0001209191-21-026370.txt : 20210412 0001209191-21-026370.hdr.sgml : 20210412 20210412164837 ACCESSION NUMBER: 0001209191-21-026370 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210408 FILED AS OF DATE: 20210412 DATE AS OF CHANGE: 20210412 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jacobs Gary E. CENTRAL INDEX KEY: 0001726114 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38118 FILM NUMBER: 21821216 MAIL ADDRESS: STREET 1: C/O MOTUS GI HOLDINGS, INC. STREET 2: 1301 BROWARD BLVD., 3RD FLOOR CITY: FT. LAUDERDALE STATE: FL ZIP: 33301 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: DermTech, Inc. CENTRAL INDEX KEY: 0001651944 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 842870849 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 11099 N. TORREY PINES ROAD STREET 2: SUITE 100 CITY: LA JOLLA STATE: CA ZIP: 92037 BUSINESS PHONE: 858-450-4222 MAIL ADDRESS: STREET 1: 11099 N. TORREY PINES ROAD STREET 2: SUITE 100 CITY: LA JOLLA STATE: CA ZIP: 92037 FORMER COMPANY: FORMER CONFORMED NAME: Constellation Alpha Capital Corp. DATE OF NAME CHANGE: 20150827 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-04-08 0 0001651944 DermTech, Inc. DMTK 0001726114 Jacobs Gary E. C/O DERMTECH, INC. 11099 N. TORREY PINES RD., SUITE 100 LA JOLLA CA 92037 1 0 0 0 Common Stock 2021-04-08 4 A 0 1692 0.00 A 525595 D Common Stock 797978 I By Jacobs Investment Company LLC Common Stock 624 I By Jacobs Family Trust Dated 11-9-99 The securities awarded are in the form of restricted stock units issued pursuant to the issuer's 2020 Equity Incentive Plan. Each restricted stock unit represents a contingent right to receive one share of issuer common stock. The award is fully vested and the shares of common stock underlying the restricted stock units will be released to the reporting person on January 10, 2022. These shares of issuer common stock are directly held by Jacobs Investment Company LLC. Reporting person is the managing member of Jacobs Investment Company LLC. Reporting person exercises sole dispositive and sole voting power over the shares owned by Jacobs Investment Company LLC. Reporting person disclaims, for purposes of Section 16 of the Securities Exchange Act of 1934, beneficial ownership of such securities, except to the extent of his indirect pecuniary interest therein, and this report shall not be deemed an admission that reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purposes. These shares of issuer common stock may be deemed beneficially owned by the reporting person as Trustee of the Jacobs Family Trust Dated 11-9-99. /s/ Jason S. Miller, attorney-in-fact 2021-04-12