SEC Form 4 · accession 0001008274-16-000006
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
Jan 14, 2016
Accepted (ET)
Jan 19, 2016 · 2:42 pm 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 | Jan 14, 2016 | G | 17,047,739 | $0.00 | D | 4,663 | D | |
| Common StockF1 | Jan 14, 2016 | G | 17,047,739 | $0.00 | A | 17,047,739 | I | By grantor retained annuity trust |
| Common StockF2 | holding | — | — | — | 1,344,269 | I | By trust | |
| Common StockF3 | holding | — | — | — | 807,250 | I | By trust | |
| Common StockF4 | holding | — | — | — | 26,114 | I | By corporation | |
| Common StockF5 | holding | — | — | — | 2,351 | I | By spouse |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On January 14, 2016, the reporting person transferred an aggregate of 17,047,739 shares of common stock of the issuer into the Landon T. Clay 2016-2 Annuity Trust u/a dated January 14, 2016 (the "2016-2 GRAT") for the benefit of himself. The reporting person's son, Thomas M. Clay, is the sole trustee under the 2016-2 GRAT.
- F2Represents shares owned by the Monadnock Charitable Lead Annuity Trust dated May 31, 1996 ("Monadnock"). 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.
- F3Represents 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
- F4Represents shares owned by LTC Corporation which is wholly owned by the reporting person.
- F5Represents shares owned by the reporting person's spouse, Lavinia D. Clay. The reporting person disclaims beneficial ownership of the shares held by his spouse.