0000950170-24-064259.txt : 20240523 0000950170-24-064259.hdr.sgml : 20240523 20240523204500 ACCESSION NUMBER: 0000950170-24-064259 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240521 FILED AS OF DATE: 20240523 DATE AS OF CHANGE: 20240523 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Tomasello Shawn CENTRAL INDEX KEY: 0001617239 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39782 FILM NUMBER: 24980544 MAIL ADDRESS: STREET 1: C/O PHARMACYCLICS, INC STREET 2: 995 EAST ARQUES AVENUE CITY: SUNNYVALE STATE: CA ZIP: 94085 FORMER NAME: FORMER CONFORMED NAME: Tomasello Shawn Fassbender DATE OF NAME CHANGE: 20140819 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: 4D Molecular Therapeutics, Inc. CENTRAL INDEX KEY: 0001650648 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] ORGANIZATION NAME: 03 Life Sciences IRS NUMBER: 473506994 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 5858 HORTON STREET #455 CITY: EMERYVILLE STATE: CA ZIP: 94608 BUSINESS PHONE: 5105052680 MAIL ADDRESS: STREET 1: 5858 HORTON STREET #455 CITY: EMERYVILLE STATE: CA ZIP: 94608 FORMER COMPANY: FORMER CONFORMED NAME: 4D Molecular Therapeutics Inc. DATE OF NAME CHANGE: 20200506 FORMER COMPANY: FORMER CONFORMED NAME: 4D Molecular Therapeutics Inc DATE OF NAME CHANGE: 20150811 4 1 ownership.xml 4 X0508 4 2024-05-21 0001650648 4D Molecular Therapeutics, Inc. FDMT 0001617239 Tomasello Shawn C/O 4D MOLECULAR THERAPEUTICS, INC. 5858 HORTON STREET #455 EMERYVILLE CA 94608 true false false false false Stock Option (Right To Buy) 25.15 2024-05-21 4 A false 22500 0 A 2034-05-20 Common Stock 22500 22500 D Automatically granted pursuant to the terms of the Company's non-employee director compensation program. The stock option vests and becomes exercisable with respect to 1/3 of the total shares on May 21, 2025 and in equal monthly installments thereafter, subject to the Reporting Person continuing service to Issuer through each vesting date, until the shares are fully vested on May 21, 2027. Additionally, the stock options will vest in full upon the consummation of a Change in Control (as defined in the 2020 Incentive Award Plan). By: /s/ Scott Bizily as Attorney-in-fact for Shawn Tomasello 2024-05-23