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