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