<SEC-DOCUMENT>0000905718-21-001025.txt : 20210812
<SEC-HEADER>0000905718-21-001025.hdr.sgml : 20210812
<ACCEPTANCE-DATETIME>20210812193435
ACCESSION NUMBER:		0000905718-21-001025
CONFORMED SUBMISSION TYPE:	3
PUBLIC DOCUMENT COUNT:		2
CONFORMED PERIOD OF REPORT:	20210812
FILED AS OF DATE:		20210812
DATE AS OF CHANGE:		20210812

REPORTING-OWNER:	

	OWNER DATA:	
		COMPANY CONFORMED NAME:			PROEHL GERALD T
		CENTRAL INDEX KEY:			0001279191
		STANDARD INDUSTRIAL CLASSIFICATION:	PHARMACEUTICAL PREPARATIONS [2834]
		STATE OF INCORPORATION:			DE
		FISCAL YEAR END:			1231

	FILING VALUES:
		FORM TYPE:		3
		SEC ACT:		1934 Act
		SEC FILE NUMBER:	001-40739
		FILM NUMBER:		211169266

	BUSINESS ADDRESS:	
		STREET 1:		10590 W OCEAN AIR DR
		STREET 2:		STE 200
		CITY:			SAN DIEGO
		STATE:			CA
		ZIP:			92130
		BUSINESS PHONE:		8583145700

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., #332
		CITY:			SAN DIEGO
		STATE:			CA
		ZIP:			92130
		BUSINESS PHONE:		(858)-223-0882

	MAIL ADDRESS:	
		STREET 1:		3525 DEL MAR HEIGHTS RD., #332
		CITY:			SAN DIEGO
		STATE:			CA
		ZIP:			92130
</SEC-HEADER>
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        <issuerName>Dermata Therapeutics, Inc.</issuerName>
        <issuerTradingSymbol>DRMA</issuerTradingSymbol>
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            <expirationDate>
                <value>2026-03-31</value>
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                <underlyingSecurityShares>
                    <value>10927</value>
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                    <value>D</value>
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                    <footnoteId id="F7"/>
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            <ownershipNature>
                <directOrIndirectOwnership>
                    <value>I</value>
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                <natureOfOwnership>
                    <value>By Allison Taylor Proehl 2020 Irrevocable Trust</value>
                    <footnoteId id="F12"/>
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            <ownershipNature>
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                <natureOfOwnership>
                    <value>By Meghan Proehl Wilder 2020 Irrevocable Trust</value>
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            <securityTitle>
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            <exerciseDate>
                <footnoteId id="F7"/>
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                <footnoteId id="F7"/>
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                <underlyingSecurityTitle>
                    <value>Common Stock</value>
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                <underlyingSecurityShares>
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                    <footnoteId id="F7"/>
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                    <value>I</value>
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                <natureOfOwnership>
                    <value>By Sean Michael Proehl 2020 Irrevocable Trust Dated December 18, 2020</value>
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                <footnoteId id="F11"/>
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                    <footnoteId id="F12"/>
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                    <value>By Proehl Investment Ventures LLC</value>
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    <footnotes>
        <footnote id="F1">Shares reported reflect the 1 for 20.5 stock split effected July 1, 2021 (the &quot;Stock Split&quot;).</footnote>
        <footnote id="F2">Options vest in 48 equal monthly installments commencing December 11, 2019. Shares reported reflect the Stock Split.</footnote>
        <footnote id="F3">Options vest in 48 equal monthly installments commencing December 19, 2018. Shares reported reflect the Stock Split.</footnote>
        <footnote id="F4">Options vest in 48 equal monthly installments commencing January 1, 2018. Shares reported reflect the Stock Split.</footnote>
        <footnote id="F5">Options vest in 48 equal monthly installments commencing January 1, 2021. Shares reported reflect the Stock Split.</footnote>
        <footnote id="F6">Options vest in 35 equal monthly installments commencing January 11, 2021. Shares reported reflect the Stock Split.</footnote>
        <footnote id="F7">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 (&quot;IPO&quot;). All shares of Series 1d Preferred Stock will be converted into 361,147 Common Stock of the Issuer upon consummation of the IPO. The conversion ratio reflects the Stock Split.</footnote>
        <footnote id="F8">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.</footnote>
        <footnote id="F9">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.</footnote>
        <footnote id="F10">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.</footnote>
        <footnote id="F11">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.</footnote>
        <footnote id="F12">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.</footnote>
        <footnote id="F13">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.</footnote>
    </footnotes>

