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