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