0001209191-19-059778.txt : 20191209 0001209191-19-059778.hdr.sgml : 20191209 20191209201306 ACCESSION NUMBER: 0001209191-19-059778 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191206 FILED AS OF DATE: 20191209 DATE AS OF CHANGE: 20191209 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kouchakji Elias CENTRAL INDEX KEY: 0001775259 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36740 FILM NUMBER: 191276358 MAIL ADDRESS: STREET 1: C/O FIBROGEN, INC. STREET 2: 409 ILLINOIS STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94158 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: FIBROGEN INC CENTRAL INDEX KEY: 0000921299 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 409 ILLINOIS STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94158 BUSINESS PHONE: 415-978-1200 MAIL ADDRESS: STREET 1: 409 ILLINOIS STREET CITY: SAN FRANCISCO STATE: CA ZIP: 94158 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-12-06 0 0000921299 FIBROGEN INC FGEN 0001775259 Kouchakji Elias C/O FIBROGEN, INC. 409 ILLINOIS ST. SAN FRANCISCO CA 94158 0 1 0 0 SVP, Clinical Dev, Drug Safety Common Stock 2019-12-06 4 F 0 2442 47.39 D 101216 D Represents shares withheld by the issuer to satisfy a tax obligation realized by the reporting person upon the vesting of restricted stock units. /s/ Dorothy Pacini, Attorney-in-fact 2019-12-09