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