0001104659-21-116360.txt : 20210916
0001104659-21-116360.hdr.sgml : 20210916
20210916160719
ACCESSION NUMBER: 0001104659-21-116360
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210914
FILED AS OF DATE: 20210916
DATE AS OF CHANGE: 20210916
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Rome Zachary
CENTRAL INDEX KEY: 0001809611
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37411
FILM NUMBER: 211258034
MAIL ADDRESS:
STREET 1: C/O TIMBER PHARMACEUTICALS, INC.
STREET 2: 900 E. HAMILTON AVENUE, SUITE 100
CITY: CAMPBELL
STATE: CA
ZIP: 95008
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Timber Pharmaceuticals, Inc.
CENTRAL INDEX KEY: 0001504167
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 593843182
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 110 ALLEN ROAD, SUITE 401
CITY: BASKING RIDGE
STATE: NJ
ZIP: 07920
BUSINESS PHONE: 914-205-3481
MAIL ADDRESS:
STREET 1: 110 ALLEN ROAD, SUITE 401
CITY: BASKING RIDGE
STATE: NJ
ZIP: 07920
FORMER COMPANY:
FORMER CONFORMED NAME: BioPharmX Corp
DATE OF NAME CHANGE: 20140304
FORMER COMPANY:
FORMER CONFORMED NAME: THOMPSON DESIGNS INC
DATE OF NAME CHANGE: 20101022
4
1
tm2127727-2_4seq1.xml
OWNERSHIP DOCUMENT
X0306
4
2021-09-14
0
0001504167
Timber Pharmaceuticals, Inc.
TMBR
0001809611
Rome Zachary
C/O TIMBER PHARMACEUTICALS, INC.
110 ALLEN ROAD, SUITE 401
BASKING RIDGE
NJ
07920
1
1
0
0
COO, Executive VP & Secretary
Stock Option (right to buy)
0.8925
2021-09-14
4
A
0
561000
0
A
2031-09-13
Common Stock, par value $0.001 per share
561000
561000
D
The shares underlying the options will vest in equal 36 monthly installments beginning on October 14, 2021, as long as the reporting person remains continuously employed through each vesting date.
/s/ Joseph Lucchese, Power of Attorney
2021-09-15