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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction 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 (Month/Day/Year) |
7. Title and Amount of Underlying Securities (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) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Stock Option (Right to Buy) | $ 5.95 | 12/08/2015 | M | 6,000 | (4) | 06/27/2022 | Common Stock | 6,000 | $ 0 | 0 | D | ||||
Stock Option (Right to Buy) | $ 2.35 | 12/08/2015 | M | 12,000 | (4) | 03/12/2018 | Common Stock | 12,000 | $ 0 | 0 | D | ||||
Stock Option (Right to Buy) | $ 3.6 | 12/08/2015 | M | 12,000 | (4) | 03/11/2019 | Common Stock | 12,000 | $ 0 | 0 | D | ||||
Stock Option (Right to Buy) | $ 18 | 12/08/2015 | M | 12,000 | (4) | 11/13/2014 | Common Stock | 12,000 | $ 0 | 0 | D | ||||
Stock Option (Right to Buy) | $ 3.5 | 12/08/2015 | M | 12,000 | (4) | 03/15/2021 | Common Stock | 12,000 | $ 0 | 0 | D | ||||
Stock Option (Right to Buy) | $ 9.775 | 12/08/2015 | M | 12,000 | (4) | 04/17/2023 | Common Stock | 12,000 | $ 0 | 0 | D | ||||
Stock Option (Right to Buy) | $ 18.34 | 12/08/2015 | M | 6,000 | (5) | 06/03/2025 | Common Stock | 6,000 | $ 0 | 6,000 | D | ||||
Stock Option (Right to Buy) | $ 2.9 | 12/08/2015 | M | 12,000 | (4) | 06/09/2020 | Common Stock | 12,000 | $ 0 | 0 | D |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
MADERO MIGUEL C/O FIBROGEN, INC. 409 ILLINOIS ST. SAN FRANCISCO, CA 94158 |
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/s/ Dorothy Pacini, Attorney-in-fact | 12/10/2015 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
(1) | The shares were sold by the reporting person to cover the exercise price and the taxes realized upon the exercise of such options. |
(2) | The shares were sold at prices ranging from $30.35 to $30.60. 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. |
(3) | The shares are held in accounts for the benefit of family members of the reporting person. The reporting person maintains voting and dispositive power over the shares held in such accounts. |
(4) | Fully vested. |
(5) | The shares subject to the option vest and become exercisable quarterly over one year measured from June 3, 2015. |