0000899243-21-025098.txt : 20210621
0000899243-21-025098.hdr.sgml : 20210621
20210621190917
ACCESSION NUMBER: 0000899243-21-025098
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210617
FILED AS OF DATE: 20210621
DATE AS OF CHANGE: 20210621
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Vickers Selwyn M MD
CENTRAL INDEX KEY: 0001823594
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-39333
FILM NUMBER: 211032532
MAIL ADDRESS:
STREET 1: 600 NORTH 18TH STREET
CITY: BIRMINGHAM
STATE: AL
ZIP: 35203
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, Inc.,
DATE OF NAME CHANGE: 20200331
FORMER COMPANY:
FORMER CONFORMED NAME: Forma Therapeutics Holdings LLC
DATE OF NAME CHANGE: 20120106
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2021-06-17
0
0001538927
Forma Therapeutics Holdings, Inc.
FMTX
0001823594
Vickers Selwyn M MD
C/O FORMA THERAPEUTICS HOLDINGS, INC.,
500 ARSENAL STREET, SUITE 100
WATERTOWN
MA
02472
1
0
0
0
Common Stock
2021-06-17
4
A
0
2750
0.00
A
2750
D
Stock Option (Right to Buy)
25.35
2021-06-17
4
A
0
8375
0.00
A
2031-06-16
Common Stock
8375
8375
D
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.
This option shall vest and become exercisable in full upon the earlier to occur of (i) June 17, 2022 and (ii) the next annual meeting of the Issuer's stockholders.
/s/ Jeannette Potts, as Attorney-in-Fact
2021-06-21