SEC Filing | Forty Seven, Inc.

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SEC FORM 3 SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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^*

McCamish Mark Anthony

(Last)

(First)

(Middle)

C/O FORTY SEVEN, INC.

1490 O'BRIEN DRIVE, SUITE A

(Street)

MENLO PARK

94025

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
06/27/2018

3. Issuer Name and Ticker or Trading Symbol
Forty Seven, Inc. [ FTSV ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
X	Officer (give title below)	Other (specify below)
President and CEO

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock	9,032	D

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Stock Option (right to buy)	⁽¹⁾	06/07/2027	Common Stock	483,870	4.8825	D
Stock Option (right to buy)	⁽²⁾	08/14/2027	Common Stock	161,578	4.8825	D
Stock Option (right to buy)	⁽³⁾	11/27/2027	Common Stock	334,239	5.27	D
Stock Option (right to buy)	⁽⁴⁾	04/26/2028	Common Stock	184,516	8.7575	D

Explanation of Responses:

1. 96,744 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 March 1, 2018, subject to Reporting Person's continuous service as of each such date.

2. The shares subject to the option vest in a series of 48 successive equal monthly installments beginning August 15, 2017, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase.

3. The shares subject to the option vest in a series of 48 successive equal monthly installments beginning November 8, 2017, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase.

4. The shares subject to the option vest in a series of 48 successive equal monthly installments beginning March 1, 2019, subject to Reporting Person's continuous service as of each such date. The shares subject to this option may be exercised prior to vesting, subject to Issuer's right to repurchase.

Remarks:

Exhibit 24 - Power of Attorney

	/s/ Mark A. McCamish	06/27/2018
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.

POWER OF ATTORNEY
(For Executing Forms 3, 4 and 5)

       Know all by these presents, that the undersigned hereby constitutes and
appoints each of ANN D. RHOADS, ERIC C. JENSEN and JOHN T. MCKENNA, signing
individually, the undersigned's true and lawful attorneys-in fact and agents to:
       (1)	Prepare, execute in the undersigned's name and on the undersigned's
behalf, and submit to the the Securities and Exchange Commission (the "SEC")
Forms 3, 4 and 5 (including amendments thereto and joint filing agreements in
connection therewith) in accordance with Section 16(a) of the Securities
Exchange Act of 1934, as amended (the "Exchange Act") and the rules thereunder
in the undersigned's capacity as an officer, director or beneficial owner of
more than 10% of a registered class of securities of FORTY SEVEN, INC. (the
"Company");
       (2)	Do and perform any and all acts for and on behalf of the undersigned
that may be necessary or desirable to prepare and execute any such Forms 3, 4 or
5 (including amendments thereto and joint filing agreements in connection
therewith) and file such forms with the SEC and any stock exchange,
self-regulatory association or any similar authority; and
       (3)	Take any other action of any type whatsoever in connection with the
foregoing that, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required of the undersigned, it being
understood that the documents executed by the attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as the attorney-in-fact may approve in the
attorney-in-fact's discretion.
       The undersigned hereby grants to each such attorney-in-fact full power
and authority to do and perform any and every act and thing whatsoever
requisite, necessary, or proper to be done in the exercise of any of the rights
and powers herein granted, as fully to all intents and purposes as the
undersigned might or could do if personally present, with full power of
substitution or revocation, hereby ratifying and confirming all that such
attorney-in-fact, or such attorney-in-fact's substitute or substitutes, shall
lawfully do or cause to be done by virtue of this power of attorney and the
rights and powers herein granted.  The undersigned acknowledges that the
foregoing attorneys-in-fact, and their substitutes, in serving in such capacity
at the request of the undersigned, are not assuming (nor is the Company
assuming) any of the undersigned's responsibilities to comply with Section 16 of
the Exchange Act.
       This Power of Attorney shall remain in full force and effect until the
earliest to occur of (a) the undersigned is no longer required to file Forms 3,
4 and 5 with respect to the undersigned's holdings of and transactions in
securities issued by the Company, (b) revocation by the undersigned in a signed
writing delivered to the Company and the foregoing attorneys-in-fact or (c) as
to any attorney-in-fact individually, until such attorney-in-fact is no longer
employed by the Company or Cooley LLP, as applicable.
       IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of the date written below.

Date:	June 27, 2018			/s/ Mark A. McCamish
					Mark A. McCamish