0001140361-23-023022.txt : 20230504 0001140361-23-023022.hdr.sgml : 20230504 20230504200922 ACCESSION NUMBER: 0001140361-23-023022 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230502 FILED AS OF DATE: 20230504 DATE AS OF CHANGE: 20230504 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Kirn David CENTRAL INDEX KEY: 0001834021 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39782 FILM NUMBER: 23890713 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 form4.xml X0407 4 2023-05-02 0001650648 4D Molecular Therapeutics, Inc. FDMT 0001834021 Kirn David C/O 4D MOLECULAR THERAPEUTICS INC. 5858 HORTON STREET #455 EMERYVILLE CA 94608 true true Chief Executive Officer false Common Stock 2023-05-02 4 G 0 600000 0 D 1259153 D Common Stock 2023-05-02 4 G 0 600000 0 A 600000 I Family Trusts Reflects gifts of shares by the Reporting Person to irrevocable trusts established for the benefit of the Reporting Person's children. The Goldman Sachs Trust Company of Delaware is the Trustee of such trusts. /s/ August J. Moretti, Attorney-in-Fact for David Kirn 2023-05-04