| | | | | | | | | | | | | | | | | | | | | | |
Ownership Document
|
| Schema Version: X0306 |
| Document Type: 4/A |
| Period of Report: 6/19/20 |
| Date of Original Submission: 6/19/20 |
| Not Subject to Section 16: 0 |
| Issuer: |
| Issuer CIK: 1103795 |
| Issuer Name: QS Energy, Inc. |
| Issuer Trading Symbol: QSEP |
| Reporting Owner: |
| Reporting Owner ID: |
| | Owner CIK: 1706453 |
| | Owner Name: Munn Richard William |
| Reporting Owner Address: |
| | Owner Street 1: 23902 FM 2978 |
| | Owner Street 2: |
| | Owner City: TOMBALL |
| | Owner State: TX |
| | Owner ZIP Code: 77375 |
| | Owner State Description: |
| Reporting Owner Relationship: |
| | Is Director? Yes |
| | Is Officer? No |
| | Is Ten Percent Owner? No |
| | Is Other? No |
| | Officer Title: |
| | Other Text: |
| Derivative Table: |
| Derivative Transaction: |
| | Security Title: |
| | | Value: Convertible Note |
| | Conversion or Exercise Price: |
| | | Value: 0.035 |
| | Transaction Date: |
| | | Value: 6/19/20 |
| | Deemed Execution Date: |
| | | Value: 6/19/20 |
| | Transaction Coding: |
| | | Transaction Form Type: 4 |
| | | Transaction Code: A |
| | | Equity Swap Involved? No |
| | Transaction Timeliness: |
| | Transaction Amounts: |
| | | Transaction Total Value: |
| Value: 10,000 |
| Footnote ID: F1 |
| | | Transaction Price Per Share: |
| Footnote ID: F1 |
| | | Transaction Acquired-Disposed Code: |
| Value: A |
| | Exercise Date: |
| | | Value: 6/19/20 |
| | Expiration Date: |
| | | Footnote ID: F2 |
| | Underlying Security: |
| | | Underlying Security Title: |
| Value: Common Stock |
| | | Underlying Security Shares: |
| Value: 314,285 |
| | Post-Transaction Amounts: |
| | | Shares Owned Following Transaction: |
| Value: 1,910,396 |
| | Ownership Nature: |
| | | Direct or Indirect Ownership: |
| Value: D |
| Derivative Transaction: |
| | Security Title: |
| | | Value: Warrants |
| | Conversion or Exercise Price: |
| | | Value: 0.035 |
| | Transaction Date: |
| | | Value: 6/19/20 |
| | Deemed Execution Date: |
| | | Value: 6/19/20 |
| | Transaction Coding: |
| | | Transaction Form Type: 4 |
| | | Transaction Code: A |
| | | Equity Swap Involved? No |
| | Transaction Timeliness: |
| | Transaction Amounts: |
| | | Transaction Shares: |
| Value: 157,143 |
| | | Transaction Price Per Share: |
| Footnote ID: F3 |
| | | Transaction Acquired-Disposed Code: |
| Value: A |
| | Exercise Date: |
| | | Value: 6/19/20 |
| | Expiration Date: |
| | | Value: 6/19/21 |
| | Underlying Security: |
| | | Underlying Security Title: |
| Value: Common Stock |
| | | Underlying Security Shares: |
| Value: 157,143 |
| | Post-Transaction Amounts: |
| | | Shares Owned Following Transaction: |
| Value: 2,067,539 |
| | Ownership Nature: |
| | | Direct or Indirect Ownership: |
| Value: D |
| Footnotes: |
| Footnote - F1: Reporting Person acquired Issuer's Convertible Note in the principal amount of $11,000, for a purchase price of $10,000, convertible into 314,285 shares of common stock of Issuer. |
| Footnote - F2: Not Applicable. |
| Footnote - F3: Reporting Person acquired Issuer's Warrants as part of Reporting Person's purchase of Issuer's Convertible Note reported above. |
| Owner Signature: |
| Signature Name: /s/ Richard W. Munn |
| Signature Date: 6/20/20 |
