0001209191-14-072506.txt : 20141202 0001209191-14-072506.hdr.sgml : 20141202 20141202195103 ACCESSION NUMBER: 0001209191-14-072506 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20141202 FILED AS OF DATE: 20141202 DATE AS OF CHANGE: 20141202 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: RAKIN KEVIN CENTRAL INDEX KEY: 0001184421 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36751 FILM NUMBER: 141261912 MAIL ADDRESS: STREET 1: C/O HISTOGENICS CORPORATION STREET 2: 830 WINTER STREET CITY: WALTHAM STATE: MA ZIP: 02451 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2014-12-02 0 0001372299 HISTOGENICS CORP HSGX 0001184421 RAKIN KEVIN C/O HISTOGENICS CORPORATION 830 WINTER STREET, 3RD FLOOR WALTHAM MA 02451 1 0 0 0 Common Stock 13209 D Series A Preferred Stock Common Stock 6444 I By Kevin L. Rakin Irrevocable Trust Series A-1 Preferred Stock Common Stock 3914 I By Kevin L. Rakin Irrevocable Trust Common Stock Warrant (Right to Buy) 0.76 Common Stock 242 D Series A Preferred Stock Common Stock 9667 D Series A-1 Preferred Stock Common Stock 5871 D Reflects a 10.804-to-1 reverse stock split effected on November 14, 2014. All outstanding shares of the Issuer's preferred stock will automatically convert into common stock immediately prior to the closing of the Issuer's initial public offering, for no additional consideration and including accrued dividends. These shares have no expiration date. The Common Stock Warrant will be net exercised immediately prior to the Issuer's initial public offering. The expiration date of the warrant is upon the consummation of the Issuer's initial public offering or a liquidity event (as described in such warrant). /s/ Kevin Rakin 2014-12-02