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