SEC Form 3 · accession 0001209191-18-039602
Forty Seven, Inc. · FTSV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Craig S Gibbs
Officer — Chief Business Officer
Period of report
Jun 27, 2018
Accepted (ET)
Jun 27, 2018 · 2:27 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 | holding | — | — | — | 56,451 | I | By Annuity Trust (CSG) | |
| Common StockF2 | holding | — | — | — | 56,451 | I | By Annuity Trust (KG) |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F3 | $2.015 | holding | — | — | — | — | Jan 21, 2026 | Common Stock | 112,903 | — | D |
| Stock Option (right to buy)F4 | $5.27 | holding | — | — | — | — | Nov 27, 2027 | Common Stock | 64,515 | — | D |
| Stock Option (right to buy)F5 | $8.7575 | holding | — | — | — | — | Apr 26, 2028 | Common Stock | 72,902 | — | D |
Explanation of responses
- F1Shares held by Craig Stafford Gibbs, Trustee of the Craig Stafford Gibbs 2018 Annuity Trust dated June 7, 2018.
- F2Shares held by Craig Stafford Gibbs, Trustee of the Kit Gibbs 2018 Annuity Trust dated June 7, 2018. Dr. Gibbs disclaims beneficial ownership of these shares.
- F3The shares subject to the option vest in a series of 24 successive equal monthly installments beginning September 14, 2017, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase.
- F4The shares subject to the option vest in a series of 48 successive equal monthly installments beginning November 8, 2017, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase.
- F5The shares subject to the option vest in a series of 48 successive equal monthly installments beginning March 1, 2019, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase.
Remarks
Exhibit 24 - Power of Attorney