0001209191-18-038600.txt : 20180619 0001209191-18-038600.hdr.sgml : 20180619 20180619165011 ACCESSION NUMBER: 0001209191-18-038600 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180619 FILED AS OF DATE: 20180619 DATE AS OF CHANGE: 20180619 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stalfort Sean CENTRAL INDEX KEY: 0001709418 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38529 FILM NUMBER: 18907701 MAIL ADDRESS: STREET 1: C/O DOVA PHARMACEUTICALS, INC. STREET 2: 240 LEIGH FARM ROAD, SUITE 245 CITY: DURHAM STATE: NC ZIP: 27707 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Verrica Pharmaceuticals Inc. CENTRAL INDEX KEY: 0001660334 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 463137900 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 200 GARRETT STREET CITY: CHARLOTTESVILLE STATE: VA ZIP: 22902 BUSINESS PHONE: 434-980-8100 MAIL ADDRESS: STREET 1: 200 GARRETT STREET CITY: CHARLOTTESVILLE STATE: VA ZIP: 22902 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-06-19 0 0001660334 Verrica Pharmaceuticals Inc. VRCA 0001709418 Stalfort Sean C/O VERRICA PHARMACEUTICALS INC. 10 NORTH HIGH STREET, SUITE 200 WEST CHESTER PA 19380 1 0 0 0 Common Stock 2018-06-19 4 C 0 394295 A 421639 D Series A Convertible Preferred Stock 2018-06-19 4 C 0 394295 0.00 D Common Stock 394295 0 D Each share of Series A Convertible Preferred Stock was convertible at any time at the option of the holder into Common Stock, had no expiration date and converted into shares of Common Stock upon the closing of the Issuer's initial public offering. /s/ Edward Sniezek, Attorney-in-Fact 2018-06-19