0000905718-22-000562.txt : 20220408 0000905718-22-000562.hdr.sgml : 20220408 20220408191215 ACCESSION NUMBER: 0000905718-22-000562 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220407 FILED AS OF DATE: 20220408 DATE AS OF CHANGE: 20220408 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: HALE DAVID F CENTRAL INDEX KEY: 0001024004 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40739 FILM NUMBER: 22818230 MAIL ADDRESS: STREET 1: 1042-B NORTH EL CAMINO REAL, SUITE 430 CITY: ENCINITAS STATE: CA ZIP: 92024 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Dermata Therapeutics, Inc. CENTRAL INDEX KEY: 0001853816 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] 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 dermata_fm4apr72022.xml X0306 4 2022-04-07 0 0001853816 Dermata Therapeutics, Inc. DRMA 0001024004 HALE DAVID F 3525 DEL MAR HEIGHTS RD., #322 SAN DIEGO CA 92130 1 0 0 0 Common Stock 2022-04-07 4 A 0 15466 0 A 19124 D Common Stock 12195 I By Hale Trading Company L.P. Common Stock 254634 I By Hale BioVentures LLC On April 7, 2022, the Reporting Person was granted 15,466 Common Stock restricted units pursuant to the Issuer's 2021 Omnibus Equity Incentive Plan. 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. /s/ Gerald T. Proehl, Attorney-in-Fact 2022-04-08