0001570562-22-000128.txt : 20220908 0001570562-22-000128.hdr.sgml : 20220908 20220908092912 ACCESSION NUMBER: 0001570562-22-000128 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220906 FILED AS OF DATE: 20220908 DATE AS OF CHANGE: 20220908 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: 221232733 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_166264373900205.xml FORM 4 X0306 4 2022-09-06 0 0001570562 Evolus, Inc. EOLS 0001366840 BLANK SIMONE 520 NEWPORT CENTER DR. SUITE 1200 NEWPORT BEACH CA 92660 1 0 0 0 Common Stock 2022-09-06 4 P 0 20000 9.2422 A 54881 D Common Stock 367577 I See Footnote The shares were purchased in multiple trades at prices ranging from $9.08 to $9.52. The price reported above reflects the weighted average purchase price. The reporting person hereby undertakes to provide upon request to the SEC staff, the issuer or a security holder of the issuer full information regarding the number of shares and prices at which the transaction was effected. Total includes 15,568 shares issuable on settlement of restricted stock units ("RSUs") granted to the reporting person. Each RSU represents a contingent right to receive one share of the Issuer's common stock. The RSUs will vest in full on the one year anniversary of January 24, 2022, provided the reporting person remains in continuous service before the vesting date, subject to accelerated vesting in certain events, including upon certain changes of control of the Issuer. Represents shares held by Dental Innovations Apus Investment BV ("DIAI) and may be deemed beneficially owned by the Reporting Person as the sole beneficial owner of DIAI. /s/ Jeffrey J. Plumer, as attorney-in-fact for Simone Blank 2022-09-07