0001209191-18-039601.txt : 20180627 0001209191-18-039601.hdr.sgml : 20180627 20180627142628 ACCESSION NUMBER: 0001209191-18-039601 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20180627 FILED AS OF DATE: 20180627 DATE AS OF CHANGE: 20180627 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Takimoto Chris H CENTRAL INDEX KEY: 0001743780 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 18921446 MAIL ADDRESS: STREET 1: C/O FORTY SEVEN, INC. STREET 2: 1490 O'BRIEN DRIVE, SUITE A 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2018-06-27 0 0001667633 Forty Seven, Inc. FTSV 0001743780 Takimoto Chris H C/O FORTY SEVEN, INC. 1490 O'BRIEN DRIVE, SUITE A MENLO PARK CA 94025 0 1 0 0 Chief Medical Officer Stock Option (right to buy) 2.015 2026-02-25 Common Stock 167741 D Stock Option (right to buy) 4.8825 2027-08-14 Common Stock 12903 D Stock Option (right to buy) 5.27 2027-11-27 Common Stock 77418 D Stock Option (right to buy) 8.7575 2028-04-26 Common Stock 56128 D 1/4th of the shares subject to the option vested one year after February 8, 2016 and 1/48th of the shares subject to the option vest monthly thereafter, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase. The shares subject to the option vest in a series of 48 successive equal monthly installments beginning August 15, 2017, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase. The shares subject to the option vest in a series of 48 successive equal monthly installments beginning November 8, 2017, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase. The shares subject to the option vest in a series of 48 successive equal monthly installments beginning March 1, 2019, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase. Exhibit 24 - Power of Attorney /s/ Chris H. Takimoto 2018-06-27 EX-24 2 attachment1.htm EX-24 DOCUMENT

POWER OF ATTORNEY
(For Executing Forms 3, 4 and 5)

       Know all by these presents, that the undersigned hereby constitutes and
appoints each of MARK A. MCCAMISH, ANN D. RHOADS, ERIC C. JENSEN and JOHN T.
MCKENNA, signing individually, the undersigned's true and lawful attorneys-in
fact and agents to:
       (1)	Prepare, execute in the undersigned's name and on the undersigned's
behalf, and submit to the the Securities and Exchange Commission (the "SEC")
Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in
connection therewith) in accordance with Section 16(a) of the Securities
Exchange Act of 1934, as amended (the "Exchange Act") and the rules thereunder
in the undersigned's capacity as an officer, director or beneficial owner of
more than 10% of a registered class of securities of FORTY SEVEN, INC. (the
"Company");
       (2)	Do and perform any and all acts for and on behalf of the undersigned
that may be necessary or desirable to prepare and execute any such Forms 3, 4 or
5 (including amendments thereto and joint filing agreements in connection
therewith) and file such forms with the SEC and any stock exchange,
self-regulatory association or any similar authority; and
       (3)	Take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required of the undersigned, it being
understood that the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as the attorney-in-fact may approve in the
attorney-in-fact's discretion.
       The undersigned hereby grants to each such attorney-in-fact full power
and authority to do and perform any and every act and thing whatsoever
requisite, necessary, or proper to be done in the exercise of any of the rights
and powers herein granted, as fully to all intents and purposes as the
undersigned might or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this power of attorney and the
rights and powers herein granted.  The undersigned acknowledges that the
foregoing attorneys-in-fact, and their substitutes, in serving in such capacity
at the request of the undersigned, are not assuming (nor is the Company
assuming) any of the undersigned's responsibilities to comply with Section 16 of
the Exchange Act.
       This Power of Attorney shall remain in full force and effect until the
earliest to occur of (a) the undersigned is no longer required to file Forms 3,
4 and 5 with respect to the undersigned's holdings of and transactions in
securities issued by the Company, (b) revocation by the undersigned in a signed
writing delivered to the Company and the foregoing attorneys-in-fact or (c) as
to any attorney-in-fact individually, until such attorney-in-fact is no longer
employed by the Company or Cooley LLP, as applicable.
       IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of the date written below.

Date:	June 27, 2018			/s/ Chris H. Takimoto
					Chris H. Takimoto