0001225208-19-009285.txt : 20190614
0001225208-19-009285.hdr.sgml : 20190614
20190614185426
ACCESSION NUMBER: 0001225208-19-009285
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190612
FILED AS OF DATE: 20190614
DATE AS OF CHANGE: 20190614
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: BIRD JEFFREY W
CENTRAL INDEX KEY: 0001250409
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 19900114
MAIL ADDRESS:
STREET 1: 755 PAGE MILL RD STE A-200
CITY: PALO ALTO
STATE: CA
ZIP: 94304-1005
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
X0306
4
2019-06-12
0001667633
Forty Seven, Inc.
FTSV
0001250409
BIRD JEFFREY W
755 PAGE MILL ROAD, SUITE A-200
PALO ALTO
CA
94304-1005
1
1
Stock Option (right to buy)
10.8100
2019-06-12
4
A
0
10322.0000
0.0000
A
2029-06-11
Common Stock
10322.0000
10322.0000
D
The shares subject to the option vest on the one-year anniversary of the grant date, subject to reporting person's continuous service on such date.
The reporting person shares pecuniary interest in these shares with other individuals pursuant to a contractual relationship. The reporting person disclaims beneficial ownership in these shares except as to the reporting person's pecuniary interest in these shares.
/s/ Robert Yin, by power of attorney
2019-06-14