SEC Form 4 · accession 0001008274-15-000001
GOLDEN QUEEN MINING CO LTD · GQM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).
Reporting owner
Landon T Clay
10% Owner
Period of report
Jul 24, 2015
Accepted (ET)
Jul 28, 2015 · 7:03 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001025362
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Convertible DebentureF1 | $1.03 | Jul 24, 2015 | J | 1,732,398 | D | Jul 26, 2013 | Jul 26, 2015 | Common Shares | 1,681,940 | 0 | D |
| Convertible DebentureF1,F3 | $1.03 | Jul 24, 2015 | J | 5,767,602 | A | Jul 26, 2013 | Jul 26, 2015 | Common Shares | 5,599,613 | 0 | I |
Explanation of responses
- F1Amounts in Canadian dollars.
- F2The reported security was retired at maturity.
- F3The reported security was registered in the name of the Landon T. Clay 2013-4 Annuity Trust u/a dated June 17, 2013 (the "Trust"), of which the reporting person is the donor. The reported security was retired at maturity.