SEC Form 3 · accession 0001683168-17-000842
QS Energy, Inc. · QSEP
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Jason B Lane
Officer — Chief Executive Officer · Director
Period of report
Apr 1, 2017
Accepted (ET)
Apr 7, 2017 · 12:52 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001103795
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | holding | — | — | — | 7,600 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Options to purchase Common StockF1 | $0.07 | holding | — | — | — | Apr 1, 2017 | Apr 1, 2027 | Common Stock | 535,714 | — | D |
| Options to purchase Common StockF2 | — | holding | — | — | — | Apr 1, 2017 | Apr 1, 2027 | Common Stock | 3,000,000 | — | D |
Explanation of responses
- F1The stock options reported under item 1 above were granted to Mr. Lane is his capacity as a 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 1/9 per month, commencing 04/01/2017, with full vesting on 12/31/2017.
- F2The stock options reported under item 1 above were granted to Mr. Lane pursuant to his employment agreement as Chief Executive Officer, approved by the Board on 03/29/2017 and effective 04/01/2017. 500,000 of the options at $.15 per share and 500,000 of the options at $.25 per share shall vest on 04/01/2018, and 1,000,000 of the options at $.30 per share and 1,000,000 of the options at $.40 per share shall vest on 04/01/2019