0000899243-20-017611.txt : 20200624 0000899243-20-017611.hdr.sgml : 20200624 20200624212501 ACCESSION NUMBER: 0000899243-20-017611 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200623 FILED AS OF DATE: 20200624 DATE AS OF CHANGE: 20200624 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kelly Patrick F. CENTRAL INDEX KEY: 0001814771 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39333 FILM NUMBER: 20986907 MAIL ADDRESS: STREET 1: C/O FORMA THERAPEUTICS HOLDINGS, INC. STREET 2: 500 ARSENAL STREET, SUITE 100 CITY: WATERTOWN STATE: MA ZIP: 02472 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Forma Therapeutics Holdings, Inc., CENTRAL INDEX KEY: 0001538927 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] IRS NUMBER: 371657129 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 500 ARSENAL STREET STREET 2: SUITE 100 CITY: WATERTOWN STATE: MA ZIP: 02472 BUSINESS PHONE: 617-679-1970 MAIL ADDRESS: STREET 1: 500 ARSENAL STREET STREET 2: SUITE 100 CITY: WATERTOWN STATE: MA ZIP: 02472 FORMER COMPANY: FORMER CONFORMED NAME: Forma Therapeutics Holdings LLC DATE OF NAME CHANGE: 20120106 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2020-06-23 0 0001538927 Forma Therapeutics Holdings, Inc., FMTX 0001814771 Kelly Patrick F. C/O FORMA THERAPEUTICS HOLDINGS, INC. 500 ARSENAL STREET, SUITE 100 WATERTOWN MA 02472 0 1 0 0 Chief Medical Officer Common Stock 2020-06-23 4 P 0 42959 A 42959 D Enterprise 3 Junior Stock 2020-06-23 4 S 0 17533 D 0 D Enterprise 4 Junior Stock 2020-06-23 4 S 0 5844 D 0 D Enterprise 6 Junior Stock 2020-06-23 4 S 0 40911 D 0 D Effective immediately upon the closing of the Registrant's initial public offering on June 23, 2020, the reporting person converted (i) 17,533 shares of Enterprise 3 Junior Stock at a conversion rate of 0.7822 shares of common stock per one share of Enterprise 3 Junior Stock, (ii) 5,844 shares of Enterprise 4 Junior Stock at a conversion rate of 0.7585 shares of common stock per one share of Enterprise 4 Junior Stock and (iii) 40,911 shares of Enterprise 6 Junior Stock at a conversion rate of 0.6065 shares of common stock per one share of Enterprise 6 Junior Stock, resulting in his acquisition of 42,959 shares of common stock. /s/ Jeannette Potts, as Attorney-in-Fact 2020-06-24