PROEHL GERALD T - 12 Aug 2021 Form 3 Insider Report for Dermata Therapeutics, Inc. (DRMA)

Role
Pres., CEO and Chairman, 10%+ Owner
Signature
/s/ Gerald T. Proehl
Issuer symbol
DRMA
Transactions as of
12 Aug 2021
Net transactions value
$0
Form type
3
Filing time
12 Aug 2021, 19:34:35 UTC
Previous filing
15 Jun 2021
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 39,512 12 Aug 2021 Direct F1
holding DRMA Common Stock 917,317 12 Aug 2021 By Proehl Investment Ventures LLC F1, F12

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 49,462 $5.74 Direct F1
holding DRMA Stock Option (Right to Buy) 12 Aug 2021 Common Stock 37,852 $5.74 Direct F2
holding DRMA Stock Option (Right to Buy) 12 Aug 2021 Common Stock 9,756 $5.74 Direct F3
holding DRMA Stock Option (Right to Buy) 12 Aug 2021 Common Stock 9,756 $5.74 Direct F4
holding DRMA Stock Option (Right to Buy) 12 Aug 2021 Common Stock 48,780 $6.31 Direct F5
holding DRMA Stock Option (Right to Buy) 12 Aug 2021 Common Stock 10,927 $6.31 Direct F6
holding DRMA Series 1d Preferred Stock 12 Aug 2021 Common Stock 120,481 By Allison Taylor Proehl 2020 Irrevocable Trust F7, F12
holding DRMA Series 1d Preferred Stock 12 Aug 2021 Common Stock 60,240 By Meghan Proehl Wilder 2020 Irrevocable Trust F7, F12
holding DRMA Series 1d Preferred Stock 12 Aug 2021 Common Stock 241,325 By Sean Michael Proehl 2020 Irrevocable Trust Dated December 18, 2020 F7, F12
holding DRMA Series 1d Preferred Stock 12 Aug 2021 Common Stock 2,436,657 By Proehl Investment Ventures LLC F7, F13
holding DRMA Series 1a Preferred Stock 12 Aug 2021 Common Stock 2,295,000 By Proehl Investment Ventures LLC F8, F13
holding DRMA Series 1b Preferred Stock 12 Aug 2021 Common Stock 3,722,500 By Proehl Investment Ventures LLC F9, F13
holding DRMA Series 1c Preferred Stock 12 Aug 2021 Common Stock 25,582,050 By Proehl Investment Ventures LLC F10, F13
holding DRMA Series 1 Preferred Stock 12 Aug 2021 Common Stock 1,755,622 By Proehl Investment Ventures LLC F11, F13
holding DRMA Series 1a Warrants 12 Aug 2021 Common Stock 573,750 By Proehl Investment Ventures LLC F12, F13
* 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 (the "Stock Split").
F2 Options vest in 48 equal monthly installments commencing December 11, 2019. Shares reported reflect the Stock Split.
F3 Options vest in 48 equal monthly installments commencing December 19, 2018. Shares reported reflect the Stock Split.
F4 Options vest in 48 equal monthly installments commencing January 1, 2018. Shares reported reflect the Stock Split.
F5 Options vest in 48 equal monthly installments commencing January 1, 2021. Shares reported reflect the Stock Split.
F6 Options vest in 35 equal monthly installments commencing January 11, 2021. Shares reported reflect the Stock Split.
F7 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 361,147 Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F8 The Series 1a Preferred Stock is convertible into shares of Common Stock in connection with the Issuer's IPO. All shares of Series 1a Preferred Stock will be converted into 111,951 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F9 The Series 1b Preferred Stock is convertible into shares of Common Stock in connection with the Issuer's IPO. All shares of Series 1b Preferred Stock will be converted into 181,585 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F10 The Series 1c Preferred Stock is convertible into shares of Common Stock in connection with the Issuer's IPO. All shares of Series 1c Preferred Stock will be converted into 1,247,904 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F11 The Series 1 Preferred Stock is convertible into shares of Common Stock in connection with the Issuer's IPO. All shares of Series 1 Preferred Stock will be converted into 85,640 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F12 The Series 1a Preferred Warrants are convertible into warrants to purchase Common Stock in connection with the Issuer's IPO. All Series 1a Preferred Warrants will be converted into warrants exercisable at $20.50 per share, to purchase up to 27,987 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio and exercise price reflect the Stock Split.
F13 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