SEC Form 4 · accession 0001570562-18-000125
Evolus, Inc. · EOLS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Simone Blank
Director
Period of report
Nov 29, 2018
Accepted (ET)
Dec 3, 2018 · 4:27 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001570562
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1,F2 | Nov 29, 2018 | P | 295,024 | $14.00 | A | 295,024 | I | See Footnote |
Table II — derivative securities
No Table II lines on this filing.
Explanation of responses
- F1The acquisition of the shares of common stock referenced in this Form 4 was conducted in a private transaction between ALPHAEON Corporation ("ALPHAEON") and Dental Innovations BVBA ("DI"). DI holds certain notes issued by ALPHAEON. DI elected to receive payment from ALPHAEON of the outstanding principal amounts of the notes due on December 23, 2018 in the form of shares of common stock rather than cash. The shares of common stock received by the Dental Innovations BVBA are deemed "restricted securities" under Rule 144 promulgated under the Securities Act of 1933, as amended.
- F2The reported securities are directly owned by DI and may be deemed beneficially owned by the Reporting Person as a shareholder of DI. The Reporting Person disclaims beneficial ownership of the reported securities except to the extent of her pecuniary interest therein, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of the securities for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose.