THOMAS INSLEY - 12 Aug 2021 Form 3 Insider Report for Dermata Therapeutics, Inc. (DRMA)

Role
Chief Financial Officer
Signature
/s/ Gerald T. Proehl, Attorney-in Fact
Issuer symbol
DRMA
Transactions as of
12 Aug 2021
Transactions value $
$0
Form type
3
Filing time
12 Aug 2021, 19:33:03 UTC
Next filing
17 Aug 2021
SEC
View on sec.gov

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
holding DRMA Common Stock 9,756 12 Aug 2021 By Insley Family Trust F4

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
holding DRMA Stock Option (Right to Buy) 12 Aug 2021 Common Stock 2,439 $5.74 Direct F1
holding DRMA Stock Option (Right to Buy) 12 Aug 2021 Common Stock 2,439 $5.74 Direct F1, F2
holding DRMA Series 1d Preferred Stock 12 Aug 2021 Common Stock 30,910 By Insley Family Trust F3, F4
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Shares reported reflect the 1 for 20.5 stock split effected July 1, 2021.
F2 Options vest in 48 equal monthly installments commencing January 1, 2021.
F3 The Series 1d Preferred Stock is convertible into shares of Common Stock at a conversion ratio equal to 80% of the offering price in connection with the Issuer's initial public offering ("IPO"). All shares of Series 1d Preferred Stock will be converted into 4,581 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F4 Reporting person disclaims beneficial ownership of these securities except to the extent of their pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.

Remarks:

Exhibit 24: Power of Attorney