Filing Details

Accession Number:
0001209191-18-040432
Form Type:
4
Zero Holdings:
No
Publication Time:
2018-07-02 17:16:47
Reporting Period:
2018-07-02
Accepted Time:
2018-07-02 17:16:47
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
1185068 J Christopher Schaepe 2200 Sand Hill Road
Menlo Park CA 94025
Yes No Yes No
1366048 Barry Eggers 2200 Sand Hill Road
Menlo Park CA 94025
No No Yes No
1366050 Ravi Mhatre 2200 Sand Hill Road
Menlo Park CA 94025
No No Yes No
1366051 Peter Nieh 2200 Sand Hill Road
Menlo Park CA 94025
No No Yes No
1668017 Lightspeed Venture Partners Select Ii, L.p. 2200 Sand Hill Road
Menlo Park CA 94025
No No Yes No
1700539 Jeremy Liew 2200 Sand Hill Road
Menlo Park CA 94025
No No Yes No
1744936 Lightspeed General Partner Select Ii, L.p. 2200 Sand Hill Road
Menlo Park CA 94025
No No Yes No
1744937 Lightspeed Ultimate General Partner Select Ii, Ltd. 2200 Sand Hill Road
Menlo Park CA 94025
No 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 1,315,519 $0.00 1,315,519 No 4 C Indirect See footnote
Common Stock Acquisiton 2018-07-02 468,750 $16.00 1,784,269 No 4 P Indirect See footnote
Equity Swap Involved Form Type Code Nature of Ownership Explanation
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 B Preferred Stock Disposition 2018-07-02 1,315,519 $0.00 1,315,519 $0.00
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
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. Lightspeed General Partner Select II, L.P., or Select II GP, is the general partner of Lightspeed Venture Partners Select II, L.P., or Lightspeed Select II. Lightspeed Ultimate General Partner Select II, Ltd., or Select II UGP, is the general partner of Select II GP. Christopher J. Schaepe, 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. Schaepe, 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.