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