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: Proehl Investment Ventures LLC (10% Owner)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	917317	Direct

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
Series 1d Preferred Stock	$		Common Stock (2436657)		Direct
Series 1a Preferred Stock	$		Common Stock (2295000)		Direct
Series 1b Preferred Stock	$		Common Stock (3722500)		Direct
Series 1c Preferred Stock	$		Common Stock (25582050)		Direct
Series 1 Preferred Stock	$		Common Stock (1755622)		Direct
Series 1a Warrants	$	2026-03-14	Common Stock (573750)		Direct

Footnotes

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

F2: 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 361,147 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F3: 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 111,951 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F4: 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 181,585 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F5: 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 1,247,904 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F6: 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 85,640 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F7: 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 27,987 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio and exercise price reflect the Stock Split.