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: INSLEY THOMAS (Chief Financial Officer)

Holdings (Non-Derivative)

Security	Shares	Ownership
Common Stock	9756	Indirect

Holdings (Derivative)

Security	Exercise Price	Expiration	Underlying	Shares	Ownership
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 (2439)		Direct
Series 1d Preferred Stock	$		Common Stock (30910)		Indirect

Footnotes

F1: Shares reported reflect the 1 for 20.5 stock split effected July 1, 2021.

F2: Options vest in 48 equal monthly installments commencing January 1, 2021.

F3: 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 4,581 shares of Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.

F4: 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.