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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) | ||
| 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 Underlying Securities (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 of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
| Clay Thomas Moragne C/O EAST HILL MANAGEMENT COMPANY, LLC 70 MAIN STREET, SUITE 300 PETERBOROUGH, NH 03458 |
X | CEO | ||
| /s/ Thomas M. Clay | 06/06/2018 | |
| **Signature of Reporting Person | Date |
| * | 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). |
| (1) | Represents shares of common stock of Golden Queen Mining Co. Ltd. (the "Issuer") held by LTC Corporation ("LTC Corp"). The Estate of Landon Thomas Clay (the "Estate") is the sole stockholder of LTC Corp following the death of Mr. Landon Thomas Clay, the Reporting Person's father, in July 2017. The Reporting Person is the executor of the Estate and the president of LTC Corp. On June 4, 2018, LTC Corp distributed all of its shares of common stock of the Issuer to the Estate. Following this disposition the Reporting Person no longer holds any beneficial interest in these shares of common stock of the Issuer. |
| (2) | Represents shares of common stock of the Issuer held by the Monadnock Charitable Lead Annuity Trust dated May 31, 1996 ("Monadnock"). East Hill Management Company, LLC ("East Hill") provides investment advisory services to Monadnock. The Reporting Person is the sole manager of East Hill. Mr. Landon Thomas Clay 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 of common stock of the Issuer held by Monadnock except to the extent of the Reporting Person's proportionate pecuniary interest therein. |
| (3) | Represents common shares of the Issuer held 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 "2009 Trust"), which owns 50% of the equity interests of Arctic Coast. Mr. Landon Thomas Clay was the donor of the portion of Arctic Coast held by the 2009 Trust. The Reporting Person is a director of Arctic Coast. The Reporting Person disclaims beneficial ownership of 50% of the shares of Common Stock held by Arctic Coast. |