0001225208-18-011387.txt : 20180703
0001225208-18-011387.hdr.sgml : 20180703
20180703194228
ACCESSION NUMBER: 0001225208-18-011387
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180702
FILED AS OF DATE: 20180703
DATE AS OF CHANGE: 20180703
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SUTTER HILL VENTURES
CENTRAL INDEX KEY: 0000879051
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 18939142
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
4
1
doc4.xml
X0306
4
2018-07-02
1
0001667633
Forty Seven, Inc.
FTSV
0000879051
SUTTER HILL VENTURES
755 PAGE MILL ROAD, SUITE A-200
PALO ALTO
CA
94304-1005
1
Former 10% Holder
Common Stock
2018-07-02
4
C
0
1052146.0000
0
A
1052146.0000
D
Common Stock
2018-07-02
4
C
0
945326.0000
0
A
1997472.0000
D
Common Stock
2018-07-02
4
C
0
774165.0000
0
A
2771637.0000
D
Common Stock
2018-07-02
4
P
0
134735.0000
16.0000
A
2906372.0000
D
Series A-1 Preferred Stock
2018-07-02
4
C
0
1052146.0000
D
Common Stock
1052146.0000
0.0000
D
Series A-2 Preferred Stock
2018-07-02
4
C
0
774165.0000
D
Common Stock
774165.0000
0.0000
D
Series B Preferred Stock
2018-07-02
4
C
0
945326.0000
D
Common Stock
945326.0000
0.0000
D
The issuer's preferred stock automatically converted 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.
/s/ Robert Yin, by power of attorney
2018-07-02