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