0001209191-13-046785.txt : 20131002
0001209191-13-046785.hdr.sgml : 20131002
20131002174335
ACCESSION NUMBER: 0001209191-13-046785
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130930
FILED AS OF DATE: 20131002
DATE AS OF CHANGE: 20131002
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Evoke Pharma Inc
CENTRAL INDEX KEY: 0001403708
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 208447886
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 12555 HIGH BLUFF DRIVE
STREET 2: SUITE 385
CITY: San Diego
STATE: CA
ZIP: 92130
BUSINESS PHONE: (760) 487-1255
MAIL ADDRESS:
STREET 1: 12555 HIGH BLUFF DRIVE
STREET 2: SUITE 385
CITY: San Diego
STATE: CA
ZIP: 92130
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: GARNER CAM L
CENTRAL INDEX KEY: 0001024007
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36075
FILM NUMBER: 131131468
MAIL ADDRESS:
STREET 1: PO BOX 675866
CITY: RANCHO SANTE FE
STATE: CA
ZIP: 92067
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2013-09-30
0
0001403708
Evoke Pharma Inc
EVOK
0001024007
GARNER CAM L
C/O EVOKE PHARMA, INC.
12555 HIGH BLUFF DRIVE, SUITE 385
SAN DIEGO
CA
92130
1
0
0
0
Common Stock
2013-09-30
4
C
0
15605
A
335605
I
See footnote
Common Stock
20000
I
See footnote
Common Stock
20000
I
See footnote
Series A Preferred Stock
2013-09-30
4
C
0
78027
D
Common Stock
15605
0
I
See footnote
The Issuer's Series A Preferred Stock (the "Preferred Stock") has no expiration date. The outstanding shares of Preferred Stock automatically converted into shares of Common Stock of the Issuer immediately prior to the closing of the Issuer's initial public offering at a conversion ratio of one share of Common Stock for every five shares of Preferred Stock, rounded down to the nearest whole number, for no additional consideration.
The shares are held by Garner Investments, L.L.C., of which Mr. Garner is the managing member.
The shares are held by the Lee Adair Garner Irrevocable Trust dtd 8/13/2007, of which Mr. Garner is a trustee.
The shares are held by the Anna Berenice Garner Irrevocable Trust dtd 8/13/2007, of which Mr. Garner is a trustee.
/s/ Matthew J. D'Onofrio, as Attorney-in-fact for Cam L. Garner
2013-10-02