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
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a4.xml
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X0306
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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