Statement of Changes in Beneficial Ownership (4)
March 19 2020 - 7:56PM
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
*
Chung Christine |
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, China Operations |
(Last)
(First)
(Middle)
C/O FIBROGEN, INC., 409 ILLINOIS ST. |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/6/2020 |
(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 | 3/6/2020 | | F | | 10126 (1) | D | $39.71 | 122518 | D | |
Common Stock | 3/17/2020 | | A | | 40000 (2) | A | $0.00 | 162518 | D | |
Common Stock | 3/18/2020 | | M | | 400 | A | $25.40 | 162918 | D | |
Common Stock | 3/18/2020 | | S | | 905 (3) | D | $23.69 (4) | 162013 | D | |
Common Stock | 3/18/2020 | | S | | 1500 (3) | D | $24.56 (5) | 160513 | D | |
Common Stock | 3/18/2020 | | S | | 1500 (3) | D | $25.68 (6) | 159013 | D | |
Common Stock | 3/19/2020 | | M | | 7345 | A | $25.40 | 166358 | D | |
Common Stock | 3/19/2020 | | S | | 300 (3) | D | $23.93 (7) | 166058 | D | |
Common Stock | 3/19/2020 | | S | | 830 (3) | D | $25.32 (8) | 165228 | D | |
Common Stock | 3/19/2020 | | S | | 6215 (3) | D | $26.08 (9) | 159013 | 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) | $26.41 | 3/17/2020 | | A | | 66250 | | (10) | 3/17/2030 | Common Stock | 66250 | $0.00 | 66250 | D | |
Stock Option (Right to Buy) | $25.40 | 3/18/2020 | | M | | | 400 | (11) | 3/8/2027 | Common Stock | 400 | $0.00 | 42064 | D | |
Stock Option (Right to Buy) | $25.40 | 3/19/2020 | | M | | | 7345 | (11) | 3/8/2027 | Common Stock | 7345 | $0.00 | 34719 | D | |
Explanation of Responses: |
(1) | Represents shares withheld by the issuer to satisfy a tax obligation realized by the reporting person upon the vesting of restricted stock units. |
(2) | Represents the grant of restricted stock units. Twenty-five percent of the restricted stock units vest on March 6, 2021, and the remainder vests in equal amounts quarterly thereafter for the following three years. |
(3) | Shares sold pursuant to a 10b5-1 plan. |
(4) | The shares were sold at prices ranging from $23.10 to $24.07. 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. |
(5) | The shares were sold at prices ranging from $24.13 to $25.10. 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. |
(6) | The shares were sold at prices ranging from $25.26 to $26.25. 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. |
(7) | The shares were sold at prices ranging from $23.50 to $24.42. 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. |
(8) | The shares were sold at prices ranging from $24.71 to $25.70. 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. |
(9) | The shares were sold at prices ranging from $25.71 to $26.525. 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. |
(10) | Twenty-five percent of the shares subject to the option vests on March 1, 2021, and the remainder vests in equal amounts quarterly thereafter for the following three years. |
(11) | Twenty-five percent of the shares subject to the option vests on March 1, 2018, 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 |
Chung Christine C/O FIBROGEN, INC. 409 ILLINOIS ST. SAN FRANCISCO, CA 94158 |
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| SVP, China Operations |
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Signatures
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/s/ Dorothy Pacini, Attorney-in-fact | | 3/19/2020 |
**Signature of Reporting Person | Date |
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