0000905718-22-000113.txt : 20220114
0000905718-22-000113.hdr.sgml : 20220114
20220114171048
ACCESSION NUMBER: 0000905718-22-000113
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220112
FILED AS OF DATE: 20220114
DATE AS OF CHANGE: 20220114
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bradrick Brittany
CENTRAL INDEX KEY: 0001904176
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40739
FILM NUMBER: 22532629
MAIL ADDRESS:
STREET 1: C/O DERMATA THERAPEUTICS, INC.
STREET 2: 3525 DEL MAR HEIGHTS RD., #322
CITY: SAN DIEGO
STATE: CA
ZIP: 92130
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_fm4jan122022.xml
X0306
4
2022-01-12
0
0001853816
Dermata Therapeutics, Inc.
DRMA
0001904176
Bradrick Brittany
C/O DERMATA THERAPEUTICS, INC.
3525 DEL MAR HEIGHTS RD., #322
SAN DIEGO
CA
92130
1
0
0
0
Stock Option (right to Buy)
1.50
2022-01-12
4
A
0
10000
0
A
2032-01-11
Common Stock
10000
10000
D
The option vests in twelve equal monthly installments commencing on January 12, 2022.
/s/ Gerald T. Proehl, Attorney-in-Fact
2022-01-14