0001209191-18-010198.txt : 20180214 0001209191-18-010198.hdr.sgml : 20180214 20180214200417 ACCESSION NUMBER: 0001209191-18-010198 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171231 FILED AS OF DATE: 20180214 DATE AS OF CHANGE: 20180214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KEARNS THOMAS F JR CENTRAL INDEX KEY: 0001189184 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36740 FILM NUMBER: 18615696 MAIL ADDRESS: STREET 1: P O BOX 587 CITY: WARSAW STATE: IN ZIP: 46581-0587 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 5 1 doc5.xml FORM 5 SUBMISSION X0306 5 2017-12-31 0 0 0 0000921299 FIBROGEN INC FGEN 0001189184 KEARNS THOMAS F JR C/O FIBROGEN, INC. 409 ILLINOIS ST. SAN FRANCSICO CA 94158 1 0 0 0 Common Stock 2017-11-13 5 G 0 1000 0.00 D 137564 D Common Stock 2017-11-20 5 G 0 500 0.00 D 137064 D Common Stock 2017-11-27 5 G 0 1000 0.00 D 136064 D Common Stock 2017-12-05 5 G 0 500 0.00 D 135564 D Common Stock 110000 I By Trust /s/ Dorothy Pacini, Attorney-in-fact 2018-02-14