0001567619-21-005967.txt : 20210310 0001567619-21-005967.hdr.sgml : 20210310 20210310160544 ACCESSION NUMBER: 0001567619-21-005967 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210308 FILED AS OF DATE: 20210310 DATE AS OF CHANGE: 20210310 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: 21729712 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: 20150811 4 1 doc1.xml FORM 4 X0306 4 2021-03-08 0 0001650648 4D Molecular Therapeutics Inc. FDMT 0001834021 Kirn David C/O 4D MOLECULAR THERAPEUTICS INC. 5858 HORTON STREET #455 EMERYVILLE CA 94608 1 1 1 0 See Remarks Stock Option (Right to Buy) 41.66 2021-03-08 4 A 0 150000 0.00 A 2031-03-07 Common Stock 150000 150000 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 March 8, 2021 (the "Vesting Commencement Date") while the grantee remains a service provider to the Company. Chief Executive Officer /s/ August J. Moretti, Attorney-in-Fact for David Kirn 2021-03-10