FibroGen (FGEN) Form 3 FIBROGEN / Elias Kouchakji ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940

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1. Name and Address of Reporting Person^*

Kouchakji Elias

(Last) (First) (Middle)

C/O FIBROGEN, INC.

409 ILLINOIS ST.

(Street)

SAN FRANCISCO CA 94158

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
05/01/2019

3. Issuer Name and Ticker or Trading Symbol
FIBROGEN INC [ FGEN ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

	Director	10% Owner
X	Officer (give title below)	Other (specify below)
SVP, Clinical Dev, Drug Safety

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	97,512	D

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
	Date Exercisable	Expiration Date	Title	Amount or Number of Shares
Stock Option (Right to Buy)	(1)	03/19/2024	Common Stock	23,082	14.58	D
Stock Option (Right to Buy)	(1)	03/04/2025	Common Stock	31,632	29.66	D
Stock Option (Right to Buy)	(2)	02/22/2026	Common Stock	17,499	19.39	D
Stock Option (Right to Buy)	(3)	03/08/2027	Common Stock	60,000	25.4	D
Stock Option (Right to Buy)	(4)	03/14/2028	Common Stock	42,000	53.75	D
Stock Option (Right to Buy)	(5)	02/05/2029	Common Stock	49,680	57.33	D

Explanation of Responses:

1. Fully vested.

2. Twenty-five percent of the shares subject to the option vested on March 1, 2017, and the remainder vested in equal amounts quarterly thereafter for the following three years.

3. Twenty-five percent of the shares subject to the option vested on March 1, 2018, and the remainder vested in equal amounts quarterly thereafter for the following three years.

4. Twenty-five percent of the shares subject to the option vested on March 1, 2019, and the remainder vested in equal amounts quarterly thereafter for the following three years.

5. Twenty-five percent of the shares subject to the option vests on March 1, 2020, and the remainder vests in equal amounts quarterly thereafter for the following three years.

Remarks:

	/s/ Dorothy Pacini, Attorney-in-fact	05/09/2019
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.