SEC Form 4 · accession 0001225208-18-011388

Forty Seven, Inc. · FTSV

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

Reporting owner

10% Owner

Period of report

Jul 2, 2018

Accepted (ET)

Jul 3, 2018 · 7:42 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	Jul 2, 2018	C	4,516	$0.00	A	4,516	D
Common Stock^F1,F2	Jul 2, 2018	C	5,161	$0.00	A	5,161	I	By Irrevocable Trust (ST)
Common Stock^F1,F3	Jul 2, 2018	C	40,477	$0.00	A	40,477	I	By Ltd Partnership (ROSE)
Common Stock^F1,F3	Jul 2, 2018	C	38,173	$0.00	A	78,650	I	By Ltd Partnership (ROSE)
Common Stock^F1,F3	Jul 2, 2018	C	33,769	$0.00	A	112,419	I	By Ltd Partnership (ROSE)
Common Stock^F1,F4	Jul 2, 2018	C	1,052,146	$0.00	A	1,052,146	I	By Ltd Partnership (SHV)
Common Stock^F1,F4	Jul 2, 2018	C	945,326	$0.00	A	1,997,472	I	By Ltd Partnership (SHV)
Common Stock^F1,F4	Jul 2, 2018	C	774,165	$0.00	A	2,771,637	I	By Ltd Partnership (SHV)
Common Stock^F4	Jul 2, 2018	P	134,735	$16.00	A	2,906,372	I	By Ltd Partnership (SHV)
Common Stock^F1,F5	Jul 2, 2018	C	18,295	$0.00	A	18,295	I	By Trust
Common Stock^F1,F5	Jul 2, 2018	C	11,544	$0.00	A	29,839	I	By Trust
Common Stock^F5	Jul 2, 2018	P	7,415	$16.00	A	37,254	I	By Trust
Common Stock^F1,F5	Jul 2, 2018	C	587	$0.00	A	37,841	I	By Trust

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series A-1 Preferred Stock^F1	—	Jul 2, 2018	C	4,516	D	—	—	Common Stock	4,516	D
Series A-1 Preferred Stock^F1,F2	—	Jul 2, 2018	C	5,161	D	—	—	Common Stock	5,161	I
Series A-1 Preferred Stock^F1,F3	—	Jul 2, 2018	C	38,173	D	—	—	Common Stock	38,173	I
Series A-2 Preferred Stock^F1,F3	—	Jul 2, 2018	C	33,769	D	—	—	Common Stock	33,769	I
Series B Preferred Stock^F1,F3	—	Jul 2, 2018	C	40,477	D	—	—	Common Stock	40,477	I
Series A-1 Preferred Stock^F1,F4	—	Jul 2, 2018	C	1,052,146	D	—	—	Common Stock	1,052,146	I
Series A-2 Preferred Stock^F1,F4	—	Jul 2, 2018	C	774,165	D	—	—	Common Stock	774,165	I
Series B Preferred Stock^F1,F4	—	Jul 2, 2018	C	945,326	D	—	—	Common Stock	945,326	I
Series A-1 Preferred Stock^F1,F5	—	Jul 2, 2018	C	587	D	—	—	Common Stock	587	I
Series A-2 Preferred Stock^F1,F5	—	Jul 2, 2018	C	18,295	D	—	—	Common Stock	18,295	I
Series B Preferred Stock^F1,F5	—	Jul 2, 2018	C	11,544	D	—	—	Common Stock	11,544	I

F1The issuer's preferred stock automatically converted into issuer's common stock on a one-to-one basis immediately upon the closing of the issuer's initial public offering and has no expiration date.
F2Shares held by a trust for the benefit of the reporting person of which the reporting person is the sole trustee.
F3Shares held by a limited partnership of which the reporting person is a trustee of a trust which is the general partner. The reporting person disclaims beneficial ownership in these shares except as to the reporting person's pecuniary interest therein.
F4Shares held by Sutter Hill Ventures, a California Limited Partnership. The reporting person is a managing director and member of the management committee of the general partner of Sutter Hill Ventures, a California Limited Partnership. The reporting person disclaims beneficial ownership in these shares except as to the reporting person's pecuniary interest therein.
F5Shares held by a trust of which the reporting person is a trustee. The reporting person disclaims beneficial ownership in these shares except as to the reporting person's pecuniary interest therein.