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