SEC Form 4 · accession 0001209191-18-040427

Forty Seven, Inc. · FTSV

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

Reporting owner

Christopher J Schaepe

Director · 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 Stock^F1,F2,F3	Jul 2, 2018	C	67,036	—	A	67,036	I	See footnote
Common Stock^F1,F3,F4	Jul 2, 2018	C	1,340,698	—	A	1,340,698	I	See footnote
Common Stock^F1,F3,F4	Jul 2, 2018	C	1,133,670	—	A	2,474,368	I	See footnote
Common Stock^F1,F5,F6	Jul 2, 2018	C	1,315,519	—	A	1,315,519	I	See footnote
Common Stock^F5,F6	Jul 2, 2018	P	468,750	$16.00	A	1,784,269	I	See footnote

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series A-1 Preferred Stock^F1,F2,F3	—	Jul 2, 2018	C	67,036	D	—	—	Common Stock	67,036	I
Series A-1 Preferred Stock^F1,F3,F4	—	Jul 2, 2018	C	1,340,698	D	—	—	Common Stock	1,340,698	I
Series A-2 Preferred Stock^F1,F3,F4	—	Jul 2, 2018	C	1,133,670	D	—	—	Common Stock	1,133,670	I
Series B Preferred Stock^F1,F5,F6	—	Jul 2, 2018	C	1,315,519	D	—	—	Common Stock	1,315,519	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.
F2Shares are held by Lightspeed Affiliates X, L.P., or Lightspeed Affiliates.
F3Lightspeed General Partner X, L.P., or Lightspeed GP X, is the general partner of Lightspeed X and Lightspeed Affiliates. Lightspeed Ultimate General Partner X, Ltd., or Lightspeed UGP X, is the general partner of Lightspeed GP X. Christopher J. Schaepe, Barry Eggers, Ravi Mhatre, Peter Nieh and Jeremy Liew are the directors of Lightspeed UGP X and share voting and dispositive power with respect to the shares held by Lightspeed X. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
F4Shares held by Lightspeed Venture Partners X, L.P., or Lightspeed X.
F5Shares are held by Lightspeed Venture Partners Select II, L.P., or Lightspeed Select II.
F6Lightspeed General Partner Select II, L.P., or Select II GP, is the general partner of Lightspeed Select II. Lightspeed Ultimate General Partner Select II, Ltd., or Select II UGP, is the general partner of Select II GP. Mr. Schaepe, Eggers, Mhatre, Nieh and Liew are the directors of Select II UGP and share voting and dispositive power with respect to the shares held by Lightspeed Select II. The Reporting Person disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.