Statement of Changes in Beneficial Ownership (4)

Date : 06/04/2019 @ 8:18PM
Source : Edgar (US Regulatory)
Stock : Qs Energy, Inc. (QB) (QSEP)
Quote : 0.143  -0.0029 (-1.99%) @ 9:14PM

Statement of Changes in Beneficial Ownership (4)

FORM 4
[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).         
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
                                                                                  
OMB APPROVAL
OMB Number: 3235-0287
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
                      

1. Name and Address of Reporting Person *

Bunting Eric
2. Issuer Name and Ticker or Trading Symbol

QS Energy, Inc. [ QSEP ]
5. Relationship of Reporting Person(s) to Issuer (Check all applicable)

__ X __ Director                      _____ 10% Owner
_____ Officer (give title below)      _____ Other (specify below)
(Last)          (First)          (Middle)

23902 FM 2978
3. Date of Earliest Transaction (MM/DD/YYYY)

5/31/2019
(Street)

TOMBALL, TX 77375
(City)        (State)        (Zip)
4. If Amendment, Date Original Filed (MM/DD/YYYY)

 
6. Individual or Joint/Group Filing (Check Applicable Line)

_ X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Trans. Date 2A. Deemed Execution Date, if any 3. Trans. Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock   5/31/2019   5/31/2019   D (1)    260419   A $.08   10306889   D    
Common Stock   5/31/2019   5/31/2019   D (2)    275000   A $.05   10581889   D    
Common Stock   6/4/2019   6/4/2019   D (5)    733333   A $.18   11315222   D    

Table II - Derivative Securities Beneficially Owned ( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivate Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Trans. Date 3A. Deemed Execution Date, if any 4. Trans. Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
6. Date Exercisable and Expiration Date 7. Title and Amount of Securities Underlying Derivative Security
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Options   $0.08   5/31/2019   5/31/2019   D         260419      (1) 1/1/2028   Common Stock   260419   $.08   639581   D    
Warrants   $0.05   5/31/2019   5/31/2019   D         275000    11/26/2018   (2) 11/26/2019   Common Stock   275000   $.05   364581   D    
Convertible Note   $0.15   6/4/2019   6/4/2019   A      $100000   (3)      6/4/2019     (6) Common Stock   733333   $100000   1097914   D    
Warrants   $0.15   6/4/2019   6/4/2019   A      367667       6/4/2019   6/4/2020   Common Stock   367667     (4) 1465581   D    
Convertible Note   $0.15   6/4/2019   6/4/2019   D         733333    6/4/2019     (6) Common Stock   733333     (5) 732248   D    

Explanation of Responses:
(1)  Reporting Person is exercising stock options granted on 01/01/2019. These stock options were granted to Reporting Person as equity compensation under Issuer's Board Compensation Policy, approved by the Board on 6/19/2015. The options vest at the rate of 1/12 per month, commencing 1/1/2019, with full vesting on 12/31/2019.
(2)  Reporting Person is exercising warrants acquired in connection with an acquisition of a Convertible Note from Issuer, as reported on Reporting Person's Form 4 dated 11/28/2018.
(3)  Reporting Person acquired Issuer's Convertible Note in the principal amount of $110,000, for a purchase price of $100,000, convertible into 733,333 shares of common stock of Issuer.
(4)  Reporting Person acquired Issuer's Warrants as part of Reporting Person's purchase of Issuer's Convertible Note reported above.
(5)  Reporting Person converted the Convertible Note reported above in footnote 3.
(6)  Not applicable.

Reporting Owners
Reporting Owner Name / Address
Relationships
Director 10% Owner Officer Other
Bunting Eric
23902 FM 2978
TOMBALL, TX 77375
X



Signatures
/s/ Eric Bunting 6/3/2019
** Signature of Reporting Person Date


Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.

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