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| Share Name | Share Symbol | Market | Type |
|---|---|---|---|
| Common Stock (QB) | USOTC:QSAM | OTCMarkets | Common Stock |
| Price Change | % Change | Share Price | Bid Price | Offer Price | High Price | Low Price | Open Price | Shares Traded | Last Trade | |
|---|---|---|---|---|---|---|---|---|---|---|
| -0.05 | -0.64% | 7.75 | 7.73 | 7.97 | 7.80 | 7.70 | 7.80 | 36,481 | 21:49:51 |
| 1. Name and Address of Reporting Person * Peitz Tristan | 2. Issuer Name and Ticker or Trading SymbolQSAM Biosciences, Inc. [QSAM] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) __X__ Other (specify below) Former Director |
| 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) | ||
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form Filed by One Reporting Person ___ Form Filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
| 1.Title of Security (Instr. 3) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Amount | (A) or (D) | Price | ||||||||
| COMMON STOCK | 12/17/2020 | A4 | 36364 (1) | A | $0.22 | 36364 | D | |||
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
| 1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (MM/DD/YYYY) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||||
| Options to Buy Common Stock | $0.50 | 12/1/2018 | 6/1/2028 | COMMON STOCK | 32000 | 32000 | D | ||||||||
| Options to Buy Common Stock | $0.50 | 1/6/2020 | A4 | 40000 | 1/6/2020 | 1/6/2030 | COMMON STOCK | 40000 | $0.00 | 40000 | D | ||||
| Explanation of Responses: | |
| (1) | Shares acquired upon conversion of accrued directors fees at a conversion price of $0.22 per share. |
| Reporting Owners | |||||
| Reporting Owner Name / Address | |||||
| Director | 10% Owner | Officer | Other | ||
| Peitz Tristan 420 ROYAL PALM WAY, #100, PALM BEACH, FL 33480 | X | Former Director | |||
| Signatures | ||
| /s/ Tristan Peitz | 2/16/2021 | |
| **Signature of Reporting Person | Date | |
1 Year Common Stock (QB) Chart |
1 Month Common Stock (QB) Chart |
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