SEC Form 4 · accession 0001209191-19-005940
Forty Seven, Inc. · FTSV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Anthony McCamish
Officer — President and CEO · Director
Period of report
Jan 25, 2019
Accepted (ET)
Jan 29, 2019 · 7:38 pm EST
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 | Jan 25, 2019 | M | 31,233 | $4.8825 | A | 40,265 | D | |
| Common Stock | Jan 25, 2019 | M | 20,454 | $4.8825 | A | 60,719 | D |
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)F1 | $4.8825 | Jan 25, 2019 | M | 31,233 | D | — | Jun 7, 2027 | Common Stock | 31,233 | 427,105 | D |
| Stock Option (right to buy)F2 | $4.8825 | Jan 25, 2019 | M | 20,454 | D | — | Aug 14, 2027 | Common Stock | 20,454 | 134,656 | D |
Explanation of responses
- F196,773 shares subject to the option vested on May 1, 2018 and the balance of the shares subject to the option vest in a series of 36 successive equal monthly installments beginning June 1, 2018, subject to the Reporting Person's continuous service as of each such date.
- F2The shares subject to the option vest in a series of 48 successive equal monthly installments beginning August 15, 2017, subject to the Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to the Issuer's right to repurchase.