SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Bunting Eric

(Last) (First) (Middle)
23902 FM 2978

(Street)
TOMBALL TX 77375

(City) (State) (Zip)
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)
3. Date of Earliest Transaction (Month/Day/Year)
03/30/2018
4. If Amendment, Date of Original Filed (Month/Day/Year)
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. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 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 04/02/2018 04/02/2018 C 225,000 A $0.08 8,239,530 D
Common Stock 04/02/2018 04/02/2018 C 550,000 A $0.08(5) 8,789,530 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 (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 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 (Month/Day/Year) 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: 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
Convertible Note $0.08 03/30/2018 03/30/2018 A $44,000(1) 03/30/2018 (2) Common Stock 550,000 $40,000 827,778 D
Warrants $0.08 03/30/2018 03/30/2018 A 225,000 03/30/2018 03/30/2019 Common Stock 225,000 (3) 1,052,778 D
Warrants $0.08 04/02/2018 04/02/2018 C 225,000 04/02/2018 03/30/2019 Common Stock 225,000 (4) 827,778 D
Convertible Note $0.08 04/02/2018 04/02/2018 C 550,000 04/02/2018(5) (2) Common Stock 550,000 (5) 277,778 D
Explanation of Responses:
1. Reporting Person acquired Issuer's Convertible Note in the principal amount of $44,000, for a purchase price of $40,000, convertible into 550,000 shares of common stock of Issuer.
2. Not Applicable.
3. Reporting Person acquired Issuer's Warrants as part of Reporting Person's purchase of Issuer's Convertible Note reported above.
4. Reporting Person converted Issuer's Warrants received as part of Reporting Person's purchase of Issuer's Convertible Note acquired on 3/30/2018.
5. Reporting Person converted the Convertible Note reported above.
/s/ Eric Bunting 04/04/2018
** 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).
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