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

Role
CEO & Director, Director
Signature
/s/ Douglas R. Baum
Issuer symbol
QSAM
Transactions as of
31 Dec 2021
Transactions value $
$9,000
Form type
5
Filing time
15 Feb 2022, 05:14:47 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 Series B Preferred Stock Purchase $9,000 +3 $3,000* 3 22 Jan 2021 Direct
transaction QSAM Series E-1 Preferred Stock Other -2,975 -100% 0 06 Dec 2021 Direct F1
transaction QSAM Common Stock Other +10,093,800 10,093,800 06 Dec 2021 Direct F1

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 Series E-1 Preferred Stock Award $0 +2,975 $0* 0 30 Dec 2020 Common Stock 2,975,000 $0 Direct F2
transaction QSAM Options to buy common Stock Award $0 +8,000 $0 8,000 14 Jan 2020 Common Stock 8,000 $0.5 Direct F3
transaction QSAM Options to buy common Stock Award $0 +125,000 $0 125,000 24 Aug 2021 Common Stock 125,000 $0.36 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 under 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 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.
F3 The options vests annually in two equal installments beginning on 1/14/2021.
F4 The option vestssemi-annually in two equal installments beginning on 02/24/2022.