0001104659-21-141383.txt : 20211118 0001104659-21-141383.hdr.sgml : 20211118 20211118185640 ACCESSION NUMBER: 0001104659-21-141383 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: Meline Susanne CENTRAL INDEX KEY: 0001731684 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35521 FILM NUMBER: 211425969 MAIL ADDRESS: STREET 1: P.O. BOX 515381 STREET 2: #86506 CITY: LOS ANGELES STATE: CA ZIP: 90051 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 tm2133431-4_4seq1.xml OWNERSHIP DOCUMENT X0306 4 2021-11-16 0 0001434524 ClearSign Technologies Corp CLIR 0001731684 Meline Susanne 12870 INTERURBAN AVENUE SOUTH SEATTLE WA 98168 1 0 0 0 Restricted Stock Units 2021-11-16 4 A 0 14531 0.00 A Common Stock 14531 14531 D Restricted Stock Units Common Stock 8017 8017 D Restricted Stock Units Common Stock 8017 8017 D Option to Purchase Common Stock 3.97 2021-04-01 2031-01-21 Common Stock 22750 22750 D Option to Purchase Common Stock 2.38 2020-11-19 2030-11-18 Common Stock 22750 22750 D Option to Purchase Common Stock 2.30 2020-08-18 2030-05-17 Common Stock 22750 22750 D Option to Purchase Common Stock 0.49 2020-05-19 2030-05-19 Common Stock 22750 22750 D Option to Purchase Common Stock 0.72 2020-04-01 2030-04-01 Common Stock 22750 22750 D Option to Purchase Common Stock 1.00 2029-04-01 Common Stock 91000 91000 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. The right to exercise the option and purchase the option shares vested in equal increments as follows: the right to purchase 22,750 shares vested on May 9, 2019 and the right to purchase the remaining 68,250 shares vested in equal increments on the last day of each calendar quarter during 2019. /s/ Susanne Meline 2021-11-18