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