Proehl Investment Ventures LLC - 12 Aug 2021 Form 3 Insider Report for Dermata Therapeutics, Inc. (DRMA)

Role
10%+ Owner
Signature
/s/ Gerald T. Proehl, Managing Member
Issuer symbol
DRMA
Transactions as of
12 Aug 2021
Net transactions value
$0
Form type
3
Filing time
12 Aug 2021, 19:42:01 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 917,317 12 Aug 2021 Direct F1

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 Series 1d Preferred Stock 12 Aug 2021 Common Stock 2,436,657 Direct F2
holding DRMA Series 1a Preferred Stock 12 Aug 2021 Common Stock 2,295,000 Direct F3
holding DRMA Series 1b Preferred Stock 12 Aug 2021 Common Stock 3,722,500 Direct F4
holding DRMA Series 1c Preferred Stock 12 Aug 2021 Common Stock 25,582,050 Direct F5
holding DRMA Series 1 Preferred Stock 12 Aug 2021 Common Stock 1,755,622 Direct F6
holding DRMA Series 1a Warrants 12 Aug 2021 Common Stock 573,750 Direct F7
* 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 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 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.
F3 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.
F4 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.
F5 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.
F6 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.
F7 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.

Remarks:

Exhibit 24- Power of Attorney