0001209191-20-054437.txt : 20201009
0001209191-20-054437.hdr.sgml : 20201009
20201009161254
ACCESSION NUMBER: 0001209191-20-054437
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20201007
FILED AS OF DATE: 20201009
DATE AS OF CHANGE: 20201009
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Mento Steven J
CENTRAL INDEX KEY: 0001324466
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36003
FILM NUMBER: 201233340
MAIL ADDRESS:
STREET 1: C/O SANGAMO BIOSCIENCES, INC.
STREET 2: 501 CANAL BLVD SUITE A-100
CITY: RICHMOND
STATE: CA
ZIP: 94804
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
2020-10-07
0
0001383701
Histogen Inc.
HSTO
0001324466
Mento Steven J
C/O HISTOGEN INC.
10655 SORRENTO VALLEY ROAD, SUITE 200
SAN DIEGO
CA
92121
1
0
0
0
Stock Option (right to buy)
1.89
2020-10-07
4
A
0
20000
0.00
A
2030-10-07
Common Stock
20000
20000
D
This option was issued to the Reporting Person, a non-employee director of the Issuer, for his service as a director of the Issuer.
The shares subject to this option become fully vested and exercisable on the first anniversary of the grant date, subject to the Reporting Person's continued service on the board of directors of the Issuer through such vesting date.
/s/ Richard W. Pascoe as attorney-in-fact for Steven J. Mento
2020-10-09
EX-24.4_941084
2
poa.txt
POA DOCUMENT
EXHIBIT 24
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and appoints
each of Richard W. Pascoe and Susan A. Knudson, signing singly, the
undersigned's true and lawful attorney-in-fact to:
(1) prepare, execute in the undersigned's name and on the undersigned's behalf,
and submit to the U.S. Securities and Exchange Commission (the "SEC") a Form ID,
including any amendments thereto, and any other documents necessary or
appropriate to obtain codes and passwords enabling the undersigned to make
electronic filings with the SEC of reports required by Section 16(a) of the
Securities Exchange Act of 1934, as amended (together with the rules and
regulations of the SEC promulgated thereunder, the "Exchange Act");
(2) execute for and on behalf of the undersigned, in the undersigned's capacity
as a director of the Histogen Inc. (the "Company") or its subsidiaries, Forms 3,
4 and 5 in accordance with Section 16(a) of the Exchange Act;
(3) do and perform any and all acts for and on behalf of the undersigned which
may be necessary or desirable to complete and execute any such Form 3, 4 or 5,
complete and execute any amendment or amendments thereto, and timely file such
form with the SEC and any stock exchange or similar authority; and
(4) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Power of Attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Exchange Act.
This Power of Attorney shall remain in full force and effect until the earliest
to occur of: (i) the date the undersigned is no longer required to file Forms
3, 4 and 5 with respect to the undersigned's holdings of and transactions in
securities issued by the Company; and (ii) the revocation hereof by the
undersigned in a signed writing delivered to the foregoing attorneys-in-fact.
This Power of Attorney revokes all prior Powers of Attorney relating to
reporting under Section 16 of the Exchange Act of holdings of and transactions
in the Company's securities.
This Power of Attorney may be executed by electronic signature (including any
electronic signature complying with the ESIGN Act of 2000, such as
www.docusign.com) and/or delivered by electronic transmission, including by
facsimile or electronic mail, and when so executed and/or delivered shall have
been duly and validly executed and/or delivered, and be valid and effective, for
all purposes.
[ the signature page follows ]
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 8th day of October, 2020.
/s/ Steven J. Mento
------------------------------------
Name: Steven J. Mento