Sec Form 4 Filing - Bunting Eric @ QS Energy, Inc. - 2019-05-31

Insider filing report for Changes in Beneficial Ownership
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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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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/YY)
05/31/2019
(Street)
TOMBALL, TX77375
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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 05/31/2019 05/31/2019 D( 1 ) 260,419 A $ 0.08 10,306,889 D
Common Stock 05/31/2019 05/31/2019 D( 2 ) 275,000 A $ 0.05 10,581,889 D
Common Stock 06/04/2019 06/04/2019 D( 5 ) 733,333 A $ 0.18 11,315,222 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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 05/31/2019 05/31/2019 D 260,419 ( 1 ) 01/01/2028 Common Stock 260,419 $ 0.08 639,581 D
Warrants $ 0.05 05/31/2019 05/31/2019 D 275,000 11/26/2018( 2 ) 11/26/2019 Common Stock 275,000 $ 0.05 364,581 D
Convertible Note $ 0.15 06/04/2019 06/04/2019 A 06/04/2019 ( 6 ) Common Stock 733,333 $ 100,000 1,097,914 D
Warrants $ 0.15 06/04/2019 06/04/2019 A 367,667 06/04/2019 06/04/2020 Common Stock 367,667 ( 4 ) 1,465,581 D
Convertible Note $ 0.15 06/04/2019 06/04/2019 D 733,333 06/04/2019 ( 6 ) Common Stock 733,333 ( 5 ) 732,248 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Bunting Eric
23902 FM 2978
TOMBALL, TX77375
X
Signatures
/s/ Eric Bunting 06/03/2019
Signature of Reporting Person Date
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.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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