0001570562-23-000021.txt : 20230131 0001570562-23-000021.hdr.sgml : 20230131 20230131204108 ACCESSION NUMBER: 0001570562-23-000021 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230127 FILED AS OF DATE: 20230131 DATE AS OF CHANGE: 20230131 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GILL DAVID N CENTRAL INDEX KEY: 0001106519 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38381 FILM NUMBER: 23574458 MAIL ADDRESS: STREET 1: C/O NXSTAGE MEDICAL INC. (NXTM) STREET 2: 439 SOUTH UNION STREET, 5TH FLOOR CITY: LAWRENCE STATE: MA ZIP: 01843 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_167521565164195.xml FORM 4 X0306 4 2023-01-27 0 0001570562 Evolus, Inc. EOLS 0001106519 GILL DAVID N 520 NEWPORT CENTER DR. SUITE 1200 NEWPORT BEACH CA 92660 1 0 0 0 Common Stock 2023-01-27 4 A 0 8293 0 A 37861 D Stock Option (Right to Buy) 10.25 2023-01-27 4 A 0 11789 0 A 2033-01-27 Common Stock 11789.0 11789 D Represents 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 27, 2023, 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. The shares subject to the option will vest over a period of twelve months, with 1/12th of the shares subject to the option vesting monthly on the anniversary of January 27, 2023, 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 David N. Gill 2023-01-31