Statement of Changes in Beneficial Ownership (4)
07 December 2022 - 09:01AM
Edgar (US Regulatory)
FORM 4
[ ] Check this box if no longer subject to Section
16. Form 4 or Form 5 obligations may continue. See
Instruction 1(b).
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL
OWNERSHIP OF SECURITIES
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OMB
APPROVAL
OMB Number: 3235-0287
Estimated average burden
hours per response... 0.5 |
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Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934 or Section 30(h) of the Investment
Company Act of 1940
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1. Name
and Address of Reporting Person * Mahmood Tahir
Ph.D. |
2. Issuer Name and Ticker or Trading
Symbol Applied Molecular Transport Inc. [ AMTI ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)__X__
Director _____
10% Owner
__X__ Officer (give title
below) _____ Other
(specify below)
Chief Executive Officer |
(Last)
(First)
(Middle)
C/O APPLIED MOLECULAR TRANSPORT INC., 450 EAST JAMIE
COURT |
3. Date of Earliest Transaction (MM/DD/YYYY)
12/2/2022
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(Street)
SOUTH SAN FRANCISCO, CA 94080
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line) _X _ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
|
1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
Common Stock |
12/2/2022 |
|
S |
|
1772 (1) |
D |
$0.00 |
75428 (2)(3) |
D |
|
Common Stock |
|
|
|
|
|
|
|
3208307 |
I |
By Living Trust (4) |
Common Stock |
|
|
|
|
|
|
|
391693 |
I |
By Irrevocable Trust (5) |
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible
securities)
|
1. Title of Derivate Security
(Instr. 3) |
2. Conversion or Exercise Price of Derivative
Security |
3. Trans. Date |
3A. Deemed Execution Date, if any |
4. Trans. Code
(Instr. 8) |
5. Number of Derivative Securities Acquired (A) or
Disposed of (D)
(Instr. 3, 4 and 5) |
6. Date Exercisable and Expiration Date |
7. Title and Amount of Securities Underlying
Derivative Security
(Instr. 3 and 4) |
8. Price of Derivative Security
(Instr. 5) |
9. Number of derivative Securities Beneficially
Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct
(D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
Explanation of
Responses: |
(1) |
Represents the number of
shares sold to cover the statutory tax withholding obligations in
connection with the vesting of Restricted Stock Units (RSUs). This
sale satisfies the minimum statutory tax withholding obligations to
be funded by a "sell-to-cover" transaction and does not represent a
discretionary sale by the Reporting Person. |
(2) |
Includes 3,046 shares
acquired under the Issuer's Employee Stock Purchase Plan on
November 15, 2022. |
(3) |
A portion of these
securities are RSUs. Each RSU represents a contingent right to
receive one share of the Issuer's Common Stock. |
(4) |
These shares are held
directly by the Mahmood-Shamsi Living Trust Agreement for which the
Reporting Person and spouse serve as co-trustees and over which
shares the Reporting Person and his spouse hold voting and
dispositive power. |
(5) |
These shares are held
directly by The Mahmood 2017 Irrevocable Trust for which the
Reporting Person serves as trustee and over which shares the
Reporting Person hold voting and dispositive power. |
Reporting
Owners
|
Reporting Owner Name / Address |
Relationships
|
Director |
10% Owner |
Officer |
Other |
Mahmood Tahir Ph.D.
C/O APPLIED MOLECULAR TRANSPORT INC.
450 EAST JAMIE COURT
SOUTH SAN FRANCISCO, CA 94080 |
X |
|
Chief Executive Officer |
|
Signatures
|
/s/ Brandon Hants, Attorney-in-Fact for Tahir
Mahmood |
|
12/6/2022 |
**Signature of Reporting
Person |
Date |
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 control number. |
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