Dermata Therapeutics, Inc. — Director's Dealing 2021

Aug 17, 2021

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: Dermata Therapeutics, Inc. (DRMA)
CIK: 0001853816
Period of Report: 2021-08-17

Reporting Person: HALE DAVID F (Director, 10% Owner)

Non-Derivative Transactions

Date	Security	Code	Shares	Price	A/D	Holdings After	Ownership
2021-08-17	Common Stock	C	44777	—	Acquired	299411	Indirect
2021-08-17	Common Stock	C	12195	—	Acquired	311606	Indirect
2021-08-17	Common Stock	C	20000	—	Acquired	331606	Indirect
2021-08-17	Common Stock	C	174216	—	Acquired	505822	Indirect
2021-08-17	Common Stock	C	27103	—	Acquired	532925	Indirect
2021-08-17	Common Stock	P	35714	—	Acquired	35714	Indirect

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2021-08-17	Series 1d Preferred Stock	$	C	302112	Disposed		Common Stock (44777)	Indirect
2021-08-17	Series 1a Preferred Stock	$	C	250000	Disposed		Common Stock (12195)	Indirect
2021-08-17	Series 1b Preferred Stock	$	C	410000	Disposed		Common Stock (20000)	Indirect
2021-08-17	Series 1c Preferred Stock	$	C	3571428	Disposed		Common Stock (174216)	Indirect
2021-08-17	Series 1 Preferred Stock	$	C	555622	Disposed		Common Stock (27103)	Indirect
2021-08-17	Series 1a Warrants	$	C	62500	Disposed	2026-03-14	Common Stock (3048)	Indirect
2021-08-17	Warrant to Purchase Common Stock	$20.50	C	3048	Acquired	2026-03-14	Common Stock (3048)	Indirect
2021-08-17	Warrant to Purchase Common Stock	$7.00	P	35714	Acquired	2026-08-17	Common Stock (35714)	Indirect

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	3658	Direct
Common Stock	12195	Indirect

Footnotes

F1: The Series 1d Preferred Stock automatically converted into Common Stock of the Issuer upon consummation of the Issuer's initial public offering (the "IPO"). The Series 1d Preferred Stock was convertible at any time and had no expiration date.

F2: The Series 1a Preferred Stock converted into Common Stock of the Issuer upon consummation of the IPO. The Series 1a Preferred Stock was convertible at any time and had no expiration date.

F3: The Series 1b Preferred Stock converted into Common Stock of the Issuer upon consummation of the IPO. The Series 1b Preferred Stock was convertible at any time and had no expiration date.

F4: The Series 1c Preferred Stock converted into Common Stock of the Issuer upon consummation of the IPO. The Series 1c Preferred Stock was convertible at any time and had no expiration date.

F5: The Series 1 Preferred Stock converted into Common Stock of the Issuer upon consummation of the IPO. The Series 1 Preferred Stock was convertible at any time and had no expiration date.

F6: The Series 1a Preferred Warrants converted into warrants to purchase Common Stock in connection with the IPO.

F7: Reporting Person disclaims beneficial ownership of these securities except to the extent of their pecuniary interest therein, and the inclusion of these shares in this report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or for any other purpose.

F8: Reporting Person purchased 35,714 Units in the IPO at $7.00 per Unit. Each Unit consists of one share of Common Stock and one warrant to purchase one share of Common Stock.