0001225208-18-010937.txt : 20180627
0001225208-18-010937.hdr.sgml : 20180627
20180627173447
ACCESSION NUMBER: 0001225208-18-010937
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: SUTTER HILL VENTURES
CENTRAL INDEX KEY: 0000879051
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18922647
BUSINESS ADDRESS:
STREET 1: 755 PAGE MILL RD
STREET 2: SUITE A200
CITY: PALO ALTO
STATE: CA
ZIP: 94304
BUSINESS PHONE: 4154935600
MAIL ADDRESS:
STREET 1: 755 PAGE MILL RD
STREET 2: SUITE A200
CITY: PALO ALTO
STATE: CA
ZIP: 94304
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
X0206
3
2018-06-27
0
0001667633
Forty Seven, Inc.
FTSV
0000879051
SUTTER HILL VENTURES
755 PAGE MILL ROAD, SUITE A-200
PALO ALTO
CA
94304-1005
1
Series A-1 Preferred Stock
Common Stock
1052146.0000
D
Series A-2 Preferred Stock
Common Stock
774165.0000
D
Series B Preferred Stock
Common Stock
945326.0000
D
The issuer's preferred stock will automatically convert into issuer's common stock on a one-to-one basis immediately upon the closing of the issuer's initial public offering and has no expiration date.
ftsvshv.txt
/s/ Robert Yin, by power of attorney
2018-06-27
EX-24
2
ftsvshv.txt
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby authorizes
David E. Sweet, Robert Yin, or Patricia Tom to execute for and on behalf of
the undersigned Forms 3, 4, and 5, and any Amendments thereto for Forty
Seven, Inc. (the "Company"), and cause such form(s) to be filed with the
United States Securities and Exchange Commission pursuant to Section 16(a)
of the Securities Act of 1934, relating to the undersigned's beneficial
ownership of securities in the Company. 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, in serving
in such a 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 Securities Exchange Act of 1934.
This Power of Attorney shall remain in full force and effect until
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, unless earlier revoked by the undersigned in a signed writing
delivered to the foregoing attorneys-in-fact.
In witness whereof, the undersigned has caused this Power of Attorney
to be executed as of this 26th day of June, 2018.
SUTTER HILL VENTURES, A CALIFORNIA
LIMITED PARTNERSHIP
/s/ Jeffrey W. Bird
Managing Director of the General Partner