|4Jun 2, 1:41 PM ET

QS Energy, Inc. 4

4 · QS Energy, Inc. · Filed Jun 2, 2017

Insider Transaction Report

Form 4
Period: 2017-05-31
Transactions
  • Conversion

    Common Stock

    2017-05-31$0.05/sh+2,200,000$110,0002,200,000 total
  • Conversion

    Convertible note

    2017-05-31$100000.00/sh2,744,569 total
    Exercise: $0.05Common Stock (2,200,000 underlying)
  • Award

    Convertible Note

    2017-05-31$100000.00/sh3,844,569 total
    Exercise: $0.05From: 2017-05-31Common Stock (2,200,000 underlying)
  • Award

    Warrants

    2017-05-31+1,100,0004,944,569 total
    Exercise: $0.05From: 2017-05-31Exp: 2018-05-31Common Stock (1,100,000 underlying)
Footnotes (4)
  • [F1]Reporting Person acquired Issuer's Convertible Note in the principal amount of $110,000, for a purchase price of $100,000, convertible into 2,200,000 shares of common stock of Issuer.
  • [F2]Not Applicable.
  • [F3]Reporting Person acquired Issuer's Warrants as part of Reporting Person's purchase of Issuer's Convertible Note reported above.
  • [F4]Reporting Person converted the Convertible Note listed above and described in Footnote 1 of this Form 4.

Documents

1 file
  • 4
    bundros_f4.xmlPrimary

    OWNERSHIP DOCUMENT