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