0001209191-20-023723.txt : 20200407
0001209191-20-023723.hdr.sgml : 20200407
20200407122716
ACCESSION NUMBER: 0001209191-20-023723
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20200407
FILED AS OF DATE: 20200407
DATE AS OF CHANGE: 20200407
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Majeti Ravindra
CENTRAL INDEX KEY: 0001743839
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-38554
FILM NUMBER: 20779015
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
2020-04-07
1
0001667633
Forty Seven, Inc.
FTSV
0001743839
Majeti Ravindra
C/O FORTY SEVEN, INC.
1490 O'BRIEN DRIVE, SUITE A
MENLO PARK
CA
94025
1
0
0
0
Common Stock
2020-03-30
5
G
0
E
1000
0.00
D
1060400
D
Common Stock
2020-04-07
4
D
0
1060400
D
0
D
Common Stock
2020-04-07
4
D
0
100000
D
0
I
By GRAT (RM)
Common Stock
2020-04-07
4
D
0
100000
D
0
I
By GRAT (JZM)
Stock Option (right to buy)
8.7575
2020-04-07
4
D
0
20645
D
2028-04-26
Common Stock
20645
0
D
Stock Option (right to buy(
10.81
2020-04-07
4
D
0
10322
D
2029-06-11
Common Stock
10322
0
D
Disposed of pursuant to an agreement and plan of merger by and between the Issuer, Gilead Sciences, Inc. ("Gilead") and Toro Merger Sub, Inc. ("Purchaser") (the "Merger") in exchange for $95.50 per share, net to the holder in cash, without interest and subject to any withholding of taxes, upon the terms and subject to the conditions described in the Offer to Purchase dated March 10, 2020 (together with any amendments or supplements thereto, the "Offer to Purchase") and in the accompanying Letter of Transmittal (together with any amendments or supplements thereto), which are annexed to and filed with the Schedule TO as Exhibits (a)(1)(A) and (a)(1)(B), respectively.
Shares held by Ravindra Majeti, Trustee of the Ravindra Majeti
Annuity Trust dated September 20, 2019.
Shares held by Ravindra Majeti, Trustee of the Jiangwen Zhu Majeti
Annuity Trust dated September 20, 2019.
This option, which provided for vesting over a three-year period as follows: 1/36th of the shares subject to the option vest in a series of 36 successive equal monthly installments beginning on the date of the closing of the Issuer's initial public offering, subject to Reporting Person's continuous service as of each such date, was accelerated and canceled in the Merger in exchange for a cash payment of $1,790,798.91, representing the difference between the market value of the common stock underlying the option on the effective date of the Merger ($95.50 per share) and the exercise price applicable to each share of common stock underlying the option, which difference is multiplied by the total number of shares of common stock subject to the option.
This option, which provided for vesting on the one-year anniversary of the grant date, subject to Reporting Person's continuous service on such date, was canceled in the Merger in exchange for a cash payment of $874,170.18, representing the difference between the market value of the common stock underlying the option on the effective date of the Merger ($95.50 per share) and the exercise price applicable to each share of common stock underlying the option, which difference is multiplied by the total number of shares of common stock subject to the option.
/s/ John T. McKenna, Attorney-in-Fact for Ravindra Majeti
2020-04-07