SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Pate Bruce Alan

(Last) (First) (Middle)
12870 INTERURBAN AVENUE SOUTH

(Street)
SEATTLE WA 98168

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ClearSign Technologies Corp [ CLIR ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
08/18/2020
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Options to Purchase Common Stock(1) $2.3 08/18/2020 A 19,750 08/18/2020 08/17/2030 Common Stock 19,750 $0.00 19,750 D
Options to Purchase Common Stock $0.49 05/19/2020 05/19/2030 Common Stock 19,750 19,750 D
Option to Purchase Common Stock $0.72 04/01/2020 04/01/2030 Common Stock 19,750 19,750 D
Option to Purchase Common Stock $1 (2) 04/01/2029 Common Stock 70,500 70,500 D
Explanation of Responses:
1. On August 18, 2020 the Issuer's Board of Directors approved compensation to be paid to the Issuer's non-executive directors for services provided to the Issuer during the period from July 1, 2020 to September 30, 2020. The reporting person is a non-executive director. As compensation for their services, each non- executive director was awarded options for shares of common stock having an exercise price of $2.30. The total numbers of option shares awarded was based on the services provided by the director. These services include Board participation, committee participation, committee chair responsibilities and lead director responsibilities, if any. The award was issued from the Issuer's 2011 Equity Incentive Plan.
2. The right to exercise the option and purchase the option shares vested in equal increments as follows: the right to purchase 17,625 shares vested on May 9, 2019 and the right to purchase the remaining 52,875 shares vested in equal increments on the last day of each calendar quarter during 2019.
/s/ Bruce A Pate 08/20/2020
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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