Statement of Changes in Beneficial Ownership (4)
February 19 2020 - 6:18PM
Edgar (US Regulatory)
FORM 4
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Majeti Ravindra |
2. Issuer Name and Ticker or Trading Symbol
Forty Seven, Inc.
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FTSV
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O FORTY SEVEN, INC., 1490 O'BRIEN DRIVE, SUITE A |
3. Date of Earliest Transaction
(MM/DD/YYYY)
2/18/2020 |
(Street)
MENLO PARK, CA 94025
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock | 2/18/2020 | | S(1) | | 5712 | D | $43.1488 (2) | 1080688 | D | |
Common Stock | 2/18/2020 | | S(1) | | 7493 | D | $44.048 (3) | 1073195 | D | |
Common Stock | 2/18/2020 | | S(1) | | 11420 | D | $45.1659 (4) | 1061775 | D | |
Common Stock | 2/18/2020 | | S(1) | | 375 | D | $45.8723 (5) | 1061400 | D | |
Common Stock | | | | | | | | 100000 | I | By GRAT (RM) (6) |
Common Stock | | | | | | | | 100000 | I | By GRAT (JZM) (7) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Explanation of Responses: |
(1) | The sale reported in this Form 4 was effected pursuant to a 10b5-1 trading plan. |
(2) | The price reported in Column 4 is a weighted-average price. The shares were sold in multiple transactions ranging from $42.61 to $43.60 inclusive. The Reporting Person undertakes to provide the Issuer, any securityholder of the Issuer, or the Staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate within the ranges set forth in these footnotes. |
(3) | The price reported in Column 4 is a weighted-average price. The shares were sold in multiple transactions ranging from $43.62 to $44.60, inclusive. |
(4) | The price reported in Column 4 is a weighted-average price. The shares were sold in multiple transactions ranging from $44.62 to $45.59, inclusive. |
(5) | The price reported in Column 4 is a weighted-average price. The shares were sold in multiple transactions ranging from $45.64 to $46.25, inclusive. |
(6) | Shares held by Ravindra Majeti, Trustee of the Ravindra Majeti
Annuity Trust dated September 20, 2019. |
(7) | Shares held by Ravindra Majeti, Trustee of the Jiangwen Zhu Majeti
Annuity Trust dated September 20, 2019. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Majeti Ravindra C/O FORTY SEVEN, INC. 1490 O'BRIEN DRIVE, SUITE A MENLO PARK, CA 94025 | X |
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Signatures
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/s/ John T. McKenna, Attorney-in-Fact for Ravindra Majeti | | 2/19/2020 |
**Signature of Reporting Person | Date |
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