0001209191-19-057863.txt : 20191122 0001209191-19-057863.hdr.sgml : 20191122 20191122185729 ACCESSION NUMBER: 0001209191-19-057863 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191120 FILED AS OF DATE: 20191122 DATE AS OF CHANGE: 20191122 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Majeti Ravindra CENTRAL INDEX KEY: 0001743839 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 191242859 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 2019-11-20 0 0001667633 Forty Seven, Inc. FTSV 0001743839 Majeti Ravindra C/O FORTY SEVEN, INC. 1490 O'BRIEN DRIVE, SUITE A MENLO PARK CA 94025 1 0 0 0 Common Stock 2019-11-20 4 S 0 5000 12.50 D 1201400 D Common Stock 100000 I By GRAT (RM) Common Stock 100000 I By GRAT (JZM) The sale reported in this Form 4 was effected pursuant to a 10b5-1 trading plan. Shares held by Ravindra Majeti, Trustee of the Ravindra Majeti Annuity Trust dated September 20, 2019. Shares held by Ravindra Majeti, Trustee of the Jiangwen Zhu Majeti Annuity Trust dated September 20, 2019. /s/ John T. McKenna, Attorney-in-Fact for Ravindra Majeti 2019-11-22