Richard C. Piazza - Dec 31, 2021 Form 5 Insider Report for QSAM Biosciences, Inc. (QSAM)

Role
Executive Chairman, Director
Signature
/s/ C. Richard Piazza
Stock symbol
QSAM
Transactions as of
Dec 31, 2021
Transactions value $
$0
Form type
5
Date filed
2/15/2022, 12:54 PM
Next filing
Mar 7, 2022
SEC
View on sec.gov

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction QSAM Series E-1 Preferred Stock Other -2.98K -100% 0 Dec 6, 2021 Direct F1
transaction QSAM Common Stock Other +10.1M 10.1M Dec 6, 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 Options to buy common stock Award $0 +125K $0.00 125K Aug 24, 2021 Common Stock 125K $0.36 Direct F2
transaction QSAM Series E-1 Preferred Stock Award $0 +2.98K $0.00* 0 Dec 30, 2020 Common Stock 2.98M $0.00 Direct F3
* 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 The option vests semi-annually in two equal installments beginning on 02/24/2022.
F3 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