Thomas Insley - Aug 17, 2021 Form 4 Insider Report for Dermata Therapeutics, Inc. (DRMA)

Role: Chief Financial Officer
Signature: /s/ Gerald T. Proehl, Attorney-in-Fact
Stock symbol: DRMA
Transactions as of: Aug 17, 2021
Transactions value $: $0
Form type: 4
Date filed: 8/17/2021, 12:40 PM
Previous filing: Aug 12, 2021

Transactions Table

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Ownership	Footnotes
transaction	DRMA	Common Stock	Conversion of derivative security		+4.58K	+46.96%		14.3K	Aug 17, 2021	By Insley Family Trust	F1, F2

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
transaction	DRMA	Series 1d Preferred Stock	Conversion of derivative security	$0	-30.9K	-100%	$0.00^*	0	Aug 17, 2021	Common Stock	4.58K		By Insley Family Trust	F1, F2

* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id	Content
F1	The Series 1d Preferred Stock converted into Common Stock of the Issuer upon consummation of the Issuer's initial public offering (the "IPO"). The Series 1d Preferred Stock was convertible at any time and had no expiration date.
F2	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.