0001654954-24-000293.txt : 20240105 0001654954-24-000293.hdr.sgml : 20240105 20240105210057 ACCESSION NUMBER: 0001654954-24-000293 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: HALE DAVID F CENTRAL INDEX KEY: 0001024004 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] ORGANIZATION NAME: 03 Life Sciences STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40739 FILM NUMBER: 24518096 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] 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 PRIMARY DOCUMENT X0508 4 2024-01-04 false 0001853816 Dermata Therapeutics, Inc. DRMA 0001024004 HALE DAVID F 3525 DEL MAR HEIGHTS RD., #322 SAN DIEGO CA 92130 true false false false false Stock Option (Right to Buy) 0.6099 2024-01-04 4 A false 10000 0 A 2034-01-03 Common Stock 10000 10000 D The option vests in twelve equal monthly installments commencing January 4, 2024. /s/ Gerald T. Proehl, Attorney-in-Fact 2024-01-05