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