0001209191-16-144613.txt : 20161004 0001209191-16-144613.hdr.sgml : 20161004 20161004180203 ACCESSION NUMBER: 0001209191-16-144613 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160930 FILED AS OF DATE: 20161004 DATE AS OF CHANGE: 20161004 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Fulgent Genetics, Inc. CENTRAL INDEX KEY: 0001674930 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MEDICAL LABORATORIES [8071] IRS NUMBER: 812621304 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 4978 SANTA ANITA AVENUE, SUITE 205 CITY: TEMPLE CITY STATE: CA ZIP: 91780 BUSINESS PHONE: 626-350-0537 MAIL ADDRESS: STREET 1: 4978 SANTA ANITA AVENUE, SUITE 205 CITY: TEMPLE CITY STATE: CA ZIP: 91780 FORMER COMPANY: FORMER CONFORMED NAME: Fulgent Diagnostics, Inc. DATE OF NAME CHANGE: 20160517 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Yen Yun CENTRAL INDEX KEY: 0001684584 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37894 FILM NUMBER: 161920530 MAIL ADDRESS: STREET 1: 1301 OAKLAWN ROAD CITY: ARCADIA STATE: CA ZIP: 91006 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-09-30 0 0001674930 Fulgent Genetics, Inc. FLGT 0001684584 Yen Yun C/O FULGENT GENETICS, INC. 4978 SANTA ANITA AVENUE TEMPLE CITY CA 91780 1 0 0 0 Predecessor Class D Voting Common Units 2016-09-30 4 D 0 4000000 D 0 D Issuer Common Stock 2016-09-30 4 A 0 526315 A 526315 D Reflects securities of Fulgent Therapeutics LLC (the "Predecessor" or "Fulgent LLC"). Fulgent LLC is considered the predecessor of Fulgent Genetics, Inc. (the "Issuer") following completion of a reorganization transaction pursuant to which the Predecessor became a wholly owned subsidiary of the Issuer (the "Reorganization"), which was completed on September 30, 2016 in connection with the initial public offering of the Issuer and which is described in the Issuer's Registration Statement on Form S-1, as amended (File No. 333-213469). In the Reorganization, all of the Predecessor's Class D voting common units were cancelled in exchange for shares of the Issuer's common stock at a ratio of 7.6-for-1. The securities were disposed of and cancelled in the Reorganization in exchange for 526,315 shares of the Issuer's common stock. The securities were received in the Reorganization in exchange for the cancellation of 4,000,000 of the Predecessor's Class D voting common units. /s/ Paul Kim as Attorney-in-Fact 2016-10-04