0001104659-21-109839.txt : 20210826
0001104659-21-109839.hdr.sgml : 20210826
20210826164548
ACCESSION NUMBER: 0001104659-21-109839
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210824
FILED AS OF DATE: 20210826
DATE AS OF CHANGE: 20210826
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Schrecker Judith S
CENTRAL INDEX KEY: 0001850679
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35521
FILM NUMBER: 211213000
MAIL ADDRESS:
STREET 1: 12870 INTERURBAN AVENUE SOUTH
CITY: SEATTLE
STATE: WA
ZIP: 98168
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
tm2125932d4_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2021-08-24
0
0001434524
ClearSign Technologies Corp
CLIR
0001850679
Schrecker Judith S
12870 INTERURBAN AVENUE SOUTH
SEATTLE
WA
98168
1
0
0
0
Restricted Stock Units
2021-08-24
4
A
0
7715
0.00
A
Common Stock
7715
7715
D
Restricted Stock Units
2021-08-24
4
A
0
7715
0.00
A
Common Stock
7715
7715
D
Options to Purchase Common Stock
4.15
2021-07-28
2031-07-27
Common Stock
17000
17000
D
As compensation for services as a non-executive director during the quarter ended June 30, 2021, the reporting person was granted restricted stock units ("RSUs") under the ClearSign Technologies Corporation 2021 Equity Incentive Plan and each RSU represents a right to receive one share of common stock or the cash equivalent thereof.
The RSUs will vest upon the first to occur of: (1) a Change in Control (as defined in the applicable RSU award agreement), (2) the reporting person's Disability (as defined in the applicable RSU award agreement); (3) the reporting peron's death; or (4) the reporting person's separation from service.
As compensation for services as a non-executive director during the quarter ending September 30, 2021, the reporting person was granted RSUs under the ClearSign Technologies Corporation 2021 Equity Incentive Plan and each RSU represents a right to receive one share of common stock or the cash equivalent thereof.
/s/ Judith S. Schrecker
2021-08-26