0001209191-20-023395.txt : 20200403
0001209191-20-023395.hdr.sgml : 20200403
20200403175327
ACCESSION NUMBER: 0001209191-20-023395
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200401
FILED AS OF DATE: 20200403
DATE AS OF CHANGE: 20200403
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: 20775086
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
2020-04-01
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
2020-04-01
4
M
0
49627
2.015
A
53533
D
Common Stock
2020-04-01
4
M
0
8333
4.8825
A
61866
D
Common Stock
2020-04-01
4
M
0
7020
5.27
A
68886
D
Common Stock
2020-04-01
4
M
0
11418
8.7575
A
80304
D
Common Stock
2020-04-01
4
M
0
2797
35.75
A
83101
D
Common Stock
2020-04-01
4
S
0
79195
95.42
D
3906
D
Stock Option (right to buy)
2.015
2020-04-01
4
M
0
49627
0.00
D
2020-02-08
2026-02-25
Common Stock
49627
58114
D
Stock Option (right to buy)
4.8825
2020-04-01
4
M
0
8333
0.00
D
2027-08-14
Common Stock
8333
4570
D
Stock Option (right to buy)
5.27
2020-04-01
4
M
0
7020
0.00
D
2027-11-27
Common Stock
7020
70398
D
Stock Option (right to buy)
8.7575
2020-04-01
4
M
0
11418
0.00
D
2028-04-26
Common Stock
11418
44710
D
Stock Option (right to buy)
35.75
2020-04-01
4
M
0
2797
0.00
D
2029-12-12
Common Stock
2797
113153
D
Includes 3,906 shares acquired under the Forty Seven, Inc. 2018 Employee Stock Purchase Plan.
The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $95.411 to $95.43, 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 in this footnote.
The shares subject to the option vest in a series of 48 successive equal monthly installments commencing on August 15, 2017, subject to Reporting Person's continuous service as of each such date.
The shares subject to the option vest in a series of 48 successive equal monthly installments commencing on November 8, 2017, subject to Reporting Person's continuous service as of each such date.
The shares subject to the option vest in a series of 48 successive equal monthly installments commencing on March 1, 2019, subject to Reporting Person's continuous service as of each such date.
The shares subject to the option vest in a series of 48 successive equal monthly installments commencing on December 13, 2019, subject to Reporting Person's continuous service as of each such date.
/s/ John T. McKenna, Attorney-in-Fact for Chris H. Takimoto
2020-04-03