Statement of Changes in Beneficial Ownership (4)
August 07 2020 - 7:46PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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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1. Name and Address of Reporting Person
*
Brennan Aoife |
2. Issuer Name and Ticker or Trading Symbol
FIBROGEN INC
[
FGEN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O FIBROGEN, INC., 409 ILLINOIS ST. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
8/5/2020 |
(Street)
SAN FRANCISCO, CA 94158
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 8/5/2020 | | A | | 3914 (1) | A | $0.00 | 3914 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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) | $42.65 | 8/5/2020 | | A | | 6496 | | (2) | 8/5/2030 | Common Stock | 6496 | $0.00 | 6496 | D | |
Stock Option (Right to Buy) | $42.65 | 8/5/2020 | | A | | 10400 | | (3) | 8/5/2030 | Common Stock | 10400 | $0.00 | 10400 | D | |
Explanation of Responses: |
(1) | Represents the grant of restricted stock units that vest on the earlier of June 4, 2021 or the date of the next annual meeting of stockholders, subject to the reporting person's continuous service on the applicable vesting date. |
(2) | Options vest on the earlier of June 4, 2021 or the date of the next annual meeting of stockholders, subject to the reporting person's continuous service on the applicable vesting date. |
(3) | Option vests quarterly over three years from August 5, 2020. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Brennan Aoife C/O FIBROGEN, INC. 409 ILLINOIS ST. SAN FRANCISCO, CA 94158 | X |
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Signatures
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/s/ Dorothy Pacini, Attorney-in-fact | | 8/7/2020 |
**Signature of Reporting Person | Date |
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