0001104659-23-106901.txt : 20231004 0001104659-23-106901.hdr.sgml : 20231004 20231004174701 ACCESSION NUMBER: 0001104659-23-106901 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231002 FILED AS OF DATE: 20231004 DATE AS OF CHANGE: 20231004 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: de Lacy Catharine CENTRAL INDEX KEY: 0001966673 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35521 FILM NUMBER: 231309094 MAIL ADDRESS: STREET 1: 6 VILLAGE NORTH DR STREET 2: #107 CITY: HILTON HEAD STATE: SC ZIP: 29926 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: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 8023 E. 63RD PLACE, SUITE 101 CITY: TULSA STATE: OK ZIP: 74133 BUSINESS PHONE: (918) 236-6461 MAIL ADDRESS: STREET 1: 8023 E. 63RD PLACE, SUITE 101 CITY: TULSA STATE: OK ZIP: 74133 FORMER COMPANY: FORMER CONFORMED NAME: CLEARSIGN COMBUSTION CORP DATE OF NAME CHANGE: 20080507 4 1 tm2327697-4_4seq1.xml OWNERSHIP DOCUMENT X0508 4 2023-10-02 0 0001434524 ClearSign Technologies Corp CLIR 0001966673 de Lacy Catharine 8023 E. 63RD PLACE, SUITE 101 TULSA OK 74133 1 0 0 0 0 Restricted Stock Units 2023-10-02 4 A 0 18333 0.00 A Common Stock 18333 64861 D As compensation for services as a non-executive director during the quarter ending December 31, 2023, 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 person's death; or (4) the reporting person's separation from service. /s/ Catharine de Lacy 2023-10-04