Dermata Therapeutics, Inc. — Director's Dealing 2021

Aug 13, 2021

SEC Form 3 — Initial Statement of Beneficial Ownership

Issuer: Dermata Therapeutics, Inc. (DRMA)
CIK: 0001853816
Period of Report: 2021-08-12

Reporting Person: Bedoya-Toro Munera Maria E (Senior VP)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	30487	Direct
Common Stock	19512	Indirect

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Stock Option (Right to Buy)	$5.74	2031-03-31	Common Stock (15608)		Direct
Stock Option (Right to Buy)	$5.74	2031-03-31	Common Stock (4878)		Direct
Stock Option (Right to Buy)	$5.74	2031-03-31	Common Stock (2439)		Direct
Stock Option (Right to Buy)	$5.74	2031-03-31	Common Stock (4878)		Direct
Stock Option (Right to Buy)	$5.74	2031-03-31	Common Stock (4878)		Direct
Series 1d Preferred Stock	$		Common Stock (61821)		Indirect
Series 1a Preferred Stock	$		Common Stock (400000)		Indirect
Series 1b Preferred Stock	$		Common Stock (100000)		Indirect
Series 1c Preferred Stock	$		Common Stock (357142)		Indirect
Series 1 Preferred Stock	$		Common Stock (280000)		Indirect
Series 1a Warrants	$	2026-03-14	Common Stock (100000)		Indirect

Footnotes

F1: Shares reported reflect the 1 for 20.5 stock split effected July 1, 2021 (the "Stock Split").

F2: Options vest in 48 equal monthly installments commencing January 1, 2018.

F3: Options vest in 48 equal monthly installments commencing December 19, 2018.

F4: Options vest in 48 equal monthly installments commencing December 11, 2019.

F5: Options vest in 48 equal monthly installments commencing January 1, 2021.

F6: The Series 1d Preferred Stock is convertible into shares of Common Stock at a conversion ratio equal to 80% of the offering price in connection with the Issuer's initial public offering ("IPO"). All shares of Series 1d Preferred Stock will be converted into 9,162 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F7: The Series 1a Preferred Stock is convertible into shares of Common Stock in connection with the Issuer's IPO. All shares of Series 1a Preferred Stock will be converted into 19,512 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F8: The Series 1b Preferred Stock is convertible into shares of Common Stock in connection with the Issuer's IPO. All shares of Series 1b Preferred Stock will be converted into 4,878 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F9: The Series 1c Preferred Stock is convertible into shares of Common Stock in connection with the Issuer's IPO. All shares of Series 1c Preferred Stock will be converted into 17,421 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F10: The Series 1 Preferred Stock is convertible into shares of Common Stock in connection with the Issuer's IPO. All shares of Series 1 Preferred Stock will be converted into 13,658 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F11: The Series 1a Preferred Warrants are convertible into warrants to purchase Common Stock in connection with the Issuer's IPO. All Series 1a Preferred Warrants will be converted into warrants exercisable at $20.50 per share, to purchase up to 4,878 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio and exercise price reflect the Stock Split.

F12: 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.