0001570562-24-000025.txt : 20240209
0001570562-24-000025.hdr.sgml : 20240209
20240209183808
ACCESSION NUMBER: 0001570562-24-000025
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20240207
FILED AS OF DATE: 20240209
DATE AS OF CHANGE: 20240209
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BLANK SIMONE
CENTRAL INDEX KEY: 0001366840
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38381
FILM NUMBER: 24616919
MAIL ADDRESS:
STREET 1: C/O SIRONA, WASSERFELDSTRASSE 30 A-5020
CITY: SALZBURG
STATE: C4
ZIP: 5020
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Evolus, Inc.
CENTRAL INDEX KEY: 0001570562
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
ORGANIZATION NAME: 03 Life Sciences
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
wk-form4_1707521878.xml
FORM 4
X0508
4
2024-02-07
0
0001570562
Evolus, Inc.
EOLS
0001366840
BLANK SIMONE
520 NEWPORT CENTER DR.
SUITE 1200
NEWPORT BEACH
CA
92660
1
0
0
0
0
Common Stock
2024-02-07
4
A
0
6464
0
A
69747
D
Common Stock
482783
I
See Footnote
Stock Option (Right to Buy)
13.15
2024-02-07
4
A
0
9377
0
A
2034-02-07
Common Stock
9377
9377
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 February 7, 2024, 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.
Represents shares held by Dental Innovations Apus Investment BV ("DIAI") and may be deemed beneficially owned by the Reporting Person as the sole beneficial owner of DIAI.
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 February 7, 2024, 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 Simone Blank
2024-02-09