0001144204-16-100171.txt : 20160510 0001144204-16-100171.hdr.sgml : 20160510 20160510091523 ACCESSION NUMBER: 0001144204-16-100171 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160505 FILED AS OF DATE: 20160510 DATE AS OF CHANGE: 20160510 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CLEARSIGN COMBUSTION CORP CENTRAL INDEX KEY: 0001434524 STANDARD INDUSTRIAL CLASSIFICATION: INDUSTRIAL INSTRUMENTS FOR MEASUREMENT, DISPLAY, AND CONTROL [3823] IRS NUMBER: 000000000 STATE OF INCORPORATION: WA 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kendrick Donald W CENTRAL INDEX KEY: 0001673849 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35521 FILM NUMBER: 161633906 MAIL ADDRESS: STREET 1: 12870 INTERURBAN AVENUE SOUTH CITY: SEATTLE STATE: WA ZIP: 98168 3 1 v439315_3.xml OWNERSHIP DOCUMENT X0206 3 2016-05-05 0 0001434524 CLEARSIGN COMBUSTION CORP CLIR 0001673849 Kendrick Donald W 12870 INTERURBAN AVENUE SOUTH SEATTLE WA 98168 0 1 0 0 Senior VP of Technology Common Stock 7000 D Common Stock 13000 I By IRA Option to Purchase Common Stock 5.07 2025-03-31 Common Stock 25000 D Option to Purchase Common Stock 4.21 2026-03-31 Common Stock 25000 D The right to purchase the option shares vests 40% on April 1, 2016 and then at the rate of 5% commencing on July 1, 2016 and on each quarterly (3-month) anniversary until the right to purchase all of the shares has vested on July 1, 2020. The right to purchase the option shares vests 6.25% on July 1, 2016 and on each quarterly (3-month) anniversary until the right to purchase all of the shares has vested on July 1, 2020. /s/ Donald W. Kendrick, Ph.D. 2016-05-10