SEC Form 4 · accession 0001728440-18-000003
GOLDEN QUEEN MINING CO LTD · GQM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
of Landon Thomas Clay Estate
10% Owner
Period of report
May 15, 2018
Accepted (ET)
Jun 7, 2018 · 4:48 pm EDT
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 | May 15, 2018 | W | 4,663 | $0.00 | D | 118,415,009 | D | |
| Common StockF2 | Jun 5, 2018 | J | 248,082 | $0.00 | A | 118,663,091 | D | |
| Common StockF2 | Jun 5, 2018 | J | 248,082 | $0.00 | D | 0 | I | By corporation |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1Represents shares of common stock of Golden Queen Mining Co. Ltd. (the "Issuer") that were held in an individual retirement account in the name of Mr. Landon Thomas Clay (the "IRA"). Ownership of these shares of common stock passed to Mr. Landon Thomas Clay's spouse following the death of Mr. Landon Thomas Clay in July 2017.
- F2Represents shares of common stock of the Issuer held by LTC Corporation ("LTC Corp"). The Reporting Person is the sole stockholder of LTC Corp following the death of Mr. Landon Thomas Clay in July 2017. On June 5, 2018, LTC Corp distributed all of its shares of common stock of the Issuer to the Reporting Person. Following this distribution the Reporting Person will report these shares of common stock of the Issuer as being directly beneficially owned.