SEC Form 4 · accession 0001454170-15-000004
GOLDEN QUEEN MINING CO LTD · GQM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Thomas Moragne Clay
Officer — CEO · Director
Period of report
Nov 24, 2015
Accepted (ET)
Nov 25, 2015 · 11:24 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 Stock | holding | — | — | — | 1,805,680 | D | ||
| Common StockF3 | holding | — | — | — | 807,250 | I | By trust | |
| Common StockF4 | holding | — | — | — | 10,000 | I | By partnership |
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 has a remainder beneficial interest in the assets held by Monadnock. The reporting person's father provides investment advisory services to Monadnock. The reporting person disclaims beneficial interest of the shares held by Monanock except to the extent of his proportionate pecuniary interest therein.
- 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 by to be made by Skadutakee II in accordance with the terms of the Skadutakee II Trust Instrument. The reporting person has a remainder beneficial interest in the assets held by Skadutakee II. The reporting person's father provides investment advisory services to Skadutakee II. The reporting person disclaims beneficial interest of the shares held by Skadutakee II except to the extent of his proportionate pecuniary interest therein.
- F3Represents shares owned by Arctic Coast Petroleums, Ltd. ("Arctic Coast"). The reporting person is a trustee of the Clay Family 2009 Irrevocable Trust dated April 14, 2009 which owns 50% of Arctic Coast. The reporting person is a director of Arctic Coast.
- F4Represents shares owned by Winter Place Associates ("Winter Place"). The reporting person has a partnership interest in Winter Place. The reporting person disclaims beneficial interest of the shares held by Winter Place except to the extent of his proportionate pecuniary interest therein.