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