0001209191-18-039618.txt : 20180627
0001209191-18-039618.hdr.sgml : 20180627
20180627145213
ACCESSION NUMBER: 0001209191-18-039618
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180627
FILED AS OF DATE: 20180627
DATE AS OF CHANGE: 20180627
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lightspeed Venture Partners Select II, L.P.
CENTRAL INDEX KEY: 0001668017
STATE OF INCORPORATION: E9
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18921565
BUSINESS ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 843-5000
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lightspeed General Partner Select II, L.P.
CENTRAL INDEX KEY: 0001744936
STATE OF INCORPORATION: E9
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18921566
BUSINESS ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-234-8300
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Lightspeed Ultimate General Partner Select II, Ltd.
CENTRAL INDEX KEY: 0001744937
STATE OF INCORPORATION: E9
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18921567
BUSINESS ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: 650-234-8300
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SCHAEPE CHRISTOPHER J
CENTRAL INDEX KEY: 0001185068
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18921568
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Eggers Barry
CENTRAL INDEX KEY: 0001366048
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18921569
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Nieh Peter
CENTRAL INDEX KEY: 0001366051
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18921570
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Mhatre Ravi
CENTRAL INDEX KEY: 0001366050
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18921571
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Liew Jeremy
CENTRAL INDEX KEY: 0001700539
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18921572
MAIL ADDRESS:
STREET 1: 2200 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Forty Seven, Inc.
CENTRAL INDEX KEY: 0001667633
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 474065674
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1490 O'BRIEN DRIVE, SUITE A
CITY: MENLO PARK
STATE: CA
ZIP: 94025
BUSINESS PHONE: (650) 352-4150
MAIL ADDRESS:
STREET 1: 1490 O'BRIEN DRIVE, SUITE A
CITY: MENLO PARK
STATE: CA
ZIP: 94025
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2018-06-27
0
0001667633
Forty Seven, Inc.
FTSV
0001668017
Lightspeed Venture Partners Select II, L.P.
2200 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001744936
Lightspeed General Partner Select II, L.P.
2200 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001744937
Lightspeed Ultimate General Partner Select II, Ltd.
2200 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001185068
SCHAEPE CHRISTOPHER J
2200 SAND HILL ROAD
MENLO PARK
CA
94025
1
0
1
0
0001366048
Eggers Barry
2200 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001366051
Nieh Peter
2200 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001366050
Mhatre Ravi
2200 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001700539
Liew Jeremy
2200 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
Series B Preferred Stock
Common Stock
1315519
I
See footnote
The Issuer's preferred stock will automatically convert 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.
Lightspeed General Partner Select II, L.P., or Select II GP, is the general partner of Lightspeed Venture Partners Select II, L.P., or Lightspeed Select II. Lightspeed Ultimate General Partner Select II, Ltd., or Select II UGP, is the general partner of Select II GP. Christopher J. Schaepe, Barry Eggers, Jeremy Liew, Ravi Mhatre and Peter Nieh are the directors of Select II UGP and share voting and dispositive power with respect to the shares held by Lightspeed Select II. Messrs. Schaepe, Eggers, Liew, Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed Select II except to the extent of their pecuniary interest therein.
Lightspeed Venture Partners Select II, L.P., by Lightspeed General Partner Select II, L.P., its general partner, by Lightspeed Ultimate General Partner Select II, Ltd., its general partner, /s/ Christopher J. Schaepe, Duly authorized signatory
2018-06-27
Lightspeed General Partner Select II, L.P, by Lightspeed Ultimate General Partner Select II, Ltd., by /s/ Christopher J. Schaepe, Duly authorized signatory
2018-06-27
Lightspeed Ultimate General Partner Select II, Ltd., by /s/ Christopher J. Schaepe, Duly authorized signatory
2018-06-27
/s/ Christopher J. Schaepe
2018-06-27
/s/ Barry Eggers
2018-06-27
/s/ Peter Nieh
2018-06-27
/s/ Ravi Mhatre
2018-06-27
/s/ Jeremy Liew
2018-06-27