0001209191-22-005706.txt : 20220131 0001209191-22-005706.hdr.sgml : 20220131 20220131174035 ACCESSION NUMBER: 0001209191-22-005706 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20220128 FILED AS OF DATE: 20220131 DATE AS OF CHANGE: 20220131 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Mahmood Tahir Ph.D. CENTRAL INDEX KEY: 0001813286 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-39306 FILM NUMBER: 22575449 MAIL ADDRESS: STREET 1: 1 TOWER PLACE, SUITE 850 CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Applied Molecular Transport Inc. CENTRAL INDEX KEY: 0001801777 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 814481426 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 450 EAST JAMIE COURT CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 BUSINESS PHONE: 650-392-0420 MAIL ADDRESS: STREET 1: 450 EAST JAMIE COURT CITY: SOUTH SAN FRANCISCO STATE: CA ZIP: 94080 FORMER COMPANY: FORMER CONFORMED NAME: Applied Molecular Transport LLC DATE OF NAME CHANGE: 20200130 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2022-01-28 0 0001801777 Applied Molecular Transport Inc. AMTI 0001813286 Mahmood Tahir Ph.D. C/O APPLIED MOLECULAR TRANSPORT INC. 450 EAST JAMIE COURT SOUTH SAN FRANCISCO CA 94080 1 1 0 0 Chief Executive Officer Common Stock 2022-01-28 4 P 0 3000 7.88 A 3000 D Common Stock 176657 I By Irrevocable Trust Common Stock 334632 I By GRAT Common Stock 3088711 I By Living Trust 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. These shares are held directly by the Tahir Mahmood 2019 Annuity Trust for which the Reporting Person serves as trustee and over which shares the Reporting Person holds voting and dispositive power. Includes 10,368 shares transferred from the Tahir Mahmood 2019 Annuity Trust since the last filing by the Reporting Person. 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. /s/ Brandon Hants Attorney-in-Fact for Tahir Mahmood 2022-01-31