Form 4 for DRMA Dermata Therapeutics, Inc.

Accepted 2021-08-17 00:00:00 ET · period of report 2021-08-17 · accession 0000905718-21-001098 · SEC index · Original document

Summary rows

Aggregated the way they appear in lists: one row per insider, transaction code and security table.

X	Filed	Traded	Ticker	Insider	Title	Type	Price	Qty	Owned	ΔOwn	Value
DI	2021-08-17	2021-08-17	DRMA	INSLEY THOMAS	CFO	C - Cnv Deriv	—	+4,581	14.3K	+47%	—
DI	2021-08-17	2021-08-17	DRMA	INSLEY THOMAS	CFO	C - Cnv Deriv	$0.00	-30.9K	0	-100%	$0

Purchase Sale Sale after option exercise All abbreviations

#	Table	Security	Date	Code	A/D	Shares	Price	Owned after	Own	Exercise / expiry	Underlying	Footnotes
1	Common	Common Stock	2021-08-17	C	A	4,581	—	14,337	I By Insley Family Trust	—	—	(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.
2	Derivative	Series 1d Preferred Stock	2021-08-17	C	D	30,910	$0.00	0	I By Insley Family Trust	— · — to —	4,581 Common Stock	(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. (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.