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