Christopher Nelson - 31 Dec 2021 Form 5 Insider Report for QSAM Biosciences, Inc. (QSAM)

Role
General Counsel and Director, Director
Signature
/s/ Christopher Nelson
Issuer symbol
QSAM
Transactions as of
31 Dec 2021
Transactions value $
$400,000
Form type
5
Filing time
14 Feb 2022, 20:58:44 UTC
Next filing
07 Mar 2022
SEC
View on sec.gov

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction QSAM Preferred Series B Stock Purchase $400,000 +20 $20,000* 20 22 Jan 2021 Direct
transaction QSAM Series E-1 Preferred Shares Other -850 -100% 0 06 Dec 2021 Direct F1
transaction QSAM Common Stock Other +2,883,943 2,883,943 06 Dec 2021 Direct F1
transaction QSAM Common Stock Award +423,609 +14.69% 3,307,552 25 Oct 2020 Direct F2

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
transaction QSAM Options to buy common stock Award $0 +115,000 $0 115,000 24 Aug 2021 Common Stock 115,000 $0.36 Direct F3
transaction QSAM Series E-1 Preferred Shares Award $0 +850 $0* 0 30 Dec 2020 Common Stock 850,000 $0 Direct F4
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Pursuant to reclassification exempt tunde Rule 16b-7, each share of Series E-1 Preferred Stock was reclassified into and exchanged for shares of Common Stock of the Issuer under the terms of Exchange Agreement and Plan of Reorganization as filed with the SEC.
F2 Shares acquired upon conversion of deferred salary and earned bonus.
F3 The option vests semi-annually in two equal installments beginning on 02/24/2022.
F4 Series E-1 Preferred Stock was convertible at any time at the discretion of the holder at a ratio of 1000 shares of Common Stock per Series E-1 Preferred Stock.