| FORM 4 | UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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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| Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). | |||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
| 2. Issuer Name and Ticker or Trading Symbol Histogen Inc. [ HSTO ] | 5. Relationship of Reporting Person(s) to Issuer (Check all applicable)
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| 3. Date of Earliest Transaction (Month/Day/Year) 05/26/2020 | ||||||||||||||||||||||||||
| 4. If Amendment, Date of Original Filed (Month/Day/Year) | 6. Individual or Joint/Group Filing (Check Applicable Line)
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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
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| 1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
| Code | V | Amount | (A) or (D) | Price | ||||||
| Common Stock | 05/26/2020 | J | 11,951 | A | $0.00 | 11,951 | D | |||
| Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
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| 1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Stock Option (right to buy) | $3.7 | 10/07/2016 | J | 28,684 | (2) | 10/07/2026 | Common Stock | 28,684 | $0.00 | 28,684 | D | ||||
| Stock Option (right to buy) | $3.84 | 03/12/2018 | J | 14,342 | (3) | 03/12/2028 | Common Stock | 14,342 | $0.00 | 14,342 | D | ||||
| Explanation of Responses: |
| 1. Shares of common stock of the corporation formerly known as Histogen Inc. ("Histogen") were converted into shares of common stock of the Issuer pursuant to that certain Agreement and Plan of Merger and Reorganization, dated as of January 28, 2020, by and among the Issuer, Chinook Merger Sub, Inc. and Histogen (the "Merger Agreement"). Pursuant to the terms of the Merger Agreement, each share of Histogen common stock was exchanged for 1.4342 shares of the Issuer's common stock (the "Conversion"). Immediately following the merger, the Issuer changed its name to Histogen Inc. All share numbers reflect the one-for-ten reverse stock split (the "Reverse Split") effected by the Issuer immediately prior to the completion of the merger. |
| 2. Shares subject to the option vest in 48 equal monthly installments. Shares subject to the option and the exercise price have been adjusted based upon the Conversion and Reverse Split. |
| 3. Shares subject to the option vest in 48 equal monthly installments. Shares subject to the option and the exercise price have been adjusted based upon the Conversion and Reverse Split. |
| Remarks: |
| Vice President, Technical Operations |
| /s/ Richard W. Pascoe as attorney-in-fact for Martin Latterich | 05/28/2020 | |
| ** 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 4 (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. | ||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. | ||
