SEC Form 3 · accession 0001690995-16-000001
GOLDEN QUEEN MINING CO LTD · GQM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Richard T Clay
10% Owner
Period of report
Nov 21, 2016
Accepted (ET)
Nov 30, 2016 · 2:09 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 Stock | holding | — | — | — | 1,505,678 | D | ||
| Common StockF1 | holding | — | — | — | 807,250 | I | By trust |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WarrantF2 | $0.95 | holding | — | — | — | Dec 8, 2015 | Jun 8, 2020 | Common Shares | 5,967,000 | — | I |
| WarrantF3 | $0.95 | holding | — | — | — | Dec 8, 2015 | Jun 8, 2020 | Common Shares | 1,533,000 | — | I |
| WarrantF4 | $0.85 | holding | — | — | — | Nov 21, 2016 | Nov 21, 2021 | Common Shares | 4,773,600 | — | I |
| WarrantF5 | $0.85 | holding | — | — | — | Nov 21, 2016 | Nov 21, 2021 | Common Shares | 1,226,400 | — | I |
Explanation of responses
- F1Represents 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 father is the donor of the portion of Arctic Coast held by the CF 2009 Trust.
- F2On 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 currently exercisable and expires on June 8, 2020.
- 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 currently exercisable and expires on June 8, 2020.
- F4On November 21, 2016 the issuer issued a warrant to purchase 4,773,600 shares of common stock to the LTC 2009 Trust, of which the reporting person is a trustee. The warrant is currently exercisable and expires on November 21, 2021.
- F5On November 21, 2016 the issuer issued a warrant to purchase 1,226,400 shares of common stock to the CF 2009 Trust, of which the reporting person is a trustee. The warrant is currently exercisable and expires on November 21, 2021.