# EDGAR Filing Document

**Accession Number:** 0001279191
**File Stem:** 0001493152-25-029468
**Filing Date:** 2025-12
**Character Count:** 10762
**Document Hash:** 8a83b535b937a758ab956b0182108113
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001493152-25-029468.hdr.sgml**: 20251229

**ACCESSION NUMBER**: 0001493152-25-029468

**CONFORMED SUBMISSION TYPE**: 4

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20251223

**FILED AS OF DATE**: 20251229

**DATE AS OF CHANGE**: 20251229

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** PROEHL GERALD T
- **CENTRAL INDEX KEY:** 0001279191
- **STANDARD INDUSTRIAL CLASSIFICATION:** PHARMACEUTICAL PREPARATIONS [2834]
- **ORGANIZATION NAME:** 03 Life Sciences
- **FISCAL YEAR END:** 1231

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-40739
- **FILM NUMBER:** 251610830

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

**MAIL ADDRESS:**
- **STREET 1:** 10590 W OCEAN AIR DR
- **STREET 2:** STE 200
- **CITY:** SAN DIEGO
- **STATE:** CA
- **ZIP:** 92130
**ISSUER**: 

**COMPANY DATA:**
- **COMPANY CONFORMED NAME:** Dermata Therapeutics, Inc.
- **CENTRAL INDEX KEY:** 0001853816
- **STANDARD INDUSTRIAL CLASSIFICATION:** PHARMACEUTICAL PREPARATIONS [2834]
- **ORGANIZATION NAME:** 03 Life Sciences
- **EIN:** 000000000
- **STATE OF INCORPORATION:** DE
- **FISCAL YEAR END:** 1231

**BUSINESS ADDRESS:**
- **STREET 1:** 3525 DEL MAR HEIGHTS RD., #322
- **CITY:** SAN DIEGO
- **STATE:** CA
- **ZIP:** 92130
- **BUSINESS PHONE:** (858)-223-0882

**MAIL ADDRESS:**
- **STREET 1:** 3525 DEL MAR HEIGHTS RD., #322
- **CITY:** SAN DIEGO
- **STATE:** CA
- **ZIP:** 92130

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>PROEHL GERALD T<br><sub>(Last) (First) (Middle)</sub><br>3525 DEL MAR HEIGHTS RD.

