0000950170-23-070015.txt : 20231213 0000950170-23-070015.hdr.sgml : 20231213 20231213160518 ACCESSION NUMBER: 0000950170-23-070015 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20231211 FILED AS OF DATE: 20231213 DATE AS OF CHANGE: 20231213 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bizily Scott CENTRAL INDEX KEY: 0001920738 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39782 FILM NUMBER: 231483993 MAIL ADDRESS: STREET 1: C/O 4D MOLECULAR THERAPEUTICS, INC. STREET 2: 5858 HORTON STREET #455 CITY: EMERYVILLE STATE: CA ZIP: 94608 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: 4D Molecular Therapeutics, Inc. CENTRAL INDEX KEY: 0001650648 STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836] 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 2023-12-11 0001650648 4D Molecular Therapeutics, Inc. FDMT 0001920738 Bizily Scott C/O 4D MOLECULAR THERAPEUTICS INC. 5858 HORTON STREET #455 EMERYVILLE CA 94608 false true false false Chief Legal and HR Officer false Stock Option (Right to Buy) 14.42 2023-12-11 4 A false 130000 0 A 2033-12-10 Common Stock 130000 130000 D The shares underlying the stock option award shall vest and become exercisable as to 1/48th of the underlying shares on each monthly anniversary of December 11, 2023 (the "Vesting Commencement Date"), such that 100% of the shares subject to the option will be fully vested and exercisable on the fourth anniversary of the Vesting Commencement Date, while the grantee remains a service provider to the Company. By: /s/ Scott Bizily 2023-12-13