0001683168-19-001784.txt : 20190604
0001683168-19-001784.hdr.sgml : 20190604
20190604161643
ACCESSION NUMBER: 0001683168-19-001784
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190531
FILED AS OF DATE: 20190604
DATE AS OF CHANGE: 20190604
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bunting Eric
CENTRAL INDEX KEY: 0001702927
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-29185
FILM NUMBER: 19876798
MAIL ADDRESS:
STREET 1: 10701 FORESTGATE
CITY: WICHITA
STATE: KS
ZIP: 67206
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: QS Energy, Inc.
CENTRAL INDEX KEY: 0001103795
STANDARD INDUSTRIAL CLASSIFICATION: OIL & GAS FILED MACHINERY & EQUIPMENT [3533]
IRS NUMBER: 522088326
STATE OF INCORPORATION: NV
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 23902 FM 2978
CITY: TOMBALL
STATE: TX
ZIP: 77375
BUSINESS PHONE: 805-845-3581
MAIL ADDRESS:
STREET 1: 23902 FM 2978
CITY: TOMBALL
STATE: TX
ZIP: 77375
FORMER COMPANY:
FORMER CONFORMED NAME: SAVE THE WORLD AIR INC
DATE OF NAME CHANGE: 20000120
4
1
ownership.xml
X0306
4
2019-05-31
0
0001103795
QS Energy, Inc.
QSEP
0001702927
Bunting Eric
23902 FM 2978
TOMBALL
TX
77375
1
0
0
0
Common Stock
2019-05-31
2019-05-31
4
D
0
260419
.08
A
10306889
D
Common Stock
2019-05-31
2019-05-31
4
D
0
275000
.05
A
10581889
D
Common Stock
2019-06-04
2019-06-04
4
D
0
733333
.18
A
11315222
D
Options
0.08
2019-05-31
2019-05-31
4
D
0
260419
.08
D
2028-01-01
Common Stock
260419
639581
D
Warrants
0.05
2019-05-31
2019-05-31
4
D
0
275000
.05
D
2018-11-26
2019-11-26
Common Stock
275000
364581
D
Convertible Note
0.15
2019-06-04
2019-06-04
4
A
0
100000
100000
A
2019-06-04
Common Stock
733333
1097914
D
Warrants
0.15
2019-06-04
2019-06-04
4
A
0
367667
A
2019-06-04
2020-06-04
Common Stock
367667
1465581
D
Convertible Note
0.15
2019-06-04
2019-06-04
4
D
0
733333
D
2019-06-04
Common Stock
733333
732248
D
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.
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.
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.
Reporting Person acquired Issuer's Warrants as part of Reporting Person's purchase of Issuer's Convertible Note reported above.
Reporting Person converted the Convertible Note reported above in footnote 3.
Not applicable.
/s/ Eric Bunting
2019-06-03