#322<br><sub>(Street)</sub><br>SAN DIEGO, CA 92130<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2025-12-23 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[X] Director [X] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_PRESIDENT, CHAIRMAN, CEO_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Dermata Therapeutics, Inc. [ DRMA ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| Common Stock | 2025-12-23 |  | A<sup>(1)</sup> |  | 490196 | A | <sup>(2)</sup> | 490255<sup>(3)</sup> | I | By Proehl Family Trust<sup>(6)</sup> |
| Common Stock | 2025-12-23 |  | A<sup>(1)</sup> |  | 122549 | A | <sup>(2)</sup> | 122563<sup>(3)</sup> | I | By Sean Michael Proehl 2020 Irrevocable Trust Dated December 18, 2020<sup>(6)</sup> |
| Common Stock |  |  |  |  |  |  |  | 24<sup>(3)</sup> | D |  |
| Common Stock |  |  |  |  |  |  |  | 7<sup>(3)</sup> | I | By Allison Taylor Proehl 2020 Irrevocable Trust<sup>(6)</sup> |
| Common Stock |  |  |  |  |  |  |  | 3<sup>(3)</sup> | I | By Meghan Proehl Wilder 2020 Irrevocable Trust<sup>(6)</sup> |
| Common Stock |  |  |  |  |  |  |  | 79795<sup>(3)</sup> | I | By Proehl Investment Ventures LLC<sup>(6)</sup> |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Series C Warrant (Right to Buy) | $2.04 | 2025-12-23 |  | A<sup>(1)</sup> |  | 490196 |  | <sup>(4)</sup> | <sup>(4)</sup> | Common Stock | 490196 | <sup>(2)</sup> | 490496 | I | By Proehl Family Trust<sup>(6)</sup> |
| Series D Warrant (Right to Buy) | $2.04 | 2025-12-23 |  | A<sup>(1)</sup> |  | 490196 |  | <sup>(5)</sup> | <sup>(5)</sup> | Common Stock | 490496 | <sup>(2)</sup> | 490496 | I | By Proehl Family Trust<sup>(6)</sup> |
| Series C Warrant (Right to Buy) | $2.04 | 2025-12-23 |  | A<sup>(1)</sup> |  | 122549 |  | <sup>(4)</sup> | <sup>(4)</sup> | Common Stock | 122549 | <sup>(2)</sup> | 122549 | I | By Sean Michael Proehl 2020 Irrevocable Trust Dated December 18, 2020<sup>(6)</sup> |
| Series D Warrant (Right to Buy) | $2.04 | 2025-12-23 |  | A<sup>(1)</sup> |  | 122549 |  | <sup>(5)</sup> | <sup>(5)</sup> | Common Stock | 122549 | <sup>(2)</sup> | 122549 | I | By Sean Michael Proehl 2020 Irrevocable Trust Dated December 18, 2020<sup>(6)</sup> |
| Warrant (Right to Buy) | $12.70 | 2025-12-23 |  | D<sup>(7)</sup> |  | 78740<sup>(3)</sup> |  | <sup>(7)</sup> | <sup>(7)</sup> | Common Stock | 78740<sup>(3)</sup> | <sup>(7)</sup> | 0 | D |  |
| Warrant (Right to Buy) | $2.04 | 2025-12-23 |  | A<sup>(7)</sup> |  | 78740<sup>(3)</sup> |  | <sup>(7)</sup> | <sup>(7)</sup> | Common Stock | 78740<sup>(3)</sup> | <sup>(7)</sup> | 78740<sup>(3)</sup> | D |  |

---

### Footnotes:

(1) The shares of common stock and accompanying warrants reported herein were purchased together by the Reporting Person from the Issuer in a private placement (the "Private Placement"), which transaction is exempt from Section 16(b) in accordance with Rule 16b-3(d)(1) promulgated under the Securities Exchange Act of 1934, as amended (the "Exchange Act"). Each share of common stock was purchased together with (i) a series C warrant to purchase one share of common stock and (ii) a series D warrant to purchase one share of common stock. The purchase price per share and accompanying warrants was $2.04.

(2) The purchase price per share of common stock and accompanying warrants was $2.04.

(3) Reflects a one-for-10 reverse stock split effected by the Issuer on August 1, 2025.

(4) This warrant will become exercisable beginning on the effective date of stockholder approval of the issuance of the shares of Common stock issuable upon exercise of the warrants. The warrant will expire five years from the effective date of stockholder approval. The warrant cannot be exercised by the Reporting Person if, after giving effect thereto, the Reporting Person, together with his/her affiliates, would beneficially own, as determined in accordance with Section 13(d) of the Exchange Act, more than 9.99% of the number of shares of the common stock outstanding immediately after giving effect to such exercise, subject to certain exceptions.

(5) This warrant will become exercisable beginning on the effective date of stockholder approval of the issuance of the shares of common stock issuable upon exercise of the warrants. The warrant will expire two years from the effective date of stockholder approval. The warrant cannot be exercised by the Reporting Person if, after giving effect thereto, the Reporting Person, together with his/her affiliates, would beneficially own, as determined in accordance with Section 13(d) of the Exchange Act, more than 9.99% of the number of shares of the common stock outstanding immediately after giving effect to such exercise, subject to certain exceptions.

(6) 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.

(7) In connection with the Private Placement, the Reporting Person entered into an amendment to an outstanding warrant issued on January 3, 2025, which amended the exercise price of the outstanding warrant from $12.70 to $2.04. This amendment is reported as the cancellation of the "old" warrant and the purchase of a replacement warrant. The warrant amendment transaction is exempt from Section 16(b) in accordance with Rule 16b-3(e) promulgated under the Exchange Act.

**Signature:** /s/ Gerald T. Proehl, Attorney-in-Fact  
**Date:** 2025-12-29

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**