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

Role
10%+ Owner
Signature
/s/ Gerald T. Proehl, Managing Member
Stock symbol
DRMA
Transactions as of
Aug 12, 2021
Transactions value $
$0
Form type
3
Date filed
8/12/2021, 07:42 PM
Next filing
Aug 17, 2021

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
holding DRMA Common Stock 917K Aug 12, 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 Aug 12, 2021 Common Stock 2.44M Direct F2
holding DRMA Series 1a Preferred Stock Aug 12, 2021 Common Stock 2.3M Direct F3
holding DRMA Series 1b Preferred Stock Aug 12, 2021 Common Stock 3.72M Direct F4
holding DRMA Series 1c Preferred Stock Aug 12, 2021 Common Stock 25.6M Direct F5
holding DRMA Series 1 Preferred Stock Aug 12, 2021 Common Stock 1.76M Direct F6
holding DRMA Series 1a Warrants Aug 12, 2021 Common Stock 574K 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