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

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