0001235802-17-000021.txt : 20170127 0001235802-17-000021.hdr.sgml : 20170127 20170127162006 ACCESSION NUMBER: 0001235802-17-000021 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161213 FILED AS OF DATE: 20170127 DATE AS OF CHANGE: 20170127 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: HISTOGENICS CORP CENTRAL INDEX KEY: 0001372299 STANDARD INDUSTRIAL CLASSIFICATION: ORTHOPEDIC, PROSTHETIC & SURGICAL APPLIANCES & SUPPLIES [3842] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 830 WINTER STREET CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 781-457-7900 MAIL ADDRESS: STREET 1: 830 WINTER STREET CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SPLIT ROCK PARTNERS II MANAGEMENT, LLC CENTRAL INDEX KEY: 0001626028 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36751 FILM NUMBER: 17553969 BUSINESS ADDRESS: STREET 1: 10400 VIKING DRIVE STREET 2: SUITE 250 CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 BUSINESS PHONE: 952-995-7474 MAIL ADDRESS: STREET 1: 10400 VIKING DRIVE STREET 2: SUITE 250 CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SPLIT ROCK PARTNERS II, LP CENTRAL INDEX KEY: 0001435895 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36751 FILM NUMBER: 17553970 BUSINESS ADDRESS: STREET 1: 10400 VIKING DRIVE STREET 2: SUITE 250 CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 BUSINESS PHONE: 952-995-7474 MAIL ADDRESS: STREET 1: 10400 VIKING DRIVE STREET 2: SUITE 250 CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 FORMER NAME: FORMER CONFORMED NAME: SPLIT ROCK PARTNERS II LP DATE OF NAME CHANGE: 20080522 4 1 primary_doc.xml PRIMARY DOCUMENT X0306 4 2016-12-13 0 0001372299 HISTOGENICS CORP HSGX 0001435895 SPLIT ROCK PARTNERS II, LP 10400 VIKING DRIVE SUITE 250 EDEN PRAIRIE MN 55344 0 0 1 0 0001626028 SPLIT ROCK PARTNERS II MANAGEMENT, LLC 10400 VIKING DRIVE SUITE 250 EDEN PRAIRIE MN 55344 0 0 1 0 Common Stock 2016-12-13 4 C 0 1114043 A 2775538 D Series A Convertible Preferred Stock 2016-12-13 4 C 0 2506.5968 0 D Common Stock 1114043 0 D All outstanding shares of the Issuer's Series A Convertible Preferred Stock converted on a 1:444.4444444 basis into shares of the Issuer's Common Stock. These shares have no expiration date. The securities are owned directly by SRP II. Voting and investment power over the securities is delegated to Split Rock Partners II Management, LLC ("SRPM II"), the general partner of SRP II. SRPM II has delegated voting and investment decisions to three individuals who require a two-thirds vote to act. SRPM II disclaims beneficial ownership of the securities except to the extent of any pecuniary interest therein. /s/ Stacy M. Campbell-Kraft, Authorized Representative 2017-01-27 /s/ Stacy M. Campbell-Kraft, Authorized Representative 2017-01-27