SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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*
Alphaeon 1 LLC

(Last) (First) (Middle)
4040 MACARTHUR BOULEVARD, SUITE 310

(Street)
NEWPORT BEACH CA 92660

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/08/2020
3. Issuer Name and Ticker or Trading Symbol
Evolus, Inc. [ EOLS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 8,662,346(1) D
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
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 and AEON Biopharma, Inc. (formerly known as Alphaeon Corporation) ("AEON"), on January 8, 2020, the Reporting Person acquired by contribution 8,662,346 shares of the Issuer from AEON (the "Contribution"). The shares of the Issuer contributed to the Reporting Person are deemed "restricted securities" under Rule 144 promulgated under the Securities Act of 1933, as amended. At the time of the Contribution, the Reporting Person was a wholly-owned subsidiary of AEON. Immediately after the Contribution, AEON distributed out all of the membership interests of Reporting Person to its stockholders.
/s/ Vik Malik, Manager of ALPHAEON 1 LLC 01/08/2020
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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