    <remarks>Exhibit 24- Power of Attorney</remarks>

    <ownerSignature>
        <signatureName>/s/ Gerald T. Proehl</signatureName>
        <signatureDate>2021-08-12</signatureDate>
    </ownerSignature>
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<TYPE>EX-24
<SEQUENCE>2
<FILENAME>poa.htm
<DESCRIPTION>POWER OF ATTORNEY
<TEXT>
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<HEAD>
     <TITLE></TITLE>
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<BODY STYLE="font: 10pt Times New Roman, Times, Serif">

<P STYLE="margin: 0"></P>

<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0; text-align: center"><B>POWER OF ATTORNEY</B></P>

<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in">Know all by these present that
the undersigned hereby constitutes and appoints each of Daniel Porco and Steven Skolnick as their true and lawful attorney-in-fact to:</P>

<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0 0 0 0.5in; text-align: justify; text-indent: 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" WIDTH="100%" STYLE="font: 11pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0"><TR STYLE="vertical-align: top">
<TD STYLE="width: 0.5in"></TD><TD STYLE="width: 0.5in">1.</TD><TD STYLE="text-align: justify">execute for and on behalf of the undersigned Schedules 13D and 13G and Forms 3, 4 and 5 in accordance
with Sections 13 and 16(a) of the Securities Exchange Act of 1934 (the &#8220;Exchange Act&#8221;) and the rules thereunder;</TD></TR></TABLE>

<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0 0 0 0.5in; text-align: justify; text-indent: 0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" WIDTH="100%" STYLE="font: 11pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0"><TR STYLE="vertical-align: top">
<TD STYLE="width: 0.5in"></TD><TD STYLE="width: 0.5in">2.</TD><TD STYLE="text-align: justify">do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable
to complete the execution of any such Schedules 13D or 13G, Form ID application for EDGAR codes, and Forms 3, 4 or 5, and the timely filing
of such Forms with the United States Securities and Exchange Commission and any other authority; and</TD></TR></TABLE>

<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0 0 0 1in; text-align: justify; text-indent: -0.5in">&nbsp;</P>

<TABLE CELLPADDING="0" CELLSPACING="0" WIDTH="100%" STYLE="font: 11pt Times New Roman, Times, Serif; margin-top: 0; margin-bottom: 0"><TR STYLE="vertical-align: top">
<TD STYLE="width: 0.5in"></TD><TD STYLE="width: 0.5in">3.</TD><TD STYLE="text-align: justify">take any other action of any type whatsoever in connection with the foregoing which, in the opinion of
such attorney-in-fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, including, without limitation,
the execution and filing of a Form 4 with respect to a transaction which may be reported on a Form 5, it being understood that the documents
executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain
such terms and conditions as such attorney-in-fact may approve in his discretion.</TD></TR></TABLE>

<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0; text-align: justify">&nbsp;</P>

<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in">The undersigned hereby grants
to each such attorney-in-fact full power and authority to do and perform all and every act and thing whatsoever requisite, necessary and
proper to be done in the exercise of any of the rights and powers herein granted, as fully and to all intents and purposes as he might
or could do in person, with full power of substitution and resubstitution, hereby ratifying and confirming all that such attorney-in-fact,
or his substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers
herein granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned,
are not assuming any of the undersigned's responsibilities to comply with Sections 13 and 16 of the Exchange Act.</P>

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<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in">This Power of Attorney shall remain
in full force and effect until the undersigned is no longer required to file any Schedules 13D and 13G and Forms 3, 4 and 5 in accordance
with Sections 13 and 16(a) of the Exchange Act and the rules thereunder with respect to the undersigned's holdings of and transactions
in securities issued by Dermata Therapeutics, Inc.&nbsp;unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.</P>

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<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 0.5in">IN WITNESS WHEREOF, the undersigned
has caused this Power of Attorney to be executed as of June 9, 2021.</P>

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<P STYLE="font: 11pt Times New Roman, Times, Serif; margin: 0; text-align: justify; text-indent: 3in"><U>/s/ Gerald T. Proehl</U></P>

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