SEC Form 4 · accession 0000899243-18-019016
Forty Seven, Inc. · FTSV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Period of report
Jul 2, 2018
Accepted (ET)
Jul 2, 2018 · 7:45 pm EDT
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001667633
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jul 2, 2018 | C | 2,023,876 | — | A | 2,023,876 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series B Convertible Preferred StockF1 | — | Jul 2, 2018 | C | 2,023,876 | D | — | — | Common Stock | 2,023,876 | 0 | D |
Explanation of responses
- F1The Series B Convertible Preferred Stock converted into Common Stock on a 1-for-1 basis immediately prior to the closing of the Issuer's initial public offering. The Series B Convertible Preferred Stock reported in the table above reflects a 1-for-7.75 reverse stock split that was effected by the Issuer on June 14, 2018. The shares had no expiration date.