Sec Form 3 Filing - Jacobs Joan @ DermTech, Inc. - 2019-08-29

Insider filing report for Changes in Beneficial Ownership
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FORM 3
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Jacobs Joan
2. Issuer Name and Ticker or Trading Symbol
DermTech, Inc. [ DMTK]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
2710 IVERNESS COURT
3. Date of Earliest Transaction (MM/DD/YY)
08/29/2019
(Street)
LA JOLLA, CA92037
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 1,766,502 ( 1 ) ( 2 ) I By Irwin & Joan Jacobs Trust Dated 6-2-80 ( 3 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant to Purchase Common Stock $ 9.54 ( 6 ) 08/29/2019( 4 ) 05/11/2020 Common Stock 41,932 ( 1 ) ( 5 ) I By Irwin & Joan Jacobs Trust Dated 6-2-80 ( 3 )
Warrant to Purchase Common Stock $ 9.54 ( 6 ) 08/29/2019( 7 ) 02/13/2021 Common Stock 41,932 ( 1 ) ( 5 ) I By Irwin & Joan Jacobs Trust Dated 6-2-80 ( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Jacobs Joan
2710 IVERNESS COURT
LA JOLLA, CA92037
X
Signatures
/s/ Christian C. Hollweg, attorney-in-fact 10/17/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )On August 29, 2019, Issuer completed a merger transaction (the "Merger") pursuant to an Agreement and Plan of Merger, dated May 29, 2019, by and among Issuer, DT Merger Sub, Inc., and DermTech Operations, Inc., formerly known as DermTech, Inc. ("DermTech Operations"), as filed with the Securities and Exchange Commission on Form 8-K on May 29, 2019 (the "Merger Agreement"). Pursuant to the Merger Agreement, all issued and outstanding common stock of DermTech Operations converted into and became common stock of Issuer, and all issued and outstanding warrants of DermTech Operations converted into and became warrants to purchase shares of Issuer common stock. On August 29, 2019, following the completion of the Merger, the Issuer effected a reverse stock split at a ratio of one share for every two shares of Issuer common stock outstanding (the "Reverse Stock Split").
( 2 )1,304,963 of the reported shares of Issuer common stock were received in connection with the Merger in exchange for shares of DermTech Operations common stock. Each share of DermTech Operations common stock was cancelled and exchanged for the right to receive 1.16150415935026 shares of common stock of Issuer. The shares of common stock of Issuer reported reflect any necessary adjustments to account for the Reverse Stock Split.
( 3 )The securities reported herein may be deemed beneficially owned by Joan K. Jacobs as Trustee of the Irwin & Joan Jacobs Trust Dated 6-2-80.
( 4 )On May 11, 2017, the reporting person was granted warrants to purchase shares of DermTech Operations common stock. In connection with the Merger, the warrants were cancelled and exchanged for warrants to purchase shares of Issuer common stock, on the same terms and conditions applicable to the original warrants. The warrants are fully vested and exercisable.
( 5 )These warrants to purchase Issuer common stock were received in connection with the Merger in exchange for warrants to purchase shares of DermTech Operations common stock. Each warrant to purchase one share of DermTech Operations common stock was cancelled and exchanged for the right to receive a warrant to purchase 1.16150415935026 shares of Issuer common stock, on the same terms and conditions applicable to the original warrant. The shares of Issuer common stock exercisable pursuant to the warrants reported reflect any necessary adjustments to account for the Reverse Stock Split.
( 6 )The exercise price reported reflects the Reverse Stock Split.
( 7 )On February 13, 2018, the reporting person was granted warrants to purchase shares of DermTech Operations common stock. In connection with the Merger, the warrants were cancelled and exchanged for warrants to purchase shares of Issuer common stock, on the same terms and conditions applicable to the original warrants. The warrants are fully vested and exercisable.

Remarks:
Exhibit ListExhibit 24 - Power of Attorney of Joan Jacobs

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