0001654954-24-000299.txt : 20240105
0001654954-24-000299.hdr.sgml : 20240105
20240105210258
ACCESSION NUMBER: 0001654954-24-000299
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240104
FILED AS OF DATE: 20240105
DATE AS OF CHANGE: 20240105
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: PROEHL GERALD T
CENTRAL INDEX KEY: 0001279191
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
ORGANIZATION NAME: 03 Life Sciences
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40739
FILM NUMBER: 24518105
BUSINESS ADDRESS:
STREET 1: 10590 W OCEAN AIR DR
STREET 2: STE 200
CITY: SAN DIEGO
STATE: CA
ZIP: 92130
BUSINESS PHONE: 8583145700
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Dermata Therapeutics, Inc.
CENTRAL INDEX KEY: 0001853816
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
ORGANIZATION NAME: 03 Life Sciences
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 3525 DEL MAR HEIGHTS RD., #322
CITY: SAN DIEGO
STATE: CA
ZIP: 92130
BUSINESS PHONE: (858)-223-0882
MAIL ADDRESS:
STREET 1: 3525 DEL MAR HEIGHTS RD., #322
CITY: SAN DIEGO
STATE: CA
ZIP: 92130
4
1
section16.xml
FORM 4
X0508
4
2024-01-04
0001853816
Dermata Therapeutics, Inc.
DRMA
0001279191
PROEHL GERALD T
3525 DEL MAR HEIGHTS RD.
#322
SAN DIEGO
CA
92130
true
true
President, CEO and Chairman
false
Stock Option (right to buy)
0.6099
2024-01-04
4
A
false
125000
0
A
2034-01-03
Common Stock
125000
125000
D
The shares underlying the option will vest as to 25% upon the 12-month anniversary of the grant date, and will vest as to 75% in 36 equal monthly installments commencing on the 12-month anniversary of the grant date.
/s/ Gerald T. Proehl
2024-01-05