SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
JACOBS CINDY

(Last) (First) (Middle)
1900 9TH AVENUE
SUITE 1100

(Street)
SEATTLE WA 98101

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
CORIXA CORP [ CRXA ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
Sr. VP, Clinical Development
3. Date of Earliest Transaction (Month/Day/Year)
07/12/2005
4. If Amendment, Date of Original Filed (Month/Day/Year)
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. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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 07/12/2005 M(1) 99,868 A $3.95 99,868 D
Common Stock 07/12/2005 D 99,868 D $4.4 0 D
Common Stock 07/12/2005 M(1) 132 A $3.95 132 D
Common Stock 07/12/2005 D 132 D $4.4 0 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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
Incentive Stock Option $3.95 07/12/2005 M 132 07/12/2005 12/15/2014 Common Stock 132 $0.00 0 D
Incentive Stock Option $6.04 07/12/2005 D(2) 21,094 07/12/2005 12/31/2013 Common Stock 21,094 $0.00 0 D
Incentive Stock Option $6.41 07/12/2005 D(2) 4,064 07/12/2005 01/03/2013 Common Stock 4,064 $0.00 0 D
Incentive Stock Option $9.5 07/12/2005 D(2) 35,328 07/12/2005 05/05/2009 Common Stock 35,328 $0.00 0 D
Incentive Stock Option $13.45 07/12/2005 D(2) 4,109 07/12/2005 10/26/2011 Common Stock 4,109 $0.00 0 D
Incentive Stock Option $15.07 07/12/2005 D(2) 9,292 07/12/2005 12/31/2011 Common Stock 9,292 $0.00 0 D
Incentive Stock Option $17 07/12/2005 D(2) 4,062 07/12/2005 12/31/2009 Common Stock 4,062 $0.00 0 D
Non-Qualified Stock Option $3.95 07/12/2005 M 99,868 07/12/2005 12/15/2014 Common Stock 99,868 $0.00 0 D
Non-Qualified Stock Option $5.7 07/12/2005 D(2) 68,750 07/12/2005 06/14/2012 Common Stock 68,750 $0.00 0 D
Non-Qualified Stock Option $6.04 07/12/2005 D(2) 19,406 07/12/2005 12/31/2013 Common Stock 19,406 $0.00 0 D
Non-Qualified Stock Option $6.41 07/12/2005 D(2) 10,936 07/12/2005 01/03/2013 Common Stock 10,936 $0.00 0 D
Non-Qualified Stock Option $9.5 07/12/2005 D(2) 9,672 07/12/2005 05/05/2009 Common Stock 9,672 $0.00 0 D
Non-Qualified Stock Option $13.45 07/12/2005 D(2) 70,891 07/12/2005 10/26/2011 Common Stock 70,891 $0.00 0 D
Non-Qualified Stock Option $15.07 07/12/2005 D(2) 36,208 07/12/2005 12/31/2011 Common Stock 36,208 $0.00 0 D
Non-Qualified Stock Option $17 07/12/2005 D(2) 10,938 07/12/2005 12/31/2009 Common Stock 10,938 $0.00 0 D
Explanation of Responses:
1. Pursuant to the Merger Agreement with GSK, these options were canceled at the time of the Merger. Net cash consideration was received.
2. Pursuant to the Merger Agreement with GSK, the underlying option was canceled at the time of the Merger. No net cash consideration was received.
Remarks:
Greg Cox (atty in fact) for: Cindy Jacobs 07/12/2005
** 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).
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