SEC Form 4/A · accession 0001683168-18-003577
QS Energy, Inc. · QSEP
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
This is an amendment (Form 4/A). It replaces an earlier filing for the same period.
Reporting owner
Eric Bunting
Director
Period of report
Mar 30, 2018
Accepted (ET)
Nov 28, 2018 · 6:05 pm EST
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 StockF4 | Apr 2, 2018 | C | 275,000 | $0.08 | A | 9,389,530 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| WarrantsF1,F4 | $0.08 | Mar 30, 2018 | A | 275,000 | A | Mar 30, 2018 | Mar 30, 2019 | Common Stock | 275,000 | 602,778 | D |
| WarrantsF3,F4,F2 | $0.08 | Apr 2, 2018 | C | 275,000 | D | Apr 2, 2018 | — | Common Stock | 275,000 | 552,778 | D |
Explanation of responses
- F1On 3/30/2018, Reporting Person acquired 275,000 Warrants as part of Reporting Person's acquisition of Issuer's Convertible note on that same date. In Reporting Person's 04/04/2018 Form 4 reporting this acquisition, the number of Warrants acquired by Reporting Person was incorrectly stated as 225,000, a shortfall of 50,000 Warrants.
- F2Not Applicable.
- F3On 3/30/2018, Reporting Person converted 275,000 of Issuer's Warrants as part of Reporting Person's purchase of Issuer's Convertible Note reported above. In Reporting Person's 04/04/2018 Form 4 reporting this acquisition, the number of Warrants converted into Issuer's Common Stock was incorrectly stated as 225,000, a shortfall of 50,000 Warrants.
- F4Amount at the time of filing of this Form 4