0001654954-22-013525.txt : 20221007 0001654954-22-013525.hdr.sgml : 20221007 20221007170545 ACCESSION NUMBER: 0001654954-22-013525 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: WIERENGA WENDELL CENTRAL INDEX KEY: 0001239956 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40739 FILM NUMBER: 221301385 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 section16.xml PRIMARY DOCUMENT X0306 4 2022-10-06 0001853816 Dermata Therapeutics, Inc. DRMA 0001239956 WIERENGA WENDELL 3525 DEL MAR HEIGHTS RD., #322 SAN DIEGO CA 92130 true Common Stock 2022-10-06 4 A false 20654 0 A 62398 D On October 6, 2022, the Reporting Person was granted 20,654 Common Stock restricted units pursuant to the Issuer's 2021 Omnibus Equity Incentive Plan. /s/ Gerald T. Proehl, Attorney-in-Fact 2022-10-07