QS Energy, Inc. — Director's Dealing 2019

Feb 21, 2019

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: QS Energy, Inc. (QSEP)
CIK: 0001103795
Period of Report: 2019-02-21

Reporting Person: Lane Jason B (Director, Chief Executive Officer)

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2019-02-21	Convertible Note	$0.05	A		Acquired		Common Stock (550000)	Direct
2019-02-21	Warrants	$0.05	A	275000	Acquired	2020-02-21	Common Stock (275000)	Direct

Footnotes

F1: Reporting Person acquired Issuer's Convertible Note in the principal amount of $27,500, for a purchase price of $25,000, convertible into 550,000 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.