0001654954-22-013528.txt : 20221007
0001654954-22-013528.hdr.sgml : 20221007
20221007170606
ACCESSION NUMBER: 0001654954-22-013528
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20221006
FILED AS OF DATE: 20221007
DATE AS OF CHANGE: 20221007
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: 221301392
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
section16.xml
PRIMARY DOCUMENT
X0306
4
2022-10-06
0001853816
Dermata Therapeutics, Inc.
DRMA
0001024004
HALE DAVID F
3525 DEL MAR HEIGHTS RD.
#322
SAN DIEGO
CA
92130
true
false
false
false
Common Stock
2022-10-06
4
A
false
30155
0
A
75720
D
Common Stock
12195
I
By Hale Trading Company L.P.
Common Stock
35714
I
By Hale Family Trust
Common Stock
532925
I
By Hale BioPharma Ventures LLC
On October 6, 2022, the Reporting Person was granted 30,155 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
2022-10-07