4/A 1 e4a.txt AMENDED FORM 4 JEAN-FRANCOIS FORMELA 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* Formela Jean-Francois -------------------------------------------------------------------------------- (Last) (First) (Middle) 222 Berkeley Street, Suite 1950 -------------------------------------------------------------------------------- (Street) Boston, Massachusetts 02116 -------------------------------------------------------------------------------- (City) (State) (Zip) -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol deCODE genetics, Inc. ("DCGN") -------------------------------------------------------------------------------- 3. I.R.S Identification Number of Reporting Person, if an entity (Voluntary) -------------------------------------------------------------------------------- 4. Statement for Month/Year July, 2000 -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) August 8, 2000 ================================================================================ 6. Relationship of Reporting Person(s) 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. 5. Owner- 4. Amount of ship 2. 3. Securities Acquired (A) or Securities Form: 7. Transaction Transaction Disposed of (D) Beneficially Direct Nature of Date Code (Instr. 3, 4 and 5) Owned at End (D) or Indirect 1. (Month/ (Instr. 8) -------------------------- of Month Indirect Beneficial Title of Security Day/ ------------ (A) or (Instr. 3 (I) Ownership (Instr. 3) Year Code V Amount (D) Price and 4) (Instr.4) (Instr. 4) ------------------------------------------------------------------------------------------------------------------------------------ Atlas Venture Common Stock 7/21/00 C 1,042,541 A 1,042,541 I(1) Fund II, L.P. ------------------------------------------------------------------------------------------------------------------------------------ Atlas Venture Europe Common Stock 7/21/00 C 1,042,541 A 1,042,541 I(1) Fund B.V. ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 7/17/00 P 5,000 A $18 5,000 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 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 Deriv- of Conver- 5. 7. ative Deriv- 11. ion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of 1. Exer- 4. Securities Date Securities Price Bene- ity: In- Title ise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct of Deri Price Trans- action or Disposed Expiration Date --------------- Deriv- Owned (D)or Bene- vate 0f action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Secur Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- ity ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship (inst. Secur- Day/ ---- ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ Series A Preferred Common Atlas 7/21/00 C 1,042,541 Immed Stock 1,042,541 -0- I(1) Ven- ture Fund II, L.P. ------------------------------------------------------------------------------------------------------------------------------------ Series A Preferred Common Atlas 7/21/00 C 1,042,541 Immed Stock 1,042,541 -0- I(1) Ven- ture Europe Fund B.V. ------------------------------------------------------------------------------------------------------------------------------------ Atlas Ven- Warrant(2) ture Common Fund 10/30/97 8/26/05 Stock 125,000 $1.00 125,000 I(1) II, L.P. ------------------------------------------------------------------------------------------------------------------------------------ Atlas Warrant(2) Ven- Common ture 10/30/97 8/26/05 Stock 125,000 $1.00 125,000 I(1) Europe Fund B.V. ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) The reporting person is a general partner of Atlas Venture Associates, L.P., which is sole general partner of Atlas Venture Fund II, L.P. Atlas Venture Europe Fund B.V. is a wholly owned subsidiary of Atlas InvesteringsGroep N.V., which is a limited partner in Atlas Venture Fund II, 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. /s/ Jean-Francois Formela 8/8/00 --------------------------------------------- ----------------------- **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 control number. Page 2