Sec Form 4 Filing - Jacobs Gary E. @ DermTech, Inc. - 2020-01-30

Insider filing report for Changes in Beneficial Ownership
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FORM 4
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 Gary E.
2. Issuer Name and Ticker or Trading Symbol
DermTech, Inc. [ DMTK]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O DERMTECH, INC., 11099 N. TORREY PINES RD., SUITE 100
3. Date of Earliest Transaction (MM/DD/YY)
01/30/2020
(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 01/30/2020 A 6,000 ( 1 ) A $ 0 515,211 D
Common Stock 797,978 I By Jacobs Investment Company LLC ( 2 )
Common Stock 624 I By Jacobs Family Trust Dated 11-9-99 ( 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
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Jacobs Gary E.
C/O DERMTECH, INC.
11099 N. TORREY PINES RD., SUITE 100
LA JOLLA, CA92037
X X
Signatures
/s/ Christian C. Hollweg, attorney-in-fact 02/03/2020
Signature of Reporting Person Date
Explanation of Responses:
( 1 )The securities awarded are in the form of restricted stock units issued pursuant to the issuer's Amended and Restated 2010 Stock Plan. Each restricted stock unit represents a contingent right to receive one share of issuer common stock. Subject to the reporting person's continued service, all of the restricted stock units shall vest in a single installment on the date of the 2020 annual meeting of the stockholders of the issuer.
( 2 )These shares of issuer common stock are directly held by Jacobs Investment Company LLC. Reporting person is the managing member of Jacobs Investment Company LLC. Reporting person exercises sole dispositive and sole voting power over the shares owned by Jacobs Investment Company LLC. Reporting person disclaims, for purposes of Section 16 of the Securities Exchange Act of 1934, beneficial ownership of such securities, except to the extent of his indirect pecuniary interest therein, and this report shall not be deemed an admission that reporting person is the beneficial owner of such securities for purposes of Section 16 or for any other purposes.
( 3 )These shares of issuer common stock may be deemed beneficially owned by the reporting person as Trustee of the Jacobs Family Trust Dated 11-9-99.

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