SEC FORM 5 SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
Form 3 Holdings Reported.
X
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Xie Jian

(Last) (First) (Middle)
C/O FULGENT GENETICS, INC.
4399 SANTA ANITA AVENUE

(Street)
EL MONTE CA 91731

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Fulgent Genetics, Inc. [ FLGT ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
President and COO
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
12/31/2023
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 03/10/2021 S4 4,300(1) D $108.2156(2) 358,824 D
Common Stock 03/11/2021 S4 5,700(3) D $101.6631(4) 353,124 D
Common Stock 220,816 I By Trust(5)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. The sale of the shares occured in the fiscal year ended December 31, 2021, but the filing of the Form 4 was inadvertently missed during that period.
2. The shares were sold in multiple transactions at prices ranging from $103.92 to $112.00, inclusive. The reported price reflects the weighted-average sale price. The reporting person hereby undertakes to provide upon request to the Securities and Exchange Commission (the "SEC") staff, Fulgent Genetics, Inc. (the "Issuer") or a security holder of the Issuer full information regarding the number of shares and prices at which the transactions were effected.
3. The sale of the shares occured in the fiscal year ended December 31, 2021, but the filing of the Form 4 was inadvertently missed during that period.
4. The shares were sold in multiple transactions at prices ranging from $100.28 to $104.09, inclusive. The reported price reflects the weighted-average sale price. The reporting person hereby undertakes to provide upon request to the SEC staff, the Issuer or a security holder of the Issuer full information regarding the number of shares and prices at which the transactions were effected.
5. Securities held by The Hsieh Family Dynasty Trust, dated January 27, 2010 (the "Trust"). Mr. Xie serves on the investment committee of the Trust. Mr. Xie disclaims any beneficial interest except with respect to any pecuniary interest therein.
/s/ Paul Kim as Attorney-in-Fact 02/09/2024
** 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 4 (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).
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