0001209191-16-144640.txt : 20161004 0001209191-16-144640.hdr.sgml : 20161004 20161004180708 ACCESSION NUMBER: 0001209191-16-144640 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: Xi Long USA, Inc. CENTRAL INDEX KEY: 0001684591 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37894 FILM NUMBER: 161920572 BUSINESS ADDRESS: STREET 1: #6 XINRUI RD., SCIENCE CITY STREET 2: LUOGANG DISTRICT CITY: GUANGZHOU CITY STATE: F4 ZIP: 510663 BUSINESS PHONE: 86.20.62612188 MAIL ADDRESS: STREET 1: #6 XINRUI RD., SCIENCE CITY STREET 2: LUOGANG DISTRICT CITY: GUANGZHOU CITY STATE: F4 ZIP: 510663 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-09-30 0 0001674930 Fulgent Genetics, Inc. FLGT 0001684591 Xi Long USA, Inc. 6 XINRUI ROAD SCIENCE CITY LUOGANG DISTRICT GUANGZHOU GUANGDONG PROVINCE F4 510663 CHINA 0 0 1 0 Issuer Common Stock 2016-09-30 4 J 0 2025623 A 2025623 D Predecessor Class D-2 Preferred Units 2016-09-30 4 J 0 15394737 D Predecessor Class D Voting Common Units 15394737 0 D The securities were received in the Reorganization (as defined below), a transaction exempt under Rule 16b-7 under the Securities Exchange Act of 1934, as amended (the "Exchange Act"), in exchange for the cancellation of 15,394,737 Class D-2 preferred units of Fulgent Therapeutics LLC (the "Predecessor" or "Fulgent LLC"). Reflects securities of the Predecessor. Fulgent LLC is considered the predecessor of 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 Issuer's initial public offering 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-2 preferred units were cancelled in exchange for shares of the Issuer's common stock at a ratio of 7.6-for-1. Prior to the Reorganization, the Predecessor's Class D-2 preferred units had no expiration date and were convertible into the Predecessor's Class D voting common units, on a one-for-one basis and for no additional consideration, at any time at the option of the holder and in connection with a qualified initial public offering of the Predecessor or a successor thereof. The securities were disposed of and cancelled in the Reorganization, a transaction exempt under Rule 16b-7 under the Exchange Act, in exchange for 2,025,623 shares of the Issuer's common stock. /s/ Paul Kim as Attorney-in-Fact 2016-10-04