Sec Form 13G Filing - SCHAFFER DAVID filing for 4D Molecular Therapeutics Inc. (FDMT) - 2022-02-14

Insider filing report for Changes in Beneficial Ownership

  • Schedule 13G & 13D forms are used to report a party's ownership of stock which exceeds 5% of a company's total stock issue.
  • Schedule 13G is a shorter version of Schedule 13D with fewer reporting requirements.
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United States

Securities and Exchange Commission

Washington, D.C. 20549

 

 

Schedule 13G

(Rule 13d-102)

Information to be Included in Statements Filed Pursuant

to § 240.13d-1(b), (c) and (d) and Amendments Thereto Filed

Pursuant to § 240.13d-2

UNDER THE SECURITIES EXCHANGE ACT OF 1934

(Amendment No. 1)*

 

 

4D Molecular Therapeutics Inc.

(Name of Issuer)

Common Stock, par value $0.0001

(Title of Class of Securities)

35104E100

(CUSIP Number)

December 31, 2021

(Date of Event Which Requires Filing of this Statement)

 

 

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

☐ Rule 13d-1(b)

☐ Rule 13d-1(c)

☒ Rule 13d-1(d)

 

*

The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

 

 

 


CUSIP No. 35104E100   Schedule 13G    Page 1 of 4

 

  1    

  Names of Reporting Persons

 

  David Schaffer

  2  

  Check the Appropriate Box if a Member of a Group

  (a)  ☐        (b)  ☐

 

  3  

  SEC Use Only

 

  4  

  Citizenship or Place of Organization

 

  United States

Number of

Shares

 Beneficially 

Owned by

Each

Reporting

Person

With

   5    

  Sole Voting Power

 

  901,215

   6  

  Shared Voting Power

 

  0

   7  

  Sole Dispositive Power

 

  901,215

   8  

  Shared Dispositive Power

 

  0

  9    

  Aggregate Amount Beneficially Owned by Each Reporting Person

 

  901,215

10  

  Check if the Aggregate Amount in Row (9) Excludes Certain Shares

 

  Not Applicable

11  

  Percent of Class Represented by Amount in Row 9

 

  2.8%

12  

  Type of Reporting Person

 

  IN


CUSIP No. 35104E100   Schedule 13G    Page 2 of 4

 

ITEM 1.

(a) Name of Issuer:

4D Molecular Therapeutics, Inc. (the “Issuer”).

 

  (b)

Address of Issuer’s Principal Executive Offices:

5858 Horton Street #455, Emeryville, California 94608.

 

ITEM 2.

(a) Name of Person Filing:

This statement is filed on behalf of David Schaffer (the “Reporting Person”).

 

  (b)

Address or Principal Business Office:

The business address of the Reporting Person is c/o 4D Molecular Therapeutics Inc. 5858 Horton Street #455, Emeryville, CA 94608.

 

  (c)

Citizenship of each Reporting Person is:

The Reporting Person is a citizen of the United States.

 

  (d)

Title of Class of Securities:

Common stock, par value $0.0001 per share (“Common Stock”).

 

  (e)

CUSIP Number:

35104E100

 

ITEM 3.

Not applicable.

 

ITEM 4.

Ownership.

The ownership information below represents beneficial ownership of Common Stock of the Issuer as of December 31, 2021, based upon 32,138,814 shares of Common Stock outstanding as of November 10, 2021 based on the Issuer’s Quarterly Report on Form 10-Q filed with the Securities and Exchange Commission on November 10, 2021.

(a) Amount beneficially owned:

The Reporting Person is the record holder of 901,215 shares of Common Stock.


CUSIP No. 35104E100   Schedule 13G    Page 3 of 4

 

(b) Percent of class: 2.8%

(c) Number of shares as to which the person has:

 

  (i)

Sole power to vote or to direct the vote: 901,215

 

  (ii)

Shared power to vote or direct the vote: 0

 

  (iii)

Sole power to dispose or to direct the disposition of: 901,215

 

  (iv)

Shared power to dispose or to direct the disposition of: 0

 

ITEM 5.

Ownership of Five Percent or Less of a Class.

If this statement is being filed to report the fact that as of the date hereof the Reporting Person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following:  ☒

 

ITEM 6.

Ownership of More than Five Percent on Behalf of Another Person.

Not applicable.

 

ITEM 7.

Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company.

Not applicable.

 

ITEM 8.

Identification and Classification of Members of the Group.

Not applicable.

 

ITEM 9.

Notice of Dissolution of Group.

Not applicable.

 

ITEM 10.

Certification.

Not applicable.


CUSIP No. 35104E100   Schedule 13G    Page 4 of 4

 

SIGNATURE

After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.

Date: February 14, 2022

 

David Schaffer

/s/ David Schaffer