Statement of Changes in Beneficial Ownership (4)
September 04 2020 - 4:31PM
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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3235-0287
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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
*
Cotroneo Pat |
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)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
SVP, Finance and CFO |
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(Last)
(First)
(Middle)
C/O FIBROGEN, INC., 409 ILLINOIS ST. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
9/3/2020 |
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(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 | 9/3/2020 | | M | | 637 | A | $29.66 | 278947 | D | |
| Common Stock | 9/3/2020 | | M | | 5696 | A | $19.39 | 284643 | D | |
| Common Stock | 9/3/2020 | | M | | 8671 | A | $25.40 | 293314 | D | |
| Common Stock | 9/3/2020 | | S | | 15004 (1) | D | $50.91 (2) | 278310 | 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) | $29.66 | 9/3/2020 | | M | | | 637 | (3) | 3/4/2025 | Common Stock | 637 | $0.00 | 4618 | D | |
| Stock Option (Right to Buy) | $19.39 | 9/3/2020 | | M | | | 5696 | (3) | 2/22/2026 | Common Stock | 5696 | $0.00 | 0 | D | |
| Stock Option (Right to Buy) | $25.40 | 9/3/2020 | | M | | | 8671 | (4) | 3/8/2027 | Common Stock | 8671 | $0.00 | 41579 | D | |
| Explanation of Responses: |
| (1) | Shares sold pursuant to a 10b5-1 plan. |
| (2) | The shares were sold at prices ranging from $50.89 to $51.00. The reporting person will provide upon request to the SEC, the issuer or security holder of the issuer, full information regarding the number of shares sold at each separate price. |
| (3) | Fully vested. |
| (4) | Twenty-five percent of the shares subject to the option vests on the first anniversary of the vesting commencement date, and the remainder vests in equal amounts quarterly thereafter for the following three years. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Cotroneo Pat
C/O FIBROGEN, INC.
409 ILLINOIS ST.
SAN FRANCISCO, CA 94158 |
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| SVP, Finance and CFO |
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Signatures
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| /s/ Dorothy Pacini, Attorney-in-fact | | 9/4/2020 |
| **Signature of Reporting Person | Date |
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