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*
Lesser Brian Andrew

(Last) (First) (Middle)
C/O FORMA THERAPEUTICS HOLDINGS, INC.
300 NORTH BEACON STREET, SUITE 501

(Street)
WATERTOWN MA 02472

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
11/15/2021
3. Issuer Name and Ticker or Trading Symbol
Forma Therapeutics Holdings, Inc. [ FMTX ]
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
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)
Common Stock 12,100(1) D
Common Stock 9,330(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 32,987 $5.05 D
Stock Option (Right to Buy) (3) 11/20/2029 Common Stock 17,533 $5.05 D
Stock Option (Right to Buy) (4) 02/11/2030 Common Stock 46,756 $5.43 D
Stock Option (Right to Buy) (5) 06/17/2030 Common Stock 46,756 $20 D
Stock Option (Right to Buy) (6) 02/25/2031 Common Stock 36,850 $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
/s/ Jeannette Potts, as Attorney-in-Fact 11/19/2021
** 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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