SEC Form 4 · accession 0001628280-18-001613
Evolus, Inc. · EOLS
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Alphaeon Corp
10% Owner
Period of report
Feb 12, 2018
Accepted (ET)
Feb 13, 2018 · 8:08 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 | Feb 12, 2018 | C | 2,065,875 | — | A | 2,065,875 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A Preferred StockF2,F1 | — | Feb 12, 2018 | C | 1,250,000 | D | — | — | Common Stock | 2,065,875 | 0 | D |
Explanation of responses
- F1Reflects a 1.6527-for-1 forward stock split of the Issuer's common stock effected on January 26, 2018.
- F2Effective immediately upon the closing of the Issuer's initial public offering of its common stock under the Securities Act of 1933, as amended, each share of Series A preferred stock automatically converted into 1.6527 shares of the Issuer's common stock. The Series A preferred stock had no expiration date.