QS Energy, Inc. — Director's Dealing 2017

Jan 30, 2017

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: QS Energy, Inc. (QSEP)
CIK: 0001103795
Period of Report: 2016-10-13

Reporting Person: Dickson Don (Director)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2016-10-13	Common Stock	C	770000	$0.10	Acquired	784620	Direct

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2016-10-13	Conversion of Note	$0.10	C	770000	Disposed		Common Stock (770000)	Direct
2017-01-01	Option to Purchase Common Stock	$.05	A	1000000	Acquired	2027-01-01	Common Stock (1000000)	Direct

Footnotes

F1: Common Stock purchased on 10/13/2016 pursuant to Issuer's Convertible Note, purchased by Reporting Person on 08/05/2016 in the principal amount of $77,000, for a purchase price of $70,000, convertible into 770,000 shares of common stock of Issuer.

F2: The stock options reported under item 1 above were granted to each member of Issuer's Board as equity compensation under the Issuer's Board Compensation Policy, approved by the Board on 06/19/2015. The options granted under item 1 vest at the rate of 1/12 per month, commencing 01/01/2017, with full vesting on 12/31/2017.