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