Filing Details

Accession Number:
0001493152-22-004619
Form Type:
5
Zero Holdings:
No
Publication Time:
2022-02-14 21:58:44
Reporting Period:
2021-12-31
Accepted Time:
2022-02-14 21:58:44
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1310527 Qsam Biosciences Inc. QSAM Specialty Cleaning, Polishing And Sanitation Preparations (2842) 201602779
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1529012 M. Christopher Nelson 9442 Capital Of Texas Hwy N,
Plaza 1, Suite 500
Austin TX 78759
General Counsel And Director Yes Yes No No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Preferred Series B Stock Acquisiton 2021-01-22 20 $20,000.00 20 No 4 P Direct
Series E-1 Preferred Shares Disposition 2021-12-06 850 $0.00 0 No 5 J Direct
Common Stock Acquisiton 2021-12-06 2,883,943 $0.00 2,883,943 No 5 J Direct
Common Stock Acquisiton 2020-10-25 423,609 $0.00 3,307,552 No 4 A Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Direct
No 5 J Direct
No 5 J Direct
No 4 A Direct
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Options to buy common stock Acquisiton 2021-08-24 115,000 $0.00 115,000 $0.36
Common Stock Series E-1 Preferred Shares Acquisiton 2020-12-30 850 $0.00 850,000 $0.00
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
115,000 2031-08-23 No 4 A Direct
0 No 4 A Direct
Footnotes
  1. 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.
  2. Shares acquired upon conversion of deferred salary and earned bonus.
  3. The option vests semi-annually in two equal installments beginning on 02/24/2022.
  4. 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.