# EDGAR Filing Document

**Accession Number:** 0001383701
**File Stem:** 0001209191-23-018479
**Filing Date:** 2023-3
**Character Count:** 7197
**Document Hash:** 05f64866360bc0781ccc14527fa445d3
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0001209191-23-018479.hdr.sgml**: 20230314

**ACCESSION NUMBER**: 0001209191-23-018479

**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:** Reyes Joyce
- **CENTRAL INDEX KEY:** 0001929891

**FILING VALUES:**
- **FORM TYPE:** 4
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-36003
- **FILM NUMBER:** 23731526

**MAIL ADDRESS:**
- **STREET 1:** 10655 SORRENTO VALLEY ROAD
- **STREET 2:** SUITE 200
- **CITY:** SAN DIEGO
- **STATE:** CA
- **ZIP:** 92121
**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

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 4

### STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

[ ] Check this box to indicate that a transaction was made pursuant to a contract, instruction or written plan for the purchase or sale of equity securities of the issuer that is intended to satisfy the affirmative defense conditions of Rule 10b5-1(c). See Instruction 10.

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Reyes Joyce<br><sub>(Last) (First) (Middle)</sub><br>C/O HISTOGEN INC.<br>10655 SORRENTO VALLEY ROAD, SUITE 200<br><sub>(Street)</sub><br>SAN DIEGO, CA 92121<br><sub>(City) (State) (Zip)</sub> | **3. Date of Earliest Transaction (Month/Day/Year)**<br>2023-03-10 | **5. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director [ ] 10% Owner<br>[X] Officer (give title below) [ ] Other (specify below)<br>_See Remarks_ |
| **2. Issuer Name and Ticker or Trading Symbol**<br>Histogen Inc. [ HSTO ] | **4. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | 3. Transaction Code (V) | 3. Transaction Code (V) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 4. Securities Acquired (A) or Disposed of (D) | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
| 1. Title of Security | 2. Transaction Date | 2A. Deemed Execution Date | Code | V | Amount | (A) or (D) | Price | 5. Amount of Securities Beneficially Owned | 6. Ownership Form | 7. Nature of Indirect Beneficial Ownership |
|  |  |  |  |  |  |  |  |  |  |  |

---

## Table II - Derivative Securities

---

|  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | 4. Transaction Code (V) | 4. Transaction Code (V) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) | 6. Date Exercisable and Expiration Date | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Underlying Securities | 7. Title and Amount of Underlying Securities | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | 2. Conversion or Exercise Price | 3. Transaction Date | 3A. Deemed Execution Date | Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 8. Price of Derivative Security | 9. Number of Derivative Securities Beneficially Owned | 10. Ownership Form | 11. Nature of Indirect Beneficial Ownership |
| Stock Option (right to buy) | $0.95 | 2023-03-10 |  | A |  | 47417 |  | <sup>(1)</sup> | 2033-03-10 | Common Stock | 47417 | $0.00 | 47417 | D |  |
| Stock Option (right to buy) | $0.95 | 2023-03-10 |  | A |  | 16659 |  | <sup>(1)</sup> | 2033-03-10 | Common Stock | 16659 | $0.00 | 16659 | D |  |
| Stock Option (right to buy) | 4.80<sup>(2)</sup> | 2023-03-10 |  | D<sup>(3)</sup> |  |  | 1200<sup>(2)</sup> | <sup>(4)</sup> | 2032-02-17 | Common Stock | 1200 | $0.00 | 0 | D |  |
| Stock Option (right to buy) | 3.20<sup>(2)</sup> | 2023-03-10 |  | D<sup>(3)</sup> |  |  | 7833<sup>(2)</sup> | <sup>(5)</sup> | 2032-06-01 | Common Stock | 7833 | $0.00 | 0 | D |  |

---

### Footnotes:

(1) 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 monthlybasis thereafter.

(2) 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.

(3) On March 10, 2023, the Issuer and the Reporting Person agreed to cancel the stock option award.

(4) 1/4 of the shares subject to the option vested on 9/15/2022 and the remaining 1/36 of the shares vest on a monthly basis thereafter.

(5) 1/4 of the shares subject to the option vested one year after the date of grant, on 6/1/2023, and the remaining 1/36 of the shares vest on a monthly basis thereafter.

**Remarks:**
Senior Vice President of Regulatory, Quality, Clinical Operations, and Technical Operations

**Signature:** /s/  Susan A. Knudson as attorney-in-fact for Joyce Reyes  
**Date:** 2023-03-14

### Remarks:

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.**