SEC Form 4 · accession 0001454170-15-000002
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
Jun 8, 2015
Accepted (ET)
Aug 14, 2015 · 10:27 am 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WarrantF2,F1 | $0.95 | Jun 8, 2015 | J | 5,967,000 | A | Dec 8, 2015 | Jun 8, 2020 | Common Shares | 5,967,000 | 5,967,000 | I |
| WarrantF2,F3 | $0.95 | Jun 8, 2015 | J | 1,533,000 | A | Dec 8, 2015 | Jun 8, 2020 | Common Shares | 1,533,000 | 1,533,000 | I |
Explanation of responses
- F1On June 8, 2015, the issuer issued a warrant to purchase 5,967,000 shares of common stock to the Landon T. Clay 2009 Irrevocable Trust dated March 6, 2009 (the "LTC 2009 Trust"), of which the reporting person is a trustee. The warrant is exercisable from December 8, 2015 through June 8, 2020.
- F2The warrant was issued in connection with the Amended and Restated Term Loan Agreement (the "Loan Agreement"),dated June 8, 2015, by and among the issuer, the LTC 2009 Trust, the Clay Family 2009 Irrevocable Trust dated April 14, 2009 (the "CF 2009 Trust") and the other lenders named therein. The Loan Agreement is described in the issuer's Current Report on Form 8-K filed with the U. S. Securities and Exchange Commission on June 9, 2015.
- F3On June 8, 2015 the issuer issued a warrant to purchase 1,533,000 shares of common stock to the CF 2009 Trust, of which the reporting person is a trustee. The warrant is exercisable from December 8, 2015 through June 8, 2020.