0001144204-19-005906.txt : 20190208 0001144204-19-005906.hdr.sgml : 20190208 20190208173041 ACCESSION NUMBER: 0001144204-19-005906 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190206 FILED AS OF DATE: 20190208 DATE AS OF CHANGE: 20190208 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kendrick Donald W CENTRAL INDEX KEY: 0001673849 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35521 FILM NUMBER: 19581157 MAIL ADDRESS: STREET 1: 12870 INTERURBAN AVENUE SOUTH CITY: SEATTLE STATE: WA ZIP: 98168 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 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 4 1 tv512875_4.xml OWNERSHIP DOCUMENT X0306 4 2019-02-06 0 0001434524 CLEARSIGN COMBUSTION CORP CLIR 0001673849 Kendrick Donald W 12870 INTERURBAN AVENUE SOUTH SEATTLE WA 98168 0 1 0 0 Chief Technology Officer Option to Purchase Common Stock 1.21 2019-02-06 4 A 0 60000 0.00 A 2029-01-01 Common Stock 60000 165000 D Option to Purchase Common Stock 1.21 2019-02-06 4 A 0 50000 0.00 A 2029-01-01 Common Stock 50000 215000 D Option to Purchase Common Stock 2.25 2019-02-06 4 A 0 50000 0.00 A 2029-01-01 Common Stock 50000 265000 D The right to purchase the option shares vested on the date of grant. The right to purchase one-third of the shares subject to the options vested as of January 1, 2019. The right to purchase the remainder of the shares will vest as follows: one-third on January 1, 2020 and one third on January 1, 2021. /s/ Donald Kendrick 2019-02-08