SEC FORM 3

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Jacobs Joan

(Last)

(First)

(Middle)

2710 IVERNESS COURT

(Street)

LA JOLLA

92037

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
08/29/2019

3. Issuer Name and Ticker or Trading Symbol
DermTech, Inc. [ DMTK ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	10% Owner
Officer (give title below)		Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	1,766,502⁽¹⁾⁽²⁾	I	By Irwin & Joan Jacobs Trust Dated 6-2-80⁽³⁾

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Warrant to Purchase Common Stock	08/29/2019⁽⁴⁾	05/11/2020	Common Stock	41,932⁽¹⁾⁽⁵⁾	$9.54⁽⁶⁾	I	By Irwin & Joan Jacobs Trust Dated 6-2-80⁽³⁾
Warrant to Purchase Common Stock	08/29/2019⁽⁷⁾	02/13/2021	Common Stock	41,932⁽¹⁾⁽⁵⁾	$9.54⁽⁶⁾	I	By Irwin & Joan Jacobs Trust Dated 6-2-80⁽³⁾

Explanation of Responses:

1. On August 29, 2019, Issuer completed a merger transaction (the "Merger") pursuant to an Agreement and Plan of Merger, dated May 29, 2019, by and among Issuer, DT Merger Sub, Inc., and DermTech Operations, Inc., formerly known as DermTech, Inc. ("DermTech Operations"), as filed with the Securities and Exchange Commission on Form 8-K on May 29, 2019 (the "Merger Agreement"). Pursuant to the Merger Agreement, all issued and outstanding common stock of DermTech Operations converted into and became common stock of Issuer, and all issued and outstanding warrants of DermTech Operations converted into and became warrants to purchase shares of Issuer common stock. On August 29, 2019, following the completion of the Merger, the Issuer effected a reverse stock split at a ratio of one share for every two shares of Issuer common stock outstanding (the "Reverse Stock Split").

2. 1,304,963 of the reported shares of Issuer common stock were received in connection with the Merger in exchange for shares of DermTech Operations common stock. Each share of DermTech Operations common stock was cancelled and exchanged for the right to receive 1.16150415935026 shares of common stock of Issuer. The shares of common stock of Issuer reported reflect any necessary adjustments to account for the Reverse Stock Split.

3. The securities reported herein may be deemed beneficially owned by Joan K. Jacobs as Trustee of the Irwin & Joan Jacobs Trust Dated 6-2-80.

4. On May 11, 2017, the reporting person was granted warrants to purchase shares of DermTech Operations common stock. In connection with the Merger, the warrants were cancelled and exchanged for warrants to purchase shares of Issuer common stock, on the same terms and conditions applicable to the original warrants. The warrants are fully vested and exercisable.

5. These warrants to purchase Issuer common stock were received in connection with the Merger in exchange for warrants to purchase shares of DermTech Operations common stock. Each warrant to purchase one share of DermTech Operations common stock was cancelled and exchanged for the right to receive a warrant to purchase 1.16150415935026 shares of Issuer common stock, on the same terms and conditions applicable to the original warrant. The shares of Issuer common stock exercisable pursuant to the warrants reported reflect any necessary adjustments to account for the Reverse Stock Split.

6. The exercise price reported reflects the Reverse Stock Split.

7. On February 13, 2018, the reporting person was granted warrants to purchase shares of DermTech Operations common stock. In connection with the Merger, the warrants were cancelled and exchanged for warrants to purchase shares of Issuer common stock, on the same terms and conditions applicable to the original warrants. The warrants are fully vested and exercisable.

Remarks:

Exhibit List Exhibit 24 - Power of Attorney of Joan Jacobs

	/s/ Christian C. Hollweg, attorney-in-fact	10/17/2019
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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