0001209191-22-034073.txt : 20220603 0001209191-22-034073.hdr.sgml : 20220603 20220603163457 ACCESSION NUMBER: 0001209191-22-034073 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220601 FILED AS OF DATE: 20220603 DATE AS OF CHANGE: 20220603 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Fuhrmann Rochelle CENTRAL INDEX KEY: 0001509312 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36003 FILM NUMBER: 22995077 MAIL ADDRESS: STREET 1: C/O WARNER CHILCOTT CORPORATION STREET 2: 100 ENTERPRISE DRIVE CITY: ROCKAWAY STATE: NJ ZIP: 07866 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 2022-06-01 0 0001383701 Histogen Inc. HSTO 0001509312 Fuhrmann Rochelle C/O HISTOGEN INC. 10655 SORRENTO VALLEY ROAD, SUITE 200 SAN DIEGO CA 92121 1 0 0 0 Stock Option (right to buy) 3.20 2022-06-01 4 A 0 1000 0.00 A 2032-06-01 Common Stock 1000 1000 D On June 2, 2022, the Issuer effected a 1-for-20 reverse stock split of its common stock (the "Reverse Stock Split"). The amount of securities reported on this Form 4 and the exercise price have been adjusted to reflect the Reverse Stock Split. This option was issued to the Reporting Person, a non-employee director of the Issuer, for her service as a director of the Issuer. The shares subject to this option become fully vested and exercisable on 6/1/2023, subject to the Reporting Person's continued service on the board of directors of the Issuer through such vesting date. /s/ Susan A. Knudson as attorney-in-fact for Rochelle Fuhrmann 2022-06-03