HALE DAVID F - 12 Aug 2021 Form 3 Insider Report for Dermata Therapeutics, Inc. (DRMA)

Role
Director
Signature
/s/ Gerald T. Proehl, Attorney-in Fact
Issuer symbol
DRMA
Transactions as of
12 Aug 2021
Net transactions value
$0
Form type
3
Filing time
12 Aug 2021, 19:35:48 UTC
Previous filing
20 Jul 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 3,658 12 Aug 2021 Direct F1
holding DRMA Common Stock 12,195 12 Aug 2021 By Hale Trading Company LP F1, F9
holding DRMA Common Stock 254,634 12 Aug 2021 By Hale BioVentures LLC F1, F9

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 12,194 $5.74 Direct F1
holding DRMA Stock Option (Right to Buy) 12 Aug 2021 Common Stock 4,878 $5.74 Direct F1, F2
holding DRMA Series 1d Preferred Stock 12 Aug 2021 Common Stock 302,112 By Hale BioVentures LLC F3, F9
holding DRMA Series 1a Preferred Stock 12 Aug 2021 Common Stock 250,000 By Hale BioVentures LLC F4, F9
holding DRMA Series 1b Preferred Stock 12 Aug 2021 Common Stock 410,000 By Hale BioVentures LLC F5, F9
holding DRMA Series 1c Preferred Stock 12 Aug 2021 Common Stock 3,571,428 By Hale BioVentures LLC F6, F9
holding DRMA Series 1 Preferred Stock 12 Aug 2021 Common Stock 555,622 By Hale BioVentures LLC F7, F9
holding DRMA Series 1a Warrants 12 Aug 2021 Common Stock 62,500 By Hale BioVentures LLC F8, F9
* 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 12 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 44,777 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F4 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 12,195 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F5 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 20,000 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F6 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 174,216 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F7 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 27,103 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F8 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 3,048 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio and exercise price reflect the Stock Split.
F9 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