SEC Form 4 · accession 0001683168-17-001812
QS Energy, Inc. · QSEP
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Eric Bunting
Director
Period of report
Jul 19, 2017
Accepted (ET)
Jul 19, 2017 · 5:19 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 | Jul 19, 2017 | C | 550,000 | $0.05 | A | 6,254,426 | D | |
| Common Stock | Jul 19, 2017 | C | 178,002 | $0.07 | A | 6,432,428 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WarrantsF1 | $0.05 | Jul 19, 2017 | C | 550,000 | D | Apr 18, 2017 | Apr 18, 2018 | Common Stock | 550,000 | 1,635,714 | D |
| OptionsF2 | $0.07 | Jul 19, 2017 | C | 178,002 | D | Apr 1, 2017 | Apr 1, 2027 | Common Stock | 178,002 | 1,457,712 | D |
Explanation of responses
- F1Reporting Person converted Issuer's Warrants received as part of Reporting Person's purchase of Issuer's Convertible Note acquired on 4/18/2017.
- F2Reporting Person converted stock options granted upon his appointment to Issuer's Board on 4/1/2017, as equity compensation under the Issuer's Board Compensation Policy, approved by the Board on 06/19/2015. As of 07/01/2017, a total of 178,002 of those stock options so issued had vested to Reporting Person.