SEC Form 4 · accession 0001008274-15-000004
GOLDEN QUEEN MINING CO LTD · GQM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Landon T Clay
10% Owner
Period of report
Nov 24, 2015
Accepted (ET)
Nov 25, 2015 · 10:55 am EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001025362
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Nov 24, 2015 | J | 1,009,000 | $0.55 | D | 1,344,269 | I | By Trust |
| Common StockF2 | Nov 24, 2015 | J | 98,000 | $0.55 | D | 0 | I | By trust |
| Common StockF3 | holding | — | — | — | 17,051,682 | D | ||
| Common StockF4 | holding | — | — | — | 807,250 | I | By trust | |
| Common StockF5 | holding | — | — | — | 10,000 | I | By partnership | |
| Common StockF6 | holding | — | — | — | 26,114 | I | By corporation | |
| Common StockF7 | holding | — | — | — | 2,351 | I | By spouse |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Represents shares owned by the Monadnock Charitable Lead Annuity Trust dated May 31, 1996 ("Monadnock"). The shares were transferred to satisfy a portion of the annual annuity payment required to be made by Monadnock in accordance with the terms of the Monadnock trust instrument. The reporting person is the donor of the assets to Monadnock. Brian James is the trustee of Monadnock and each of the reporting person's sons has a beneficial interest in Monadnock. The reporting person provides investment advisory services to Monadnock. The reporting person disclaims beneficial ownership of the shares held by Monadnock
- F2Represents shares owned by the Skadutakee Charitable Annuity Lead Trust II dated June 28, 1993 ("Skadutakee II"). The shares were transferred to satisfy a portion of the annual annuity payment required to be made by Skadutakee II in accordance with the terms of the Skadutakee II trust instrument. The reporting person is the donor of the assets to Skadutakee II. Brian James is the trustee of Skadutakee II and each of the reporting person's sons has a beneficial interest in Skadutakee II. The reporting person provides investment advisory services to Skadutakee II. The reporting person disclaims beneficial ownership of the shares held by Skadutakee II.
- F3Includes 4,663 share that were previously held by LTC Corporation Profit Sharing Retirement Plan (the "Plan"). Following the termination of the Plan, the reporting person's beneficial ownership in these shares changed from indirect to direct ownership.
- F4Represents shares owned by Arctic Coast Petroleums, Ltd. ("Arctic Coast"). The reporting person owned 50% of Arctic Coast and transferred his interest in Arctic Coast on October 22, 2009 to the Clay Family 2009 Irrevocable Trust dated April 14, 2009 which owns 50% of Arctic Coast. The reporting person disclaims beneficial ownership of the shares held by Arctic Coast.
- F5Represents shares owned by Winter Place Associates ("Winter Place"). The reporting person has a partnership interest in Winter Place. The reporting person disclaims beneficial ownership of the shares held by Winter Place except to the extent of his proportionate pecuniary interest therein
- F6Represents shares owned by LTC Corporation which is wholly owned by the reporting person.
- F7Represents shares owned by the reporting person's spouse, Lavinia D. Clay. The reporting person disclaims beneficial ownership of the shares held by his spouse.