0001209191-19-061040.txt : 20191217
0001209191-19-061040.hdr.sgml : 20191217
20191217192538
ACCESSION NUMBER: 0001209191-19-061040
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20191213
FILED AS OF DATE: 20191217
DATE AS OF CHANGE: 20191217
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: RHOADS ANN D
CENTRAL INDEX KEY: 0001250252
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 191291050
MAIL ADDRESS:
STREET 1: 4000 NORTH FIRST STREET
CITY: SAN JOSE
STATE: CA
ZIP: 95134
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2019-12-13
0
0001667633
Forty Seven, Inc.
FTSV
0001250252
RHOADS ANN D
C/O FORTY SEVEN, INC.
1490 O'BRIEN DRIVE, SUITE A
MENLO PARK
CA
94025
0
1
0
0
Chief Financial Officer
Stock Option (right to buy)
35.75
2019-12-13
4
A
0
107827
0.00
A
2029-12-12
Common Stock
107827
107827
D
The shares subject to the option vest in a series of 48 successive equal monthly installments beginning with the vesting commencement date, subject to Reporting Person's continuous service as of each such date.
/s/ John T. McKenna, Attorney-in-Fact for Ann D. Rhoads
2019-12-17