SEC Form 4 · accession 0001144204-17-004032

ClearSign Technologies Corp · CLIR

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — See Remarks

Period of report

Jan 25, 2017

Accepted (ET)

Jan 26, 2017 · 4:31 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001434524

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock/CLIR^F1	Jan 25, 2017	X	1,000	$4.00	A	6,000	D
Common Stock/CLIR^F1	Jan 25, 2017	X	800	$4.00	A	4,800	I	By IRA

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Subscription Rights (Right to Purchase)^F1	$4.00	Dec 27, 2016	X	1,000	D	Dec 27, 2016	Jan 13, 2017	See Footnote	1,000	0	D
Subscription Rights (Right to Purchase)^F1	$4.00	Dec 27, 2016	X	800	D	Dec 27, 2016	Jan 13, 2017	See Footnote	800	0	I
Warrant to Purchase Common Stock^F1,F2	$4.00	Jan 25, 2017	X	1,000	A	Jan 25, 2017	Jan 25, 2019	Common Stock	1,000	1,000	D
Warrant to Purchase Common Stock^F1,F2	$4.00	Jan 25, 2017	X	800	A	Jan 25, 2017	Jan 25, 2019	Common Stock	800	800	I

F1The common stock and the warrants reported on this Form 4 were acquired pursuant to the exercise of subscription rights previously distributed by the Issuer to all holders of the Issuer's common stock. Each holder received 0.2 subscription rights per share of stock owned, and each right allowed the recipient to purchase one unit, consisting of one share of common stock and one warrant to purchase one share of common stock. The subscription price per unit was $4.00.
F2Each warrant entitles the holder to purchase one share of the Company's common stock at an exercise price of $4.00 from the date of issuance through January 25, 2019.

Senior Vice President of Business Development