0000905718-22-000572.txt : 20220408 0000905718-22-000572.hdr.sgml : 20220408 20220408192627 ACCESSION NUMBER: 0000905718-22-000572 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: WIERENGA WENDELL CENTRAL INDEX KEY: 0001239956 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40739 FILM NUMBER: 22818256 MAIL ADDRESS: STREET 1: C/O CIPHERGEN BIOSYSTEMS INC STREET 2: 6611 DUMBARTON CIRCLE CITY: FREMONT STATE: CA ZIP: 94555 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 0001239956 WIERENGA WENDELL 3525 DEL MAR HEIGHTS RD., #322 SAN DIEGO CA 92130 1 0 0 0 Common Stock 2022-04-07 4 A 0 10593 0 A 15471 D On April 7, 2022, the Reporting Person was granted 10,593 Common Stock restricted units pursuant to the Issuer's 2021 Omnibus Equity Incentive Plan. /s/ Gerald T. Proehl, Attorney-in-Fact 2022-04-08