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