SEC Form 4 · accession 0001454170-15-000005
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
Dec 8, 2015
Accepted (ET)
Dec 14, 2015 · 1:10 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 | Dec 8, 2015 | J | 10,000 | $3.18 | D | 0 | I | By partnership |
| Common StockF2 | Dec 8, 2015 | J | 720 | $3.18 | A | 1,806,400 | D | |
| Common StockF3 | holding | — | — | — | 1,344,269 | I | By trust | |
| Common SharesF4 | holding | — | — | — | 807,250 | I | By trust |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Represents shares previously owned by Winter Place Associates ("Winter Place"). The reporting person has a partnership interest in Winter Place. Winter Place distributed these shares on December 8, 2015.
- F2Represents the reporting person's proportionate interest in the shares distributed by Winter Place. The price indicated represents the cost basis of the shares transferred.
- F3Represents shares owned by the Monadnock Charitable Lead Annuity Trust dated May 31, 1996 ("Monadnock"). 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 Monadnock except to the extent of his proportionate pecuniary interest therein.
- F4Represents 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.