0001570562-21-000017.txt : 20210201 0001570562-21-000017.hdr.sgml : 20210201 20210201192900 ACCESSION NUMBER: 0001570562-21-000017 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210127 FILED AS OF DATE: 20210201 DATE AS OF CHANGE: 20210201 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: MOATAZEDI DAVID CENTRAL INDEX KEY: 0001700836 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38381 FILM NUMBER: 21578326 MAIL ADDRESS: STREET 1: C/O OBALON THERAPEUTICS, INC. STREET 2: 5421 AVENIDA ENCINAS, SUITE F CITY: CARLSBAD STATE: CA ZIP: 92008 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_161222572441823.xml FORM 4 X0306 4 2021-01-27 0 0001570562 Evolus, Inc. EOLS 0001700836 MOATAZEDI DAVID 520 NEWPORT CENTER DR. SUITE 1200 NEWPORT BEACH CA 92660 1 1 0 0 See Remarks Common Stock 2021-01-27 2021-01-27 4 A 0 266667 0 A 440427 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 over a period of four years, with 1/4th of the RSU vesting annually on the anniversary of January 27, 2021, 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. President and Chief Executive Officer /s/ Jeffrey J. Plumer, as attorney-in-fact for David Moatazedi 2021-02-01