0001209191-19-005057.txt : 20190123 0001209191-19-005057.hdr.sgml : 20190123 20190123194204 ACCESSION NUMBER: 0001209191-19-005057 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190118 FILED AS OF DATE: 20190123 DATE AS OF CHANGE: 20190123 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: McCamish Mark Anthony CENTRAL INDEX KEY: 0001390798 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19538427 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 2019-01-18 0 0001667633 Forty Seven, Inc. FTSV 0001390798 McCamish Mark Anthony C/O FORTY SEVEN, INC. 1490 O'BRIEN DRIVE, SUITE A MENLO PARK CA 94025 1 1 0 0 President and CEO Common Stock 2019-01-18 4 M 0 16500 4.8825 A 25532 D Common Stock 2019-01-18 4 M 0 3500 4.8825 A 29032 D Common Stock 2019-01-18 4 S 0 20000 14.5946 D 9032 D Stock Option (right to buy) 4.8825 2019-01-18 4 M 0 16500 0.00 D 2027-06-07 Common Stock 16500 458338 D Stock Option (right to purchase) 4.8825 2019-01-18 4 M 0 3500 0.00 D 2027-08-14 Common Stock 3500 155110 D The sales reported in this Form 4 were effected pursuant to a Rule 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 $14.33 to $15.28, 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 ranges set forth in this footnote. 96,773 shares subject to the option vested on May 1, 2018 and the balance of the shares subject to the option vest in a series of 36 successive equal monthly installments beginning June 1, 2018, subject to the 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 beginning August 15, 2017, subject to the Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to the Issuer's right to repurchase. /s/ John T. McKenna, Attorney-in-Fact for Mark A. McCamish 2019-01-23