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