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*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol GOLDEN QUEEN MINING CO LTD [ GQM ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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3. Date of Earliest Transaction (Month/Day/Year) 02/22/2018 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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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 | ||||||
Common Stock | 02/22/2018(1)(2) | X(1)(2) | 101,367,270(3) | A | $0.1325(1)(2) | 118,419,672 | D | |||
Common Stock | 02/22/2018(1)(2) | X(1)(2) | 221,968(4) | A | $0.1325(1)(2) | 248,082 | I | By corporation(5) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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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 | ||||||||
Subscription Rights | $0.1325(1)(2) | 02/22/2018(1)(2) | X(1)(2) | 17,052,402 | 01/11/2018 | 02/20/2018 | Common Stock | 28,981,155(1)(2) | (1)(2) | 0 | D | ||||
Subscription Rights | $0.1325(1)(2) | 02/22/2018(1)(2) | X(1)(2) | 26,114 | 01/11/2018 | 02/20/2018 | Common Stock | 44,393 | (1)(2) | 0 | I | By corporation(5) |
Explanation of Responses: |
1. In November 2017, Golden Queen Mining Co. Ltd (the "Issuer") announced the commencement of a pro rata offering (the "Rights Offering") of transferable rights (the "Rights") to holders of the Issuer's common shares, as of the record date of December 1, 2017 ("Record Date Shareholder"), entitling the holders of such rights to subscribe for up to an aggregate of 188,952,761 of the Issuer's common shares. Record Date Shareholders received one Right for each outstanding common share held on the record date. The Rights entitled their holders to purchase 1.7 new common shares for every Right held. The subscription price per common share was $0.1325 (the "basic subscription privilege"). (see footnote 2) |
2. The Rights Offering also included an oversubscription privilege, which entitled holders who fully exercised their basic subscription privilege the right to purchase, at a price of $0.1325 per common share, additional common shares of the Issuer, subject to availability and pro rata allocation of shares among Record Date Shareholders exercising such oversubscription privilege. The Rights were exercisable until February 20, 2018 at 5:00 p.m. Toronto time. Following the conclusion of the Rights Offering, the common shares that were not purchased by other Record Date Shareholders were allocated pro rata among Rights holders exercising their oversubscription privilege based on the number of common shares of the Issuer each of those Rights holders owned on the record date. |
3. Represents 28,981,155 common shares of the Issuer acquired upon the exercise of the basic subscription privilege and 72,386,115 common shares of the Issuer acquired upon the exercise of the oversubscription privilege. |
4. Represents 44,393 shares of common stock of the Issuer acquired upon the exercise of the basic subscription privilege and 177,575 common shares of the Issuer acquired upon the exercise of the oversubscription privilege. |
5. Represents shares of common stock of the Issuer held by LTC Corporation ("LTC Corp"). The Reporting Person owns all of the equity interests of LTC Corp. The equity interests of LTC Corp transferred automatically to the Reporting Person following the death of Landon T. Clay in July 2017. |
/s/ Thomas M. Clay, Executor | 02/26/2018 | |
** 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). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
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 Number. |