Sec Form 4 Filing - Lightspeed Venture Partners X, L.P. @ Forty Seven, Inc. - 2018-07-02

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FORM 4
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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Lightspeed Venture Partners X, L.P.
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)
(Last) (First) (Middle)
2200 SAND HILL ROAD
3. Date of Earliest Transaction (MM/DD/YY)
07/02/2018
(Street)
MENLO PARK, CA94025
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 07/02/2018 C 67,036 A 67,036 I See footnote ( 2 ) ( 3 )
Common Stock 07/02/2018 C 1,340,698 A 1,340,698 I See footnote ( 3 ) ( 4 )
Common Stock 07/02/2018 C 1,133,670 A 2,474,368 I See footnote ( 3 ) ( 4 )
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
Series A-1 Preferred Stock ( 1 ) 07/02/2018 C 67,036 ( 1 ) ( 1 ) Common Stock 67,036 ( 1 ) 0 I See footnote ( 2 ) ( 3 )
Series A-1 Preferred Stock ( 1 ) 07/02/2018 C 1,340,698 ( 1 ) ( 1 ) Common Stock 1,340,698 ( 1 ) 0 I See footnote ( 3 ) ( 4 )
Series A-2 Preferred Stock ( 1 ) 07/02/2018 C 1,133,670 ( 1 ) ( 1 ) Common Stock 1,133,670 ( 1 ) 0 I See footnote ( 3 ) ( 4 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Lightspeed Venture Partners X, L.P.
2200 SAND HILL ROAD
MENLO PARK, CA94025
X
Lightspeed Affiliates X, L.P.
2200 SAND HILL ROAD
MENLO PARK, CA94025
X
Lightspeed General Partner X, L.P.
2200 SAND HILL ROAD
MENLO PARK, CA94025
X
Lightspeed Ultimate General Partner X, Ltd.
2200 SAND HILL ROAD
MENLO PARK, CA94025
X
SCHAEPE CHRISTOPHER J
2200 SAND HILL ROAD
MENLO PARK, CA94025
X X
Eggers Barry
2200 SAND HILL ROAD
MENLO PARK, CA94025
X
Nieh Peter
2200 SAND HILL ROAD
MENLO PARK, CA94025
X
Mhatre Ravi
2200 SAND HILL ROAD
MENLO PARK, CA94025
X
Liew Jeremy
2200 SAND HILL ROAD
MENLO PARK, CA94025
X
Signatures
Lightspeed Venture Partners X, L.P., by Lightspeed General Partner X, L.P., its general partner, by Lightspeed Ultimate General Partner X, Ltd., its general partner, by /s/ Christopher J. Schaepe, Duly authorized signatory 07/02/2018
Signature of Reporting Person Date
Lightspeed Affiliates X, L.P., by Lightspeed General Partner X, L.P., its general partner, by Lightspeed Ultimate General Partner X, Ltd., its general partner, by /s/ Christopher J. Schaepe, Duly authorized signatory 07/02/2018
Signature of Reporting Person Date
Lightspeed General Partner X, L.P., by Lightspeed Ultimate General Partner X, Ltd., its general partner, by /s/ Christopher J. Schaepe, Duly authorized signatory 07/02/2018
Signature of Reporting Person Date
Lightspeed Ultimate General Partner X, Ltd., by /s/ Christopher J. Schaepe, Duly authorized signatory 07/02/2018
Signature of Reporting Person Date
/s/ Christopher J. Schaepe 07/02/2018
Signature of Reporting Person Date
/s/ Barry Eggers 07/02/2018
Signature of Reporting Person Date
/s/ Peter Nieh 07/02/2018
Signature of Reporting Person Date
/s/ Ravi Mahtre 07/02/2018
Signature of Reporting Person Date
/s/ Jeremy Liew 07/02/2018
Signature of Reporting Person Date
Explanation of Responses:
( 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 )Shares held by Lighspeed Affiliates X, L.P., or Lightspeed Affiliates.
( 3 )Lightspeed General Partner X, L.P., or Lightspeed GP X, is the general partner of Lightspeed X and Lightspeed Affiliates. Lightspeed Ultimate General Partner X, Ltd., or 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. Messrs. Schaepe, Eggers, Liew,Mhatre and Nieh disclaim beneficial ownership of the shares held by Lightspeed X and Lightspeed Affiliates except to the extent of their pecuniary interest therein.
( 4 )Shares held by Lightspeed Venture Partners X, L.P., or Lightspeed X.

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