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