0001209191-21-036675.txt : 20210528 0001209191-21-036675.hdr.sgml : 20210528 20210528190406 ACCESSION NUMBER: 0001209191-21-036675 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210526 FILED AS OF DATE: 20210528 DATE AS OF CHANGE: 20210528 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: EDWARDS JEFFREY L CENTRAL INDEX KEY: 0001190642 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36740 FILM NUMBER: 21982272 MAIL ADDRESS: STREET 1: 2525 DUPONT DR CITY: IRVINE STATE: CA ZIP: 92612 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 2021-05-26 0 0000921299 FIBROGEN INC FGEN 0001190642 EDWARDS JEFFREY L C/O FIBROGEN, INC. 409 ILLINOIS STREET SAN FRANCISCO CA 94158 1 0 0 0 Common Stock 2021-05-26 4 A 0 4700 0.00 A 17800 D Stock Option (Right to Buy) 20.86 2021-05-26 4 A 0 7800 0.00 A 2031-05-25 Common Stock 7800 7800 D Represents the grant of restricted stock units that vest on the earlier of May 26, 2022 or the date of the next annual meeting of stockholders, subject to the reporting person's continuous service on the applicable vesting date. Options vest on the earlier of May 26, 2022 or the date of the next annual meeting of stockholders, subject to the reporting person's continuous service on the applicable vesting date. /s/ Dorothy Pacini, Attorney-in-fact 2021-05-28