0001209191-15-053892.txt : 20150616
0001209191-15-053892.hdr.sgml : 20150616
20150616171413
ACCESSION NUMBER: 0001209191-15-053892
CONFORMED SUBMISSION TYPE: 3/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20141113
FILED AS OF DATE: 20150616
DATE AS OF CHANGE: 20150616
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Routti Jorma
CENTRAL INDEX KEY: 0001621330
FILING VALUES:
FORM TYPE: 3/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36740
FILM NUMBER: 15935062
MAIL ADDRESS:
STREET 1: C/O FIBROGEN, INC.
STREET 2: 409 ILLINOIS ST.,
CITY: SAN FRANCISCO
STATE: CA
ZIP: 94158
3/A
1
doc3a.xml
FORM 3/A SUBMISSION
X0206
3/A
2014-11-13
2014-11-13
0
0000921299
FIBROGEN INC
FGEN
0001621330
Routti Jorma
C/O FIBROGEN, INC.
409 ILLINOIS ST.
SAN FRANCISCO
CA
94158
1
0
0
0
Series B Preferred Stock of Fibrogen Europe Oy
Common Stock
39840
D
Each share of Fibrogen Europe Oy's Series B Preferred will be automatically exchanged into 0.664 of a share of common stock immediately prior to the closing of the issuer's initial public offering, and has no expiration date.
This form 3/A is being filed to add information that was omitted from the original form 3.
/s/ Dorothy Pacini, Attorney-in-fact
2015-06-16