SEC Form 4 · accession 0001683168-17-000172
QS Energy, Inc. · QSEP
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Charles Blum
Director
Period of report
Jan 1, 2017
Accepted (ET)
Jan 26, 2017 · 3:02 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001103795
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Option to Purchase Common StockF1 | $0.05 | Jan 1, 2017 | A | 1,000,000 | A | Jan 1, 2017 | Jan 1, 2027 | Common Stock | 1,000,000 | 3,051,271 | D |
Explanation of responses
- F1The stock options reported under item 1 above were granted to each member of Issuer's Board as equity compensation under the Issuer's Board Compensation Policy, approved by the Board on 06/19/2015. The options granted under item 1 vest at the rate of 1/12 per month, commencing 01/01/2017, with full vesting on 12/31/2017.