SEC Form 4 · accession 0001683168-18-001449
QS Energy, Inc. · QSEP
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Richard William Munn
Director
Period of report
May 14, 2018
Accepted (ET)
May 16, 2018 · 9:19 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 | May 14, 2018 | C | 110,000 | $0.05 | A | 372,000 | 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 | May 14, 2018 | C | 110,000 | D | May 15, 2017 | May 15, 2018 | Common Stock | 110,000 | 527,778 | 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 5/15/2017.