0000905718-22-000566.txt : 20220408
0000905718-22-000566.hdr.sgml : 20220408
20220408191506
ACCESSION NUMBER: 0000905718-22-000566
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: Sandler Andrew Seth
CENTRAL INDEX KEY: 0001596060
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40739
FILM NUMBER: 22818236
MAIL ADDRESS:
STREET 1: 1301 2ND AVE
CITY: SEATTLE
STATE: WA
ZIP: 98101
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
0001596060
Sandler Andrew Seth
3525 DEL MAR HEIGHTS RD., #322
SAN DIEGO
CA
92130
1
0
0
0
Common Stock, par value $0.0001 per share
2022-04-07
4
A
0
5190
0
A
5190
D
On April 7, 2022, the Reporting Person was granted 5,190 Common Stock restricted units pursuant to the Issuer's 2021 Omnibus Equity Incentive Plan.
/s/ Gerald T. Proehl, Attorney-in-Fact
2022-04-08