0001209191-23-018474.txt : 20230314 0001209191-23-018474.hdr.sgml : 20230314 20230314163212 ACCESSION NUMBER: 0001209191-23-018474 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230310 FILED AS OF DATE: 20230314 DATE AS OF CHANGE: 20230314 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mento Steven J CENTRAL INDEX KEY: 0001324466 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36003 FILM NUMBER: 23731499 MAIL ADDRESS: STREET 1: C/O SANGAMO BIOSCIENCES, INC. STREET 2: 501 CANAL BLVD SUITE A-100 CITY: RICHMOND STATE: CA ZIP: 94804 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Histogen Inc. CENTRAL INDEX KEY: 0001383701 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 203183915 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 10655 SORRENTO VALLEY ROAD STREET 2: SUITE 200 CITY: San Diego STATE: CA ZIP: 92121 BUSINESS PHONE: (858) 526-3100 MAIL ADDRESS: STREET 1: 10655 SORRENTO VALLEY ROAD STREET 2: SUITE 200 CITY: San Diego STATE: CA ZIP: 92121 FORMER COMPANY: FORMER CONFORMED NAME: Conatus Pharmaceuticals Inc. DATE OF NAME CHANGE: 20140729 FORMER COMPANY: FORMER CONFORMED NAME: Conatus Pharmaceuticals Inc DATE OF NAME CHANGE: 20061214 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2023-03-10 0 0001383701 Histogen Inc. HSTO 0001324466 Mento Steven J C/O HISTOGEN INC. 10655 SORRENTO VALLEY ROAD, SUITE 200 SAN DIEGO CA 92121 1 1 0 0 President and CEO Stock Option (right to buy) 0.95 2023-03-10 4 A 0 158055 0.00 A 2033-03-10 Common Stock 158055 158055 D Stock Option (right to buy) 0.95 2023-03-10 4 A 0 55532 0.00 A 2033-03-10 Common Stock 55532 55532 D Stock Option (right to buy) 14.60 2023-03-10 4 D 0 18892 0.00 D 2031-11-08 Common Stock 18892 0 D Stock Option (right to buy) 5.40 2023-03-10 4 D 0 7582 0.00 D 2032-02-24 Common Stock 7582 0 D 1/4 of the shares subject to the option vest one year after the date of grant, on 3/10/2024, and the remaining 1/36 of the shares vest on a monthly basis thereafter. The shares subject to this option are subject to forfeiture in the event that the shares available pursuant to the Issuer's 2020 Incentive Award Plan are not increased prior to the one-year anniversary and vesting of the award by an amount required to be available for issuance for all outstanding stock awards containing this forfeiture condition. Effective June 2, 2022, the Issuer effected a 1-for-20 reverse stock split of the Company's issued and outstanding common stock, par value $0.0001 per share. On March 10, 2023, the Issuer and the Reporting Person agreed to cancel the stock option award. 1/4 of the shares subject to the option vested one year after the date of grant, on 11/8/2022, and the remaining 1/36 of the shares vest on a monthly basis thereafter. 1/4 of the shares subject to the option vested one year after the date of grant, on 2/24/2023, and the remaining 1/36 of the shares vest on a monthly basis thereafter. /s/ Susan A. Knudson as attorney-in-fact for Steven J. Mento, Ph.D. 2023-03-14