SEC FORM 3 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*
Bellon Steven F.

(Last) (First) (Middle)
500 TECHNOLOGY SQUARE
STE 700

(Street)
CAMBRIDGE MA 02139

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
01/10/2022
3. Issuer Name and Ticker or Trading Symbol
Foghorn Therapeutics Inc. [ FHTX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Scientific 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 115,707 D
Common Stock 50,000 I See Footnote(1)
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 Options (Right to buy) (2) 01/30/2028 Common Stock 675 0.73 D
Stock Options (Right to buy) (3) 02/13/2029 Common Stock 9,291 3.72 D
Stock Options (Right to buy) (4) 08/18/2030 Common Stock 29,730 8.77 D
Stock Options (Right to buy) (4) 08/20/2030 Common Stock 64,864 8.77 D
Stock Options (Right to buy) (5) 01/27/2031 Common Stock 50,000 16.63 D
Explanation of Responses:
1. Shares held by the Steven F. Bellon 2021 Irrevocable Trust dated December 3, 2021, of which the Reporting Person's children are the trustees.
2. The option vested at a rate of 6.25% of the underlying shares beginning on April 1, 2018 and thereafter on the first day of each calendar quarter until the option is fully vested.
3. The option vested as to 25% of the underlying shares of common stock on January 30, 2020, the first anniversary of the of the vesting commencement date, and at a rate of 6.25% of the underlying shares thereafter on the first day of each calendar quarter following such first anniversary until the option is fully vested.
4. The option shall vest as to 25% of the underlying shares of common stock on August 17, 2021, the first anniversary of the of the vesting commencement date, and at a rate of 6.25% of the underlying shares thereafter on the first day of each calendar quarter following such first anniversary until the option is fully vested.
5. The options will vest as to 25% of the underlying shares of common stock on January 28, 2022, the first anniversary of the vesting commencement date, and at a rate of 6.25% of the underlying shares thereafter on the first day of each calendar quarter following such first anniversary until the option is fully vested.
Remarks:
/s /Allan Reine, M.D., Attorney-in-Fact 01/11/2022
** 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).
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