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