0001570562-20-000103.txt : 20200717 0001570562-20-000103.hdr.sgml : 20200717 20200716213159 ACCESSION NUMBER: 0001570562-20-000103 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: 06b FILED AS OF DATE: 20200717 DATE AS OF CHANGE: 20200716 EFFECTIVENESS DATE: 20200717 FILER: 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 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-371264 FILM NUMBER: 201032640 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 D 1 primary_doc.xml X0708 D LIVE 0001570562 Evolus, Inc. 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 9492844555 DELAWARE None None Corporation true David Moatazedi 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Executive Officer Director Lauren Silvernail 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Executive Officer Michael Jafar 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Executive Officer Rui Avelar 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Executive Officer Vikram Malik 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Director Simone Blank 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Director Peter Farrell 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Director David Gill 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Director Robert Hayman 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Director Karah Parschauer 520 Newport Center Drive Suite 1200 Newport Beach CA CALIFORNIA 92660 Director Pharmaceuticals Decline to Disclose 06b false 2020-07-06 false true Convertible Promissory Note false 0 40000000 40000000 0 false 1 0 0 0 false Evolus, Inc. /s/David Moatazedi David Moatazedi President, Chief Executive Officer and Director 2020-07-16