SEC Form 4 · accession 0001454170-18-000002
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 · 10% Owner
Period of report
Jan 25, 2018
Accepted (ET)
Jan 29, 2018 · 6:23 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 25, 2018 | J | 10,163,295 | $0.1686 | D | 0 | I | By grantor retained annuity trust |
| Common StockF2 | holding | — | — | — | 26,114 | I | By corporation | |
| Common Stock | holding | — | — | — | 1,806,400 | D | ||
| Common StockF3 | holding | — | — | — | 1,344,269 | I | By trust | |
| Common StockF4 | holding | — | — | — | 807,250 | I | By trust |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1On January 25, 2018, the reporting person, as the sole trustee of the Landon T. Clay 2016-2 Annuity Trust u/a dated January 14, 2016 (the "2016-2 GRAT"), authorized the transfer of all 10,163,295 shares of common stock of Golden Queen Mining Co. Ltd. (the "Issuer") held by the 2016-2 GRAT from the 2016-2 GRAT to the Estate of Landon Thomas Clay in satisfaction of the final annuity payment required by the terms of the 2016-2 GRAT. Mr. Landon Thomas Clay died in July 2017 and was the reporting person's father. The price in Column 4 was determined in accordance with the terms of the 2016-2 GRAT and is based on the average trading price of the Issuer's shares of common stock one day prior to the date of the transaction and converted to U.S. dollars at the prevailing conversion rate on such date.
- F2Represents shares owned by LTC Corporation ("LTC Corp"). The reporting person was appointed president of LTC Corp on November 21, 2017. The Estate of Landon Thomas Clay owns all of the equity interests of LTC Corp. The reporting person disclaims beneficial ownership of the shares held by LTC Corp.
- F3Represents shares owned by the Monadnock Charitable Lead Annuity Trust dated May 31, 1996 ("Monadnock"). The reporting person provides investment advisory services to Monadnock. The reporting person's late father was the donor of the assets to Monadnock and the reporting person has a remainder beneficial interest in the assets held by Monadnock. The reporting person disclaims beneficial ownership 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 (the "CF 2009 Trust"), which owns 50% of Arctic Coast. The reporting person's late father was the donor of the portion of Arctic Coast held by the CF 2009 Trust. The reporting person is a director of Arctic Coast.