SEC Form 4 · accession 0001454170-15-000001
GOLDEN QUEEN MINING CO LTD · GQM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Thomas Moragne Clay
Director
Period of report
Jul 24, 2015
Accepted (ET)
Jul 28, 2015 · 6:18 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,F2 | $1.03 | Jul 24, 2015 | J | 5,767,602 | D | Jul 26, 2013 | Jul 26, 2015 | Common Shares | 5,599,613 | 0 | I |
Explanation of responses
- F1Amounts in Canadian dollars.
- F2The 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 sole trustee. The reporting person exercises voting and investment control of the securities held by the Trust. The reported security was retired at maturity.