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