Form Type: 4

SEC EDGAR Link
Accession Number:0001209191-19-005057
Date:2019-01-18
Issuer: FORTY SEVEN, INC. (FTSV)
Original Submission Date:

Reporting Person:

MCCAMISH MARK ANTHONY
C/O FORTY SEVEN, INC.
1490 O'BRIEN DRIVE, SUITE A MENLO PARK, CA 94025

Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
Title of SecurityTransaction Date2a. Deemed Execution Date Transaction CodeSharesAcquired or DisposedPrice per share 5. Amount of Securities Beneficially Owned Following Reported Transaction 6. Ownership Form Direct or IndirectNature of Indirect Ownership
COMMON STOCK 2019-01-18 M 16,500 a $4.88 25,532 direct
COMMON STOCK 2019-01-18 M 3,500 a $4.88 29,032 direct
COMMON STOCK 2019-01-18 S 20,000 d $14.59 9,032 direct
Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, convertible securities
Title of Derivative Security Conversion or Exercise Price of Derivative Security Transaction Date Deemed Execution Date Transaction Code Number of Derivative Securities Acquired (A) or Disposed of (D) Date ExercisableExpiration Date Title and Amount of Securities Underlying Derivative Security Price of Derivative Security Number of derivative Securities Beneficially Owned Following Reported Transaction(s) Ownership Form: Direct (D) or Indirect (I) Nature of Indirect Beneficial Ownership
STOCK OPTION (RIGHT TO BUY) 4.8825 2019-01-18 deemed execution date M 16,500 (d) 2027-06-07 common stock 16,500 $4.88 458,338 direct
STOCK OPTION (RIGHT TO PURCHASE) 4.8825 2019-01-18 deemed execution date M 3,500 (d) 2027-08-14 common stock 3,500 $4.88 155,110 direct
Footnotes
IDfootnote
f1 the sales reported in this form 4 were effected pursuant to a rule 10b5-1 trading plan.
f2 the price reported in column 4 is a weighted average price. these shares were sold in multiple transactions at prices ranging from $14.33 to $15.28, 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 price within the ranges set forth in this footnote.
f3 96,773 shares subject to the option vested on may 1, 2018 and the balance of the shares subject to the option vest in a series of 36 successive equal monthly installments beginning june 1, 2018, subject to the reporting person's continuous service as of each such date.
f4 the shares subject to the option vest in a series of 48 successive equal monthly installments beginning august 15, 2017, subject to the reporting person's continuous service as of each such date. the shares subject to this option may be exercised prior to vesting, subject to the issuer's right to repurchase.
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