0001104659-18-053568.txt : 20180824 0001104659-18-053568.hdr.sgml : 20180824 20180824183836 ACCESSION NUMBER: 0001104659-18-053568 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180822 FILED AS OF DATE: 20180824 DATE AS OF CHANGE: 20180824 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mhatre Ravi CENTRAL INDEX KEY: 0001366050 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 181037891 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 4 1 a4.xml 4 X0306 4 2018-08-22 0 0001667633 Forty Seven, Inc. FTSV 0001366050 Mhatre Ravi 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 Common Stock 2018-08-22 4 P 0 44000 14.9740 A 44000 I By Mhatre Investments LP - Fund 1 Common Stock 2018-08-22 4 P 0 44000 14.9740 A 44000 D Common Stock 2018-08-22 4 P 0 22000 14.9740 A 22000 I By Mhatre 2011 Irrevocable Children's Trust Common Stock 2018-08-23 4 P 0 22743 15.2711 A 66743 I By Mhatre Investments LP - Fund 1 Common Stock 2018-08-23 4 P 0 22743 15.2711 A 66743 D Common Stock 2018-08-23 4 P 0 11372 15.2711 A 33372 I By Mhatre 2011 Irrevocable Children's Trust Common Stock 1784269 I By: Lightspeed Venture Partners Select II, L.P. Common Stock 67036 I By: Lightspeed Affiliates X, L.P. Common Stock 2474368 I By: Lightspeed Venture Partners X, L.P. These sales were executed in multiple trades at prices ranging from $14.25 to $15.245. The price reported above reflects the weighted average sale price. Mr. Mhatre hereby undertakes to provide full information regarding the number of shares and prices at which these sales were effected, upon request, to the staff of the Securities and Exchange Commission, the Issuer or a security holder of the Issuer. Shares held by Mhatre Investments LP- Fund 1. Ravi Mhatre serves as trustee of the general partner of such entity. Shares held by Mhatre 2011 Irrevocable Children's Trust. Ravi Mhatre serves as trustee of such entity. These sales were executed in multiple trades at prices ranging from $15.00 to $15.50. The price reported above reflects the weighted average sale price. Mr. Mhatre hereby undertakes to provide full information regarding the number of shares and prices at which these sales were effected, upon request, to the staff of the Securities and Exchange Commission, the Issuer or a security holder of the Issuer. Lightspeed General Partner Select II, L.P. ("Select II GP") is the general partner of Lightspeed Venture Partners Select II, L.P. ("Lightspeed Select II"). Lightspeed Ultimate General Partner Select II, Ltd. ("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. Mr. Mhatre disclaims beneficial ownership of the shares held by Lightspeed Select II except to the extent of his pecuniary interest therein. Lightspeed General Partner X, L.P. ("Lightspeed GP X") is the general partner of Lightspeed Venture Partners X, L.P. ("Lightspeed X") and Lightspeed Affiliates X, L.P. ("Lightspeed Affiliates"). Lightspeed Ultimate General Partner X, Ltd. ("Lightspeed UGP X") is the general partner of Lightspeed GP X. Christopher J. Schaepe, Barry Eggers, Ravi Mhatre, Peter Nieh and Jeremy Liew are the directors of Lightspeed UGP X and share voting and dispositive power with respect to the shares held by Lightspeed X and Lightspeed Affiliates. Mr. Mhatre disclaims beneficial ownership of the shares held by Lightspeed X and Lightspeed Affiliates except to the extent of his pecuniary interest therein. RAVI MHATRE By: /s/ Ravi Mhatre 2018-08-22