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