SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Mhatre Ravi

(Last) (First) (Middle)
2200 SAND HILL ROAD

(Street)
MENLO PARK CA 94025

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
Forty Seven, Inc. [ FTSV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
08/22/2018
4. 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 Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/22/2018 P 44,000 A $14.974(1) 44,000 I By Mhatre Investments LP - Fund 1(2)
Common Stock 08/22/2018 P 44,000 A $14.974(1) 44,000 D
Common Stock 08/22/2018 P 22,000 A $14.974(1) 22,000 I By Mhatre 2011 Irrevocable Children's Trust(3)
Common Stock 08/23/2018 P 22,743 A $15.2711(4) 66,743 I By Mhatre Investments LP - Fund 1(2)
Common Stock 08/23/2018 P 22,743 A $15.2711(4) 66,743 D
Common Stock 08/23/2018 P 11,372 A $15.2711(4) 33,372 I By Mhatre 2011 Irrevocable Children's Trust(3)
Common Stock 1,784,269 I By: Lightspeed Venture Partners Select II, L.P.(5)
Common Stock 67,036 I By: Lightspeed Affiliates X, L.P.(6)
Common Stock 2,474,368 I By: Lightspeed Venture Partners X, L.P.(6)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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. These sales were executed in multiple trades at prices ranging from $14.25 to $15.245. The price reported above reflects the weighted average sale price. Mr. Mhatre hereby undertakes to provide full information regarding the number of shares and prices at which these sales were effected, upon request, to the staff of the Securities and Exchange Commission, the Issuer or a security holder of the Issuer.
2. Shares held by Mhatre Investments LP- Fund 1. Ravi Mhatre serves as trustee of the general partner of such entity.
3. Shares held by Mhatre 2011 Irrevocable Children's Trust. Ravi Mhatre serves as trustee of such entity.
4. These sales were executed in multiple trades at prices ranging from $15.00 to $15.50. The price reported above reflects the weighted average sale price. Mr. Mhatre hereby undertakes to provide full information regarding the number of shares and prices at which these sales were effected, upon request, to the staff of the Securities and Exchange Commission, the Issuer or a security holder of the Issuer.
5. Lightspeed General Partner Select II, L.P. ("Select II GP") is the general partner of Lightspeed Venture Partners Select II, L.P. ("Lightspeed Select II"). Lightspeed Ultimate General Partner Select II, Ltd. ("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. Mr. Mhatre disclaims beneficial ownership of the shares held by Lightspeed Select II except to the extent of his pecuniary interest therein.
6. Lightspeed General Partner X, L.P. ("Lightspeed GP X") is the general partner of Lightspeed Venture Partners X, L.P. ("Lightspeed X") and Lightspeed Affiliates X, L.P. ("Lightspeed Affiliates"). Lightspeed Ultimate General Partner X, Ltd. ("Lightspeed UGP X") is the general partner of Lightspeed GP X. Christopher J. Schaepe, Barry Eggers, Ravi Mhatre, Peter Nieh and Jeremy Liew are the directors of Lightspeed UGP X and share voting and dispositive power with respect to the shares held by Lightspeed X and Lightspeed Affiliates. Mr. Mhatre disclaims beneficial ownership of the shares held by Lightspeed X and Lightspeed Affiliates except to the extent of his pecuniary interest therein.
RAVI MHATRE By: /s/ Ravi Mhatre 08/22/2018
** 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 4 (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).
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