0000950170-24-064211.txt : 20240523 0000950170-24-064211.hdr.sgml : 20240523 20240523191200 ACCESSION NUMBER: 0000950170-24-064211 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: Miller-Rich Nancy CENTRAL INDEX KEY: 0001735084 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39782 FILM NUMBER: 24980334 MAIL ADDRESS: STREET 1: C/O INTERCEPT PHARMACEUTICALS, INC. STREET 2: 10 HUDSON YARDS, 37TH FL CITY: NEW YORK STATE: NY ZIP: 10001 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 0001735084 Miller-Rich Nancy 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 Nancy Miller-Rich 2024-05-23