4 1 f4_012903-placenti.txt STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ------------------------------ OMB APPROVAL ------------------------------ OMB Number: 3235-0287 Expires: January 31, 2005 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(h) 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* Placenti Frank M. -------------------------------------------------------------------------------- (Last) (First) (Middle) 2 North Central Avenue, Suite 2200 -------------------------------------------------------------------------------- (Street) Phoenix, AZ 85004-4406 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol Lipid Sciences, Inc. (LIPD) ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) ________________________________________________________________________________ 4. Statement for Month/Day/Year January 28, 2003 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) |X| Director |_| 10% Owner |_| Officer (give title below) |_| Other (specify below) ____________________________________________________________________ ________________________________________________________________________________ 7. 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 ================================================================================
5. Amount of 6. 4. Securities Owner- Securities Acquired (A) or Beneficially ship 2A. 3. Disposed of (D) Owned Form: 7. 2. Deemed Transaction (Instr. 3, 4 and 5) Following Direct Nature of Trans- Execution Code ------------------------------- Reported (D) or Indirect 1. action Date, if (Instr. 8) (A) Transaction(s) Indirect Beneficial Title of Security Date any ------------ or (Instr. 3 & (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V Amount (D) Price Instr.4) (Instr.4) (Instr.4) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
(Over) Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
FORM 4 (continued) Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ==================================================================================================================================== 9. Number 10. of Owner- deriv- ship ative Form 2. Secur- of Conver- 5. 7. ities Deriv- 11. sion Number of Title and Amount Bene- ative Nature or Derivative 6. of Underlying 8. ficially Secur- of Exer- 4. Securities Date Securities Price Owned ity: In- cise Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of Follow- Direct direct Price 3. action or Disposed Expiration Date ---------------- Deriv- ing (D) or Bene- 1. of Trans- Code of(D) (Month/Day/Year) Amount ative Reported In- ficial Title of Deriv- action (Instr. (Instr. 3, ---------------- or Secur- Trans- direct Owner- Derivative ative Date 8) 4 and 5) Date Expira- Number ity action(s) (I) ship Security Secur- (mm/dd/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity yy) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ---------------------------------------------------------------------------------------------------------------------------- Stock $3.50/ 1/28/03 A 120,000 (1) 1/28/13 Common 120,000 120,000 D Option Share Stock (right to buy) ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ============================================================================================================================
Explanation of Responses: (1) The option with respect to 1/3 of the shares has already vested, and it vests with respect to 1/3 of the shares on each of January 28, 2004 and January 28, 2005. Lipid Sciences, Inc. /s/ Frank M. Placenti January 30, 2003 --------------------------------------------- ----------------------- Name: Frank M. Placenti Date Title: Director **Signature of Reporting Person * 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. Page 2