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