4 1 e4.txt FORM 4 - MCGUIRE 1 ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: December 31, 2001 Estimated average burden hours per response ....... 0.5 ------------------------------ UNITED STATES SECURITIES AND EXCHANGE COMMISSION WASHINGTON, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(f) of the Investment Company Act of 1940 [_] Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b) (Print or Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* McGuire Terrance -------------------------------------------------------------------------------- (Last) (First) (Middle) 1000 Winter Street -------------------------------------------------------------------------------- (Street) Waltham, Massachusetts 02154 -------------------------------------------------------------------------------- (City) (State) (Zip) deCODE genetics, Inc. ("DCGN") ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an Entity (Voluntary) July, 2000 ________________________________________________________________________________ 4. Statement for Month/Year ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ================================================================================ 6. Relationship of Reporting Persons to Issuer (Check all applicable) [xx] Director [__] 10% Owner [__] Officer (give title below) [__] Other (specify below) ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check Applicable Line) [xx] 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 ================================================================================
6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 2. 3. Disposed of (D) Securities Form: 7. Transaction Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of Date Code ------------------------------- Owned at End (D) or Indirect 1. (Month/ (Instr. 8) (A) of Month Indirect Beneficial Title of Security Day/ ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) Year Code V (D) and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 7/21/00 C 1,582,854 A 1,582,854 I(1) Polaris Venture Partners, L.P. ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 7/21/00 C 92,161 A 92,161 I(1) Polaris Venture Partners Founders' Fund, L.P. ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 7/17/00 P 3,000 A $18 3,000 D ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
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). POTENTIAL PERSONS WHO ARE TO 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. (Over) SEC 1474(3-99) 2 FORM 4 (CONTINUED) Table II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (e.g., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ================================================================================
10. 9. Owner- Number ship of Form 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ----------------- or Secur- of direct Owner- Derivate ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ----------------------------------------------------------------------------------------------------------------------------------- Polaris Venture Series A Common Partners, Preferred 7/21/00 C 1,582,854 Immed -0- Stock 1,582,854 -0- I(1) L.P. ----------------------------------------------------------------------------------------------------------------------------------- Polaris Venture Partners Founders' Series A Common Fund, Preferred 7/21/00 C 92,161 Immed -0- Stock 92,161 -0- I(1) L.P. ----------------------------------------------------------------------------------------------------------------------------------- Polaris Venture Common Partners, Warrant (2) 10/30/97 8/26/05 Stock 189,496 $.01 189,496 I(1) L.P. ----------------------------------------------------------------------------------------------------------------------------------- Polaris Venture Partners Founders' Common Fund, Warrant (2) 10/30/97 8/26/05 Stock 11,337 $.01 11,397 I(1) L.P. ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ===================================================================================================================================
Explanation of Responses: (1) THE REPORTING PERSON IS A MEMBER OF POLARIS VENTURE MANAGEMENT CO, L.L.C. WHICH IS THE GENERAL PARTNER OF POLARIS VENTURE PARTNERS, L.P. AND POLARIS VENTURE PARTNERS FOUNDERS' FUND, L.P. THE REPORTING PERSON DISCLAIMS BENEFICIAL OWNERSHIP OF THE REPORTED SECURITIES EXCEPT TO THE EXTENT OF HIS PECUNIARY INTEREST THEREIN. (2) UPON CLOSING OF ISSUER'S PUBLIC OFFERING ON JULY 21, 2000, THE WARRANTS EXERCISABLE FOR SERIES A PREFERRED STOCK BECAME EXERCISABLE FOR COMMON STOCK. Terrance McGuire 8/9/00 --------------------------------------------- ----------------------- **Signature of Reporting Person Date ** 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. Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. Page 2