0001570562-19-000022.txt : 20190125
0001570562-19-000022.hdr.sgml : 20190125
20190125202018
ACCESSION NUMBER: 0001570562-19-000022
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190123
FILED AS OF DATE: 20190125
DATE AS OF CHANGE: 20190125
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BLANK SIMONE
CENTRAL INDEX KEY: 0001366840
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38381
FILM NUMBER: 19543677
MAIL ADDRESS:
STREET 1: C/O SIRONA, WASSERFELDSTRASSE 30 A-5020
CITY: SALZBURG
STATE: C4
ZIP: 5020
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Evolus, Inc.
CENTRAL INDEX KEY: 0001570562
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 461385614
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 520 NEWPORT CENTER DRIVE
STREET 2: SUITE 1200
CITY: NEWPORT BEACH
STATE: CA
ZIP: 92660
BUSINESS PHONE: (949) 284-4555
MAIL ADDRESS:
STREET 1: 520 NEWPORT CENTER DRIVE
STREET 2: SUITE 1200
CITY: NEWPORT BEACH
STATE: CA
ZIP: 92660
4
1
wf-form4_154846560188517.xml
FORM 4
X0306
4
2019-01-23
0
0001570562
Evolus, Inc.
EOLS
0001366840
BLANK SIMONE
520 NEWPORT CENTER DR.
SUITE 1200
NEWPORT BEACH
CA
92660
1
0
0
0
Stock Option (Right to Buy)
16.19
2019-01-23
4
A
0
14500
0
A
2029-01-23
Common Stock
14500.0
14500
D
The shares subject to the option will vest as to 1/12 of the underlying shares monthly from the vesting commencement date of January 23, 2019, provided the reporting person remains in continuous service on each vesting date, subject to accelerated vesting in certain events, including certain terminations of the reporting person or upon certain changes of control of the issuer.
/s/ Jeffrey J. Plumer, as attorney-in-fact for Simone Blank
2019-01-25