# EDGAR Filing Document

**Accession Number:** 0002091461
**File Stem:** 0000950130-25-000195
**Filing Date:** 2025-10
**Character Count:** 6339
**Document Hash:** 361ba03b00a05ad9e9bfbf33f0d5241b
**Contains OCR:** False
**Source Format:** 

## Filing Content

## Filing Summary
**0000950130-25-000195.hdr.sgml**: 20251010

**ACCESSION NUMBER**: 0000950130-25-000195

**CONFORMED SUBMISSION TYPE**: 3

**PUBLIC DOCUMENT COUNT**: 1

**CONFORMED PERIOD OF REPORT**: 20250930

**FILED AS OF DATE**: 20251010

**DATE AS OF CHANGE**: 20251010

**REPORTING-OWNER**: 

**OWNER DATA:**
- **COMPANY CONFORMED NAME:** Gupta Ashoo
- **CENTRAL INDEX KEY:** 0002091461

**ORGANIZATION NAME:**

**FILING VALUES:**
- **FORM TYPE:** 3
- **SEC ACT:** 1934 Act
- **SEC FILE NUMBER:** 001-39782
- **FILM NUMBER:** 251389100

**MAIL ADDRESS:**
- **STREET 1:** 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]
- **ORGANIZATION NAME:** 03 Life Sciences
- **EIN:** 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

### UNITED STATES SECURITIES AND EXCHANGE COMMISSION
**Washington, D.C. 20549**

## FORM 3

### INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

[ ] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).

---

| | | |
|:---|:---|:---|
| **1. Name and Address of Reporting Person**<sup>*</sup><br>Gupta Ashoo<br><sub>(Last) (First) (Middle)</sub><br>C/O 4D MOLECULAR THERAPEUTICS, INC.<br>5858 HORTON STREET #455<br><sub>(Street)</sub><br>EMERYVILLE, CA 94608<br><sub>(City) (State) (Zip)</sub> | **3. Issuer Name and Ticker or Trading Symbol**<br>4D Molecular Therapeutics, Inc. [ FDMT ] | **5. If Amendment, Date of Original Filed (Month/Day/Year)**<br>  |
| **2. Date of Event Requiring Statement (Month/Day/Year)**<br>2025-09-30 | **4. Relationship of Reporting Person(s) to Issuer**<br>(Check all applicable)<br>[ ] Director   [ ] 10% Owner<br>[X] Officer (give title below)   [ ] Other (specify below)<br>_VP, Finance and Controller_ | **6. Individual or Joint/Group Filing (Check Applicable Line)**<br>[X] Form filed by One Reporting Person<br>[ ] Form filed by More than One Reporting Person |

---

## Table I - Non-Derivative Securities Beneficially Owned

---

|  |  |  |  |
| --- | --- | --- | --- |
| 1. Title of Security | 2. Amount of Securities Beneficially Owned | 3. Ownership Form | 4. Nature of Indirect Beneficial Ownership |
| Common Stock | 45662 | D |  |

---

## Table II - Derivative Securities Beneficially Owned

---

|  |  |  |  |  |  |  |  |
| --- | --- | --- | --- | --- | --- | --- | --- |
| 1. Title of Derivative Security | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Underlying Securities | 3. Title and Amount of Underlying Securities | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| 1. Title of Derivative Security | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | 4. Conversion or Exercise Price | 5. Ownership Form | 6. Nature of Indirect Beneficial Ownership |
| Stock Option (Right to Buy) | <sup>(1)</sup> | 2034-07-08 | Common Stock | 27700 | $22.69 | D |  |
| Stock Option (Right to Buy) | <sup>(2)</sup> | 2035-03-05 | Common Stock | 7056 | $4.14 | D |  |
| Restricted Stock Units | <sup>(3)</sup> | <sup>(3)</sup> | Common Stock | 13850 | <sup>(4)</sup> | D |  |
| Restricted Stock Units | <sup>(5)</sup> | <sup>(5)</sup> | Common Stock | 3528 | <sup>(4)</sup> | D |  |

---

### Footnotes:

(1) 25% of the shares subject to the stock option vest on the first anniversary measured from June 12, 2024 (the "Vesting Commencement Date"), and 1/48th of the total number of shares vest in thirty-six (36) successive and equal monthly installments thereafter, 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.

(2) 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 6, 2025 (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.

(3) The shares underlying the restricted stock unit award shall vest as to 25% of the shares on June 20, 2025 and as to 1/16th of the underlying shares on each quarterly anniversary of such date thereafter, while the grantee remains a service provider to the Company.

(4) Each Restricted Stock Unit represents a contingent right to receive one share of Common Stock.

(5) The shares underlying the restricted stock unit award shall vest as to 1/16th of the shares on June 20, 2025 and as to 1/16th of the underlying shares on each quarterly anniversary of such date thereafter, while the grantee remains a service provider to the Company.

**Signature:** /s/ Ashoo Gupta  
**Date:** 2025-10-10

### Remarks:

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.

* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).

** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.

**Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.**