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