SEC Form 4 · accession 0001209191-18-040424

Forty Seven, Inc. · FTSV

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director · 10% Owner

Period of report

Jul 2, 2018

Accepted (ET)

Jul 2, 2018 · 5:13 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 Stock^F1,F2	Jul 2, 2018	C	938,489	—	A	938,489	I	See footnote
Common Stock^F1,F2	Jul 2, 2018	C	755,780	—	A	1,694,269	I	See footnote
Common Stock^F1,F2	Jul 2, 2018	C	1,922,682	—	A	3,616,951	I	See footnote
Common Stock^F2	Jul 2, 2018	P	200,000	$16.00	A	3,816,951	I	See footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series A-1 Preferred Stock^F1,F2	—	Jul 2, 2018	C	938,489	D	—	—	Common Stock	938,489	I
Series A-2 Preferred Stock^F1,F2	—	Jul 2, 2018	C	755,780	D	—	—	Common Stock	755,780	I
Series B Preferred Stock^F1,F2	—	Jul 2, 2018	C	1,922,682	D	—	—	Common Stock	1,922,682	I

F1The Issuer's preferred stock automatically converted into an equal number of shares of Issuer's common stock immediately upon the closing of the Issuer's initial public offering and has no expiration date.
F2Clarus Ventures III GP, LP, or GPLP, as the sole general partner of Clarus Lifesciences III, LP, or Clarus, may be deemed to beneficially own certain of the shares held by Clarus. GPLP disclaims beneficial ownership of all shares held by Clarus in which the GPLP does not have a pecuniary interest. Clarus Ventures III, LLC, or GPLLC, as the sole general partner of the GPLP, may be deemed to beneficially own certain of the shares held by Clarus. GPLLC disclaims beneficial ownership of all shares held by Clarus in which it does not have an actual pecuniary interest. Each of Dennis Henner, Nicholas Galakatos, Robert Liptak, Nicholas Simon, Scott Requadt and Kurt Wheeler, as individual managing directors of GPLLC, may be deemed to beneficially own certain of the shares held of record by Clarus. Dr. Henner and Messrs. Galakatos, Liptak, Simon, Requadt and Wheeler disclaims beneficial ownership of all shares held of record by Clarus in which they do not have an actual pecuniary interest.