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*
CLACKSON TIMOTHY P

(Last) (First) (Middle)
C/O FORMA THERAPEUTICS HOLDINGS, INC.
500 ARSENAL STREET, SUITE 100

(Street)
WATERTOWN MA 02472

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/18/2020
3. Issuer Name and Ticker or Trading Symbol
Forma Therapeutics Holdings, Inc., [ FMTX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
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)
Enterprise 5 Junior Stock 21,572(1) 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)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) (2) 11/20/2029 Common Stock 14,026 $5.05 D
Stock Option (Right to Buy) (3) 11/20/2029 Common Stock 9,351 $5.05 D
Stock Option (Right to Buy) (4) 02/11/2030 Common Stock 28,053 $5.43 D
Explanation of Responses:
1. The Enterprise 5 Junior Stock will convert into shares of the Registrant's common stock immediately upon the closing of the Registrant's initial public offering based on a conversion price calculated in accordance with the Registrant's certificate of incorporation in effect as of immediately prior to such conversion.
2. The shares subject to this option fully vested on January 1, 2020.
3. 25% of the shares subject to this stock option shall vest on November 21, 2020, and the remainder of the shares vest in equal monthly installments for a period of 36 months thereafter.
4. The shares subject to this option shall vest in full on February 12, 2021.
Remarks:
Exhibit 24 - Power of Attorney
/s/ Jeannette Potts, as Attorney-in-Fact 06/18/2020
** 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.
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