0001567619-23-003006.txt : 20230214 0001567619-23-003006.hdr.sgml : 20230214 20230214202315 ACCESSION NUMBER: 0001567619-23-003006 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230210 FILED AS OF DATE: 20230214 DATE AS OF CHANGE: 20230214 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: 23633179 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 doc1.xml FORM 4 X0306 4 2023-02-10 0 0001650648 4D Molecular Therapeutics, Inc. FDMT 0001920738 Bizily Scott C/O 4D MOLECULAR THERAPEUTICS INC. 5858 HORTON STREET #455 EMERYVILLE CA 94608 0 1 0 0 Chief Legal and HR Officer Stock Option (Right to Buy) 20.24 2023-02-10 4 A 0 50000 0 A 2033-02-09 Common Stock 50000 50000 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 February 10, 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. /s/ August J. Moretti, Attorney-in-Fact for Scott Bizily 2023-02-14