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Filing Details

Accession Number:
0001209191-18-040424
Form Type:
4
Zero Holdings:
No
Publication Time:
2018-07-02 17:13:00
Reporting Period:
2018-07-02
Accepted Time:
2018-07-02 17:13:00
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
1667633 Forty Seven Inc. FTSV () 4
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1249153 Dennis Henner 101 Main Street, 12Th Floor
Cambridge MA 02142
Yes No Yes No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2018-07-02 938,489 $0.00 938,489 No 4 C Indirect See footnote
Common Stock Acquisiton 2018-07-02 755,780 $0.00 1,694,269 No 4 C Indirect See footnote
Common Stock Acquisiton 2018-07-02 1,922,682 $0.00 3,616,951 No 4 C Indirect See footnote
Common Stock Acquisiton 2018-07-02 200,000 $16.00 3,816,951 No 4 P Indirect See footnote
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 C Indirect See footnote
No 4 C Indirect See footnote
No 4 C Indirect See footnote
No 4 P Indirect See footnote
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Series A-1 Preferred Stock Disposition 2018-07-02 938,489 $0.00 938,489 $0.00
Common Stock Series A-2 Preferred Stock Disposition 2018-07-02 755,780 $0.00 755,780 $0.00
Common Stock Series B Preferred Stock Disposition 2018-07-02 1,922,682 $0.00 1,922,682 $0.00
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
0 No 4 C Indirect
0 No 4 C Indirect
0 No 4 C Indirect
Footnotes
  1. The Issuer's preferred stock automatically converted into an equal number of shares of Issuer's common stock immediately upon the closing of the Issuer's initial public offering and has no expiration date.
  2. Clarus Ventures III GP, LP, or GPLP, as the sole general partner of Clarus Lifesciences III, LP, or Clarus, may be deemed to beneficially own certain of the shares held by Clarus. GPLP disclaims beneficial ownership of all shares held by Clarus in which the GPLP does not have a pecuniary interest. Clarus Ventures III, LLC, or GPLLC, as the sole general partner of the GPLP, may be deemed to beneficially own certain of the shares held by Clarus. GPLLC disclaims beneficial ownership of all shares held by Clarus in which it does not have an actual pecuniary interest. Each of Dennis Henner, Nicholas Galakatos, Robert Liptak, Nicholas Simon, Scott Requadt and Kurt Wheeler, as individual managing directors of GPLLC, may be deemed to beneficially own certain of the shares held of record by Clarus. Dr. Henner and Messrs. Galakatos, Liptak, Simon, Requadt and Wheeler disclaims beneficial ownership of all shares held of record by Clarus in which they do not have an actual pecuniary interest.