0001104659-20-076562.txt : 20200624 0001104659-20-076562.hdr.sgml : 20200624 20200624212013 ACCESSION NUMBER: 0001104659-20-076562 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: Shah Rajeev M. CENTRAL INDEX KEY: 0001619841 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39333 FILM NUMBER: 20986897 MAIL ADDRESS: STREET 1: 200 BERKELEY STREET STREET 2: 18TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RA Capital Healthcare Fund LP CENTRAL INDEX KEY: 0001315082 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39333 FILM NUMBER: 20986898 BUSINESS ADDRESS: STREET 1: 200 BERKELEY STREET STREET 2: 18TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 6177782500 MAIL ADDRESS: STREET 1: 200 BERKELEY STREET STREET 2: 18TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 FORMER NAME: FORMER CONFORMED NAME: RA Capital Biotech Fund LP DATE OF NAME CHANGE: 20050121 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: RA CAPITAL MANAGEMENT, L.P. CENTRAL INDEX KEY: 0001346824 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39333 FILM NUMBER: 20986899 BUSINESS ADDRESS: STREET 1: 200 BERKELEY STREET, 18TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 BUSINESS PHONE: 617-778-2500 MAIL ADDRESS: STREET 1: 200 BERKELEY STREET, 18TH FLOOR CITY: BOSTON STATE: MA ZIP: 02116 FORMER NAME: FORMER CONFORMED NAME: RA CAPITAL MANAGEMENT, LLC DATE OF NAME CHANGE: 20051213 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 tm2023374-1_4.xml OWNERSHIP DOCUMENT X0306 4 2020-06-23 0 0001538927 Forma Therapeutics Holdings, Inc., FMTX 0001346824 RA CAPITAL MANAGEMENT, L.P. 200 BERKELEY STREET, 18TH FLOOR BOSTON MA 02116 0 0 1 0 0001315082 RA Capital Healthcare Fund LP C/O RA CAPITAL MANAGEMENT, L.P. 200 BERKELEY STREET, 18TH FLOOR BOSTON MA 02116 0 0 1 0 0001619841 Shah Rajeev M. C/O RA CAPITAL MANAGEMENT, L.P. 200 BERKELEY STREET, 18TH FLOOR BOSTON MA 02116 0 0 1 0 Common Stock 2020-06-23 4 C 0 5011651 A 5011651 I See footnote Common Stock 2020-06-23 4 P 0 4000000 20 A 9011651 I See footnote Series D Redeemable Convertible Preferred Stock 2020-06-23 4 C 0 21437376 D Common Stock 5011651 0 I See footnote All series of preferred stock automatically converted into the Issuer's common stock on a one-for-4.2775 basis upon the closing of the Issuer's initial public offering on June 23, 2020 and had no expiration date. Includes (a) 3,216,720 shares held by RA Capital Healthcare Fund, L.P. (the "Fund"), (b) 1,252,913 shares held by RA Capital Nexus Fund, L.P. (the "Nexus Fund") and (c) 542,018 shares held by a separately managed account (the "Account"). RA Capital Management, L.P. (the "Adviser") is the investment manager for the Fund, the Nexus Fund and the Account. The general partner of the Adviser is RA Capital Management GP, LLC (the "Adviser GP"), of which Dr. Peter Kolchinsky and Mr. Rajeev Shah are the managing members. The Adviser, the Adviser GP, Dr. Kolchinsky, and Mr. Shah may be deemed indirect beneficial owners of the reported securities for purposes of Section 13(d) of the Securities Exchange Act of 1934 (the "Act"). They disclaim beneficial ownership of any of the reported securities for the purpose of determining whether they are subject to Section 16 of the Act, however, in reliance on Rule 16a-1(a)(1)(v) and (vii). To the extent that they might be deemed subject to Section 16, they disclaim beneficial ownership of securities held by the Fund and the Nexus Fund for purposes of Rule 16a-1(a)(2), except to the extent of their pecuniary interest therein, and disclaim any pecuniary interest in securities held in the Account for purposes of Rule 16a-1(a)(2). The filing of this Form 4 shall not be construed as an admission that either the Adviser, the Adviser GP, Dr. Kolchinsky, or Mr. Shah is or was for the purposes of Section 16(a), or otherwise, the beneficial owner of any of the securities held in the Account. Includes 3,741,488 shares held by the Fund and 258,512 shares held by the Nexus Fund, in each case acquired in the Issuer's initial public offering. Includes (a) 6,958,208 shares held by the Fund, (b) 1,511,425 shares held by the Nexus Fund and (c) 542,018 shares held by the Account. /s/Rajeev Shah, Manager of RA Capital Management, L.P. 2020-06-24 /s/Rajeev Shah, Manager of RA Capital Healthcare GP, LLC, the General Partner of RA Capital Healthcare Fund, L.P. 2020-06-24 /s/ Rajeev Shah, individually 2020-06-24