0001209191-20-006599.txt : 20200204
0001209191-20-006599.hdr.sgml : 20200204
20200204182631
ACCESSION NUMBER: 0001209191-20-006599
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200204
FILED AS OF DATE: 20200204
DATE AS OF CHANGE: 20200204
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: CHAUDHURI BHASKAR
CENTRAL INDEX KEY: 0001458643
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39186
FILM NUMBER: 20575466
MAIL ADDRESS:
STREET 1: ONE ENTERPRISE
CITY: ALISO VIEJO
STATE: CA
ZIP: 92656
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Arcutis Biotherapeutics, Inc.
CENTRAL INDEX KEY: 0001787306
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 812974255
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 2945 TOWNSGATE ROAD
STREET 2: SUITE 110
CITY: WESTLAKE VILLAGE
STATE: CA
ZIP: 91361
BUSINESS PHONE: 805-418-5006
MAIL ADDRESS:
STREET 1: 2945 TOWNSGATE ROAD
STREET 2: SUITE 110
CITY: WESTLAKE VILLAGE
STATE: CA
ZIP: 91361
FORMER COMPANY:
FORMER CONFORMED NAME: Arcutis, Inc.
DATE OF NAME CHANGE: 20190905
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2020-02-04
0
0001787306
Arcutis Biotherapeutics, Inc.
ARQT
0001458643
CHAUDHURI BHASKAR
C/O ARCUTIS BIOTHERAPEUTICS, INC.
2945 TOWNSGATE ROAD, SUITE 110
WESTLAKE VILLAGE
CA
91361
1
0
0
0
Common Stock
2020-02-04
4
C
0
37486
A
901391
D
Common Stock
2020-02-04
4
C
0
49981
A
49981
I
By Trust
Series A Preferred Stock
2020-02-04
4
C
0
37486
0.00
D
Common Stock
37486
0
D
Series A Preferred Stock
2020-02-04
4
C
0
49981
0.00
D
Common Stock
49981
0
I
By Trust
Each share of the Issuer's Series A Preferred Stock will automatically convert into 1 share of the issuer's Common Stock immediately upon the closing of the Issuer's initial public offering and has no expiration date.
The securities are held of record by The Chaudhuri Family Trust, of which the Reporting Person is trustee. The Reporting Person disclaims beneficial ownership of such securities except to the extent of his pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of such securities for purposes of Section 16 or for any other purposes.
/s/ Bhaskar Chaudhuri, by John W. Smither, as Attorney-in-Fact
2020-02-04