reporting person's tax withholding obligation. /s/ Brian Fike 2021-01-12