Ownership Submission
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FORM 4
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Check this box if no longer subject to Section 16, Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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OMB APPROVAL
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OMB Number:3235-0287Expires:January 31, 2005Estimated average burden hours per response...0.5
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1. Name and Address of Reporting Person *
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Piazza C Richard
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2. Issuer Name and Ticker or Trading Symbol
TELIX QSAM INC. [QSAM]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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__X__ Director
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_____ 10% Owner
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_____ Officer (give title below)
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_____ Other (specify below)
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Executive Chairman /
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(Last)
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(First)
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(Middle)
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9442 CAPITAL OF TEXAS HWY N, PLAZA 1, , SUITE 500
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3. Date of Earliest Transaction (Month/Day/Year)
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4. If Amendment, Date Original Filed(Month/Day/Year)
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6. Individual or Join/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security
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2. Transaction Date (Month/Day/Year)
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2A. Deemed Execution Date, if any (Month/Day/Year)
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3. Transaction Code
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4. Securities Acquired (A) or Disposed of (D)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
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6. Ownership Form: Direct (D) or Indirect (I)
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7. Nature of Indirect Beneficial Ownership
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
(e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date (Month/Day/Year)
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3A. Deemed Execution Date, if any (Month/Day/Year)
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4. Transaction Code
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5. Number of Derivative Securities Acquired (A) or Disposed of (D)
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6. Date Exercisable and Expiration Date
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7. Title and Amount of Securities Underlying Derivative Security
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8. Price of Derivative Security
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9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s)
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10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
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11. Nature of Indirect Beneficial Ownership
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Code
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V
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(A)
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(D)
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Date Exercisable
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Expriation Date
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Title
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Amount or Number of Shares
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Reporting Owners
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Reporting Owner Name / Address
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Relationships
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Director
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10% Owner
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Officer
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Other
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Piazza C Richard
9442 CAPITAL OF TEXAS HWY N, PLAZA 1,
SUITE 500
AUSTIN, TX78759
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X
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Executive Chairman
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Signatures
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/s/ Richard C. Piazza
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2024-05-02
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**Signature of Reporting Person
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Date
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Explanation of Responses:
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(*)
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If the form is filed by more than one reporting person, see Instruction 5(b)(v).
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(**)
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Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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(1)
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Pursuant to the Agreement and Plan of Merger (the "Merger Agreement") dated as of February 7, 2024, by and among QSAM Biosciences, Inc., a Delaware corporation ("Issuer"), Telix Pharmaceuticals Limited, a public limited company registered under the laws of the Commonwealth of Australia ("Telix"), Cyclone Merger Sub I, Inc. ("Merger Sub I"), a Delaware corporation and a direct, wholly owned subsidiary of Telix, Cyclone Merger Sub II, Inc., a Delaware corporation and a direct wholly owned subsidiary of Telix, and David H. Clarke, as stockholder representative to the QSAM stockholders (the "QSAM Stockholder Representative"), effective May 2, 2024 (the "Effective Time"), Merger Sub I merged with and into the Issuer, with the Issuer continuing as the surviving corporation and a wholly-owned subsidiary of Telix.
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(2)
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Pursuant to the Merger Agreement, at the Effective Time, each share of Issuer common stock, $0.0001 par value per share, issued and outstanding immediately prior to the Effective Time, was converted into the right to receive (i) 1,744 fully paid and non-assessable ordinary shares of Telix, and (ii) 2,000 non-transferable contingent value rights representing the right to receive one or more contingent payments, if any, upon the achievement of certain milestones, as set forth in the Contingent Value Rights Agreement by and among QSAM, Telix, the QSAM Stockholder Representative, and Equiniti Trust Company, LLC, as the rights agent.
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(3)
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At the Effective Time, the closing price of Telix ordinary shares was US$9.62 per share.
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(4)
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Accounts for a 1-for-2,000 reverse stock-split effective May 2, 2024.
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Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
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