0001209191-19-002922.txt : 20190108 0001209191-19-002922.hdr.sgml : 20190108 20190108201742 ACCESSION NUMBER: 0001209191-19-002922 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190104 FILED AS OF DATE: 20190108 DATE AS OF CHANGE: 20190108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Takimoto Chris H CENTRAL INDEX KEY: 0001743780 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19517089 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2019-01-04 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 Common Stock 2019-01-04 4 M 0 8000 2.015 A 8000 D Common Stock 2019-01-04 4 S 0 8000 15.5453 D 0 D Stock Option (right to buy) 2.015 2019-01-04 4 M 0 8000 0.00 D 2026-02-25 Common Stock 8000 159741 D The sale reported in this Form 4 was effected pursuant to a 10b5-1 trading plan. The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $15.10 to $16.02, inclusive. The Reporting Person undertakes to provide the Issuer, any securityholder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the ranges set forth this footnote. 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. /s/ John T. McKenna, Attorney-in-Fact for Chris H. Takimoto 2019-01-08