Initial Statement of Beneficial Ownership (3)
20 November 2021 - 9:32AM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Lesser Brian Andrew |
2. Date of Event Requiring Statement (MM/DD/YYYY)
11/15/2021
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3. Issuer Name and Ticker or Trading Symbol
Forma Therapeutics Holdings, Inc. [FMTX]
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(Last)
(First)
(Middle)
C/O FORMA THERAPEUTICS HOLDINGS, INC., 300 NORTH BEACON STREET, SUITE 501 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner ___X___ Officer (give title below) _____ Other (specify below) SVP, Commercial Officer / |
(Street)
WATERTOWN, MA 02472
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 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 Beneficially Owned
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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 | 12100 (1) | D | |
Common Stock | 9330 (1) | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) |
Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Stock Option (Right to Buy) | (2) | 11/20/2029 | Common Stock | 32987 | $5.05 | D | |
Stock Option (Right to Buy) | (3) | 11/20/2029 | Common Stock | 17533 | $5.05 | D | |
Stock Option (Right to Buy) | (4) | 2/11/2030 | Common Stock | 46756 | $5.43 | D | |
Stock Option (Right to Buy) | (5) | 6/17/2030 | Common Stock | 46756 | $20.00 | D | |
Stock Option (Right to Buy) | (6) | 2/25/2031 | Common Stock | 36850 | $38.61 | D | |
Explanation of Responses: |
(1) | These shares represented restricted stock units and will be settled into common stock upon vesting. Each restricted stock unit would be converted into one share of FMTX common stock. |
(2) | 25% of the shares shall vest on the first anniversary of September 23, 2019, and the remaining 75% of such shares shall vest in thirty-six (36) equal monthly installments; provided that the Reporting Person remains continuously engaged by the Company on each such date. |
(3) | 25% of the shares shall vest on the first anniversary of November 21, 2019, and the remaining 75% of such shares shall vest in thirty-six (36) equal monthly installments; provided that the Reporting Person remains continuously engaged by the Company on each such date. |
(4) | 25% of the shares shall vest on the first anniversary of February 12, 2020, and the remaining 75% of such shares shall vest in thirty-six (36) equal monthly installments; provided that the Reporting Person remains continuously engaged by the Company on each such date. |
(5) | 25% of the shares shall vest on the first anniversary of June 18, 2020, and the remaining 75% of such shares shall vest in thirty-six (36) equal monthly installments; provided that the Reporting Person remains continuously engaged by the Company on each such date. |
(6) | 25% of the shares shall vest on the first anniversary of February 22, 2021, and the remaining 75% of such shares shall vest in thirty-six (36) equal monthly installments; provided that the Reporting Person remains continuously engaged by the Company on each such date. |
Remarks: Exhibit 24 - Power of Attorney |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Lesser Brian Andrew C/O FORMA THERAPEUTICS HOLDINGS, INC. 300 NORTH BEACON STREET, SUITE 501 WATERTOWN, MA 02472 |
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| SVP, Commercial Officer |
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Signatures
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/s/ Jeannette Potts, as Attorney-in-Fact | | 11/19/2021 |
**Signature of Reporting Person | Date |
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