Statement of Changes in Beneficial Ownership (4)
January 10 2020 - 4:11PM
Edgar (US Regulatory)
FORM 4
[X]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
AEON Biopharma, Inc. |
2. Issuer Name and Ticker or Trading Symbol
Evolus, Inc.
[
EOLS
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner _____ Officer (give title below) __X__ Other (specify below) Former 10% Owner |
(Last)
(First)
(Middle)
4040 MACARTHUR BOULEVARD, SUITE 310 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/8/2020 |
(Street)
NEWPORT BEACH, CA 92660
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 1/8/2020 | | J(1) | | 8662346 | D | $0 | 0 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | Pursuant to a Contribution Agreement dated January 8, 2020, by and between the Reporting Person (formerly known as Alphaeon Corporation) and Alphaeon 1 LLC ("Alphaeon"), on January 8, 2020, the Reporting Person contributed 8,662,346 shares of the Issuer to Alphaeon (the "Contribution"). The shares of the Issuer contributed to Alphaeon are deemed "restricted securities" under Rule 144 promulgated under the Securities Act of 1933, as amended. At the time of the Contribution, Alphaeon was a wholly-owned subsidiary of the Reporting Person. Immediately after the Contribution, the Reporting Person distributed out all of the membership interests of Alphaeon to its stockholders. The Reporting Person is filing this exit Form 4 to report that it is no longer a beneficial owner of the Issuer's securities. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
AEON Biopharma, Inc. 4040 MACARTHUR BOULEVARD SUITE 310 NEWPORT BEACH, CA 92660 |
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| Former 10% Owner |
Signatures
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/s/ Vik Malik, Acting President of AEON BIOPHARMA, INC | | 1/8/2020 |
**Signature of Reporting Person | Date |
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