Rome Zachary 4

4 · Timber Pharmaceuticals, Inc. · Filed Apr 15, 2022

Form 4

Period: 2022-03-04

DirectorExecutive VP, COO and Sec.

Transactions

Exercise/Conversion
Common Stock, par value $0.001 per share
2022-03-04$0.01/sh+79,326$793→ 79,326 total
Tax Payment
Common Stock, par value $0.001 per share
2022-03-04$0.28/sh−19,630$5,496→ 59,696 total
Disposition to Issuer
Value Appreciation Rights
2022-03-04−52,884→ 79,326 total
Exercise: $0.01From: 2022-03-04Exp: 2029-03-01→ Common Stock, par value $0.001 per share (52,884 underlying)
Exercise/Conversion
Value Appreciation Rights
2022-03-04+79,326→ 0 total
Exercise: $0.01From: 2022-03-04Exp: 2029-03-01→ Common Stock, par value $0.001 per share (79,326 underlying)

Footnotes (2)

[F1]Represents shares of common stock, par value $0.001 per share (the "Common Stock") of Timber Pharmaceuticals, Inc. (the "Issuer") withheld by the Issuer to satisfy tax withholding obligations on the exercise of value appreciation rights ("VARs").
[F2]The VARs were to vest in five equal annual installments commencing on March 1, 2019, so long as the Reporting Person remained employed by the Issuer or its affiliates. The Reporting Person stepped down from his positions as the Chief Operating Officer and Executive Vice President of the Issuer effective March 4, 2022. As a result, the VARs were exercisable as of March 4, 2022.

Documents

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