0001104659-19-041614.txt : 20190724 0001104659-19-041614.hdr.sgml : 20190724 20190724165731 ACCESSION NUMBER: 0001104659-19-041614 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190722 FILED AS OF DATE: 20190724 DATE AS OF CHANGE: 20190724 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed Venture Partners X, L.P. CENTRAL INDEX KEY: 0001602573 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971610 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-233-8300 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed General Partner X, L.P. CENTRAL INDEX KEY: 0001700550 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971611 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: (650) 234-8300 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 FORMER NAME: FORMER CONFORMED NAME: Lightspeed General Partner X, L,P. DATE OF NAME CHANGE: 20170310 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed Ultimate General Partner X, Ltd. CENTRAL INDEX KEY: 0001700549 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971612 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: (650) 234-8300 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed Venture Partners Select II, L.P. CENTRAL INDEX KEY: 0001668017 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971613 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: (650) 843-5000 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed General Partner Select II, L.P. CENTRAL INDEX KEY: 0001744936 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971614 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-234-8300 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Lightspeed Ultimate General Partner Select II, Ltd. CENTRAL INDEX KEY: 0001744937 STATE OF INCORPORATION: E9 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971615 BUSINESS ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 BUSINESS PHONE: 650-234-8300 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Eggers Barry CENTRAL INDEX KEY: 0001366048 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971616 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Liew Jeremy CENTRAL INDEX KEY: 0001700539 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971617 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mhatre Ravi CENTRAL INDEX KEY: 0001366050 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971618 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD CITY: MENLO PARK STATE: CA ZIP: 94025 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Nieh Peter CENTRAL INDEX KEY: 0001366051 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-38554 FILM NUMBER: 19971619 MAIL ADDRESS: STREET 1: 2200 SAND HILL ROAD 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 a4.xml 4 X0306 4 2019-07-22 0 0001667633 Forty Seven, Inc. FTSV 0001602573 Lightspeed Venture Partners X, L.P. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001700550 Lightspeed General Partner X, L.P. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001700549 Lightspeed Ultimate General Partner X, Ltd. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001668017 Lightspeed Venture Partners Select II, L.P. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001744936 Lightspeed General Partner Select II, L.P. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001744937 Lightspeed Ultimate General Partner Select II, Ltd. 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001366048 Eggers Barry 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001700539 Liew Jeremy 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001366050 Mhatre Ravi 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 0001366051 Nieh Peter 2200 SAND HILL ROAD MENLO PARK CA 94025 0 0 1 0 Common Stock 2019-07-22 4 P 0 312500 8.00 A 2786868 I By Lightspeed Venture Partners X, L.P. Common Stock 2019-07-22 4 P 0 312500 8.00 A 2096769 I By Lightspeed Venture Partners Select II, L.P. Common Stock 67036 I By Lightspeed Affiliates X, L.P. Common Stock 66743 I By Ravi Mhatre Common Stock 66743 I By Mhatre Investments LP - Fund 1 Common Stock 33372 I By Mhatre 2011 Irrevocable Children's Trust Common Stock 67500 I By Peter Nieh Lightspeed General Partner X, L.P. ("Lightspeed GP X") is the general partner of Lightspeed Venture Partners X, L.P. ("Lightspeed X") and Lightspeed Affiliates X, L.P. ("Lightspeed Affiliates"). Lightspeed Ultimate General Partner X, Ltd. ("Lightspeed UGP X") is the general partner of Lightspeed GP X. Barry Eggers, Jeremy Liew, Ravi Mhatre and Peter Nieh are the directors of Lightspeed UGP X and share voting and dispositive power with respect to the shares held by Lightspeed X and Lightspeed Affiliates. Messrs. Eggers, Liew, Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed X and Lightspeed Affiliates except to the extent of their pecuniary interest therein. Lightspeed General Partner Select II, L.P. ("Select II GP") is the general partner of Lightspeed Venture Partners Select II, L.P. ("Lightspeed Select II"). Lightspeed Ultimate General Partner Select II, Ltd. ("Select II UGP") is the general partner of Select II GP. Barry Eggers, Jeremy Liew, Ravi Mhatre and Peter Nieh are the directors of Select II UGP and share voting and dispositive power with respect to the shares held by Lightspeed Select II. Messrs. Eggers, Liew, Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed Select II except to the extent of their pecuniary interest therein. Ravi Mhatre serves as trustee of the general partner of Mhatre Investments LP- Fund 1. Ravi Mhatre serves as trustee of Mhatre 2011 Irrevocable Children's Trust. LIGHTSPEED VENTURE PARTNERS X, L.P. By: Lightspeed General Partner X, L.P., its general partner By: Lightspeed Ultimate General Partner X, Ltd., its general partner By: Duly Authorized Signatory /s/ Ravi Mhatre 2019-07-24 LIGHTSPEED GENERAL PARTNER X, L.P. By: Lightspeed Ultimate General Partner X, Ltd., its general partner By: Duly Authorized Signatory /s/ Ravi Mhatre 2019-07-24 LIGHTSPEED ULTIMATE GENERAL PARTNER X, LTD. By: Duly Authorized Signatory /s/ Ravi Mhatre 2019-07-24 LIGHTSPEED VENTURE PARTNERS SELECT II, L.P. By: Lightspeed General Partner Select II, L.P., its general partner By: Lightspeed Ultimate General Partner Select II, Ltd., its general partner By: Duly Authorized Signatory /s/ Ravi Mhatre 2019-07-24 LIGHTSPEED GENERAL PARTNER SELECT II, L.P. By: Lightspeed Ultimate General Partner Select II, Ltd., its general partner By: Duly Authorized Signatory /s/ Ravi Mhatre 2019-07-24 LIGHTSPEED ULTIMATE GENERAL PARTNER SELECT II, LTD. By: Duly Authorized Signatory /s/ Ravi Mhatre 2019-07-24 /s/ Barry Eggers 2019-07-24 /s/ Jeremy Liew 2019-07-24 /s/ Ravi Mharte 2019-07-24 /s/ Peter Nieh 2019-07-24