0001209191-21-027810.txt : 20210421
0001209191-21-027810.hdr.sgml : 20210421
20210421164639
ACCESSION NUMBER: 0001209191-21-027810
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210419
FILED AS OF DATE: 20210421
DATE AS OF CHANGE: 20210421
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Jacobs Gary E.
CENTRAL INDEX KEY: 0001726114
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38118
FILM NUMBER: 21842077
MAIL ADDRESS:
STREET 1: C/O MOTUS GI HOLDINGS, INC.
STREET 2: 1301 BROWARD BLVD., 3RD FLOOR
CITY: FT. LAUDERDALE
STATE: FL
ZIP: 33301
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: DermTech, Inc.
CENTRAL INDEX KEY: 0001651944
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071]
IRS NUMBER: 842870849
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 11099 N. TORREY PINES ROAD
STREET 2: SUITE 100
CITY: LA JOLLA
STATE: CA
ZIP: 92037
BUSINESS PHONE: 858-450-4222
MAIL ADDRESS:
STREET 1: 11099 N. TORREY PINES ROAD
STREET 2: SUITE 100
CITY: LA JOLLA
STATE: CA
ZIP: 92037
FORMER COMPANY:
FORMER CONFORMED NAME: Constellation Alpha Capital Corp.
DATE OF NAME CHANGE: 20150827
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-04-19
0
0001651944
DermTech, Inc.
DMTK
0001726114
Jacobs Gary E.
C/O DERMTECH, INC.
11099 N. TORREY PINES RD., SUITE 100
LA JOLLA
CA
92037
1
0
0
0
Common Stock
2021-04-19
4
M
0
692
1.08
A
526287
D
Common Stock
2021-04-19
4
M
0
3990
1.08
A
530277
D
Common Stock
2021-04-19
4
M
0
3990
1.08
A
534267
D
Common Stock
2021-04-19
4
M
0
13171
1.12
A
547438
D
Common Stock
797978
I
By Jacobs Investment Company LLC
Common Stock
624
I
By Jacobs Family Trust Dated 11-9-99
Stock Option (right to buy)
1.08
2021-04-19
4
M
0
692
0.00
D
2022-03-10
Common Stock
692
0
D
Stock Option (right to buy)
1.08
2021-04-19
4
M
0
3990
0.00
D
2023-11-07
Common Stock
3990
0
D
Stock Option (right to buy)
1.08
2021-04-19
4
M
0
3990
0.00
D
2024-02-25
Common Stock
3990
0
D
Stock Option (right to buy)
1.12
2021-04-19
4
M
0
13171
0.00
D
2029-01-04
Common Stock
13171
0
D
These shares of issuer common stock are directly held by Jacobs Investment Company LLC. Reporting person is the managing member of Jacobs Investment Company LLC. Reporting person exercises sole dispositive and sole voting power over the shares owned by Jacobs Investment Company LLC. Reporting person disclaims, for purposes of Section 16 of the Securities Exchange Act of 1934, beneficial ownership of such securities, except to the extent of his indirect pecuniary interest therein, and this report shall not be deemed an admission that reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purposes.
These shares of issuer common stock may be deemed beneficially owned by the reporting person as Trustee of the Jacobs Family Trust Dated 11-9-99.
This option is fully vested and exercisable.
/s/ Jason S. Miller, attorney-in-fact
2021-04-21