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