0001104659-21-141380.txt : 20211118 0001104659-21-141380.hdr.sgml : 20211118 20211118185552 ACCESSION NUMBER: 0001104659-21-141380 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211116 FILED AS OF DATE: 20211118 DATE AS OF CHANGE: 20211118 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: 211425966 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 tm2133431-2_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-11-16 0 0001434524 ClearSign Technologies Corp CLIR 0001850679 Schrecker Judith S 12870 INTERURBAN AVENUE SOUTH SEATTLE WA 98168 1 0 0 0 Restricted Stock Units 2021-11-16 4 A 0 13984 0.00 A Common Stock 13984 13984 D Restricted Stock Units Common Stock 7715 7715 D Restricted Stock Units 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 ending December 31, 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 ended September 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. 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. /s/ Judith S. Schrecker 2021-11-18