SEC Form 4 · accession 0001209191-18-040426
Forty Seven, Inc. · FTSV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owners
Dennis Henner
Director · 10% Owner
Nicholas Galakatos
10% Owner
Robert Liptak
10% Owner
Kurt Wheeler
10% Owner
Nicholas Simon
10% Owner
Clarus Lifesciences III, L.P.
10% Owner
Clarus Ventures III GP, L.P.
10% Owner
Scott Requadt
10% Owner
Clarus Ventures III, LLC
10% Owner
Period of report
Jul 2, 2018
Accepted (ET)
Jul 2, 2018 · 5:14 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,F2 | Jul 2, 2018 | C | 938,489 | — | A | 938,489 | I | See foonote |
| Common StockF1,F2 | Jul 2, 2018 | C | 755,780 | — | A | 1,694,269 | I | See footnote |
| Common StockF1,F2 | Jul 2, 2018 | C | 1,922,682 | — | A | 3,616,951 | I | See footnote |
| Common StockF2 | Jul 2, 2018 | P | 200,000 | $16.00 | A | 3,816,951 | I | See footnote |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Series A-1 Preferred StockF1,F2 | — | Jul 2, 2018 | C | 938,489 | D | — | — | Common Stock | 938,489 | 0 | I |
| Series A-2 Preferred StockF1,F2 | — | Jul 2, 2018 | C | 755,780 | D | — | — | Common Stock | 755,780 | 0 | I |
| Series B Preferred StockF1,F2 | — | Jul 2, 2018 | C | 1,922,682 | D | — | — | Common Stock | 1,922,682 | 0 | I |
Explanation of responses
- 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.