Filing Details

Accession Number:
0001454170-10-000001
Form Type:
5
Zero Holdings:
No
Publication Time:
2010-02-12 12:00:00
Reporting Period:
2009-12-31
Filing Date:
2010-02-12
Accepted Time:
2010-02-12 17:46:54
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1025362 Golden Queen Mining Co Ltd GQM Metal Mining (1000) 000000000
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1454170 Moragne Thomas Clay 188 Old Street Road
Peterborough NH 03458
Yes No No No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2009-07-15 1,200,000 $0.65 17,047,019 No 4 P Indirect By father
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Indirect By father
Reported Non-Derivative Holdings
Sec. Name Remaning Holdings Nature of Ownership Explanation
Common Stock 868,522 Direct
Common Stock 807,250 Indirect By corporation
Common Stock 2,351 Indirect By mother
Common Stock 2,594,384 Indirect By siblings
Common Stock 30,777 Indirect By corporation
Common Stock 4,797,094 Indirect By trusts
Reported Derivative Holdings
Sec. Name Sec. Type Price Date Expiration Date Amount Remaning Holdings Nature of Ownership
Common Stock Stock Options $0.26 2009-05-21 2014-01-28 300,000 300,000 Direct
Expiration Date Amount Remaning Holdings Nature of Ownership
2014-01-28 300,000 300,000 Direct
Footnotes
  1. Includes 30,251 shares that are held in brokerage accounts on behalf of the reporting person that were not included in the reporting person's intial statement of beneficial ownership of securities report on Form 3 which was filed on January 30, 2009.
  2. Represents shares held by Arctic Coast Petroleums, Ltd. ("Arctic Coast"). The reporting person is a trustee of the Clay Family 2009 Irrevocable Trust u/a dated April 14, 2009 (the "Trust") which owns 50% of the shares of Arctic Coast which shares of Arctic Coast were transferred to the Trust on October 22, 2009. The reporting person is a director of Arctic Coast.
  3. Represents shares held by reporting person's mother, Lavinia D. Clay. The reporting person disclaims beneficial ownership of these shares.
  4. Represents shares held by the reporting person's three siblings including 868,524 shares held by Richard T. Clay, 862,930 shares held by Landon H. Clay and 862,930 shares held by Cassius M.C. Clay. The reporting person disclaims beneficial ownership of these shares.
  5. Price in Canadian dollars.
  6. Represents shares held directly by reporting person's father, Landon T. Clay. The reporting person disclaims beneficial ownership of these shares.
  7. Represents shares held indirectly by the reporting person's father, Landon T. Clay. Such shares include 26,144 shares held by LTC Corp. and 4,663 shares held by LTC Pension and Profit Sharing Plan. The reporting person disclaims beneficial ownership of these shares.
  8. Represents shares held by various charitable annuity lead trusts (the "Trusts") in which the reporting person has a remainder beneficial interest. The reporting person's father, Landon T. Clay, provides investment advisory services to the Trusts. The reporting person disclaims beneficial interest in these shares except to the extent of his proportionate pecuniary interest therein.
  9. The stock options were granted by the issuer's board of directors on January 28, 2009, subject to shareholder approval of the issuer's new stock option plan. The issuer's shareholders approved the plan on May 21, 2009. The options became fully vested and exercisable as of May 21, 2009 and expire five (5) years from the date of grant on January 28, 2014.