0001209191-19-017588.txt : 20190306
0001209191-19-017588.hdr.sgml : 20190306
20190306205501
ACCESSION NUMBER: 0001209191-19-017588
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190304
FILED AS OF DATE: 20190306
DATE AS OF CHANGE: 20190306
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: 19664107
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
2019-03-04
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
2019-03-04
4
M
0
8000
2.015
A
8000
D
Common Stock
2019-03-04
4
S
0
8000
16.9438
D
0
D
Stock Option (right to buy)
2.015
2019-03-04
4
M
0
8000
0.00
D
2026-02-25
Common Stock
8000
143741
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 $16.50 to $17.30, 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 range 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
2019-03-06