3 1 f3_021103.txt FORM 3 FOR SANDRA GARDINER UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 3 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES 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 (Print or Type Responses) ________________________________________________________________________________ 1. Name and Address of Reporting Person* Gardiner Sandra -------------------------------------------------------------------------------- (Last) (First) (Middle) c/o Lipid Sciences, Inc. 7068 Koll Center Parkways, Suite 401 -------------------------------------------------------------------------------- (Street) Pleasanton CA 94566 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Date of Event Requiring Statement (Month/Day/Year) January 28, 2003 ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary) ________________________________________________________________________________ 4. Issuer Name and Ticker or Trading Symbol Lipid Sciences, Inc. "LIPD" ________________________________________________________________________________ 5. Relationship of Reporting Person(s) to Issuer (Check all applicable) | | Director |_| 10% Owner |X| Officer (give title below) |_| Other (specify below) Chief Accounting Officer --------------------------------------------------------------------- ________________________________________________________________________________ 6. If Amendment, Date of Original (Month/Day/Year) ________________________________________________________________________________ 7. Individual or Joint/Group Filing (Check Applicable List) |X| Form filed by One Reporting Person |_| Form filed by More than One Reporting Person ================================================================================ Table I -- Non-Derivative Securities Beneficially Owned ================================================================================
2. Amount of Securities 3. Ownership Form: 1. Title of Security Beneficially Owned Direct (D) or 4. Nature of Indirect Beneficial Ownership (Instr. 4) (Instr. 4) Indirect (I) (Instr. 5) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
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 5(b)(v).
FORM 3 (continued) Table II -- Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ==================================================================================================================================== 5. Owner- 3. Title and Amount of Securities ship Underlying Derivative Security Form of 2. Date Exercisable (Instr. 4) Derivative and Expiration Date --------------------------------- 4. Conver- Security: (Month/Day/Year) Amount sion or Direct 6. Nature of ---------------------- or Exercise (D) or Indirect Date Expira- Number Price of Indirect Beneficial 1. Title of Derivative Exer- tion of Derivative (I) Ownership Security (Instr. 4) cisable Date Title Shares Security (Instr. 5) (Instr. 5) ------------------------------------------------------------------------------------------------------------------------------------ Employee Stock Option (1) 02/01/11 Common Stock 77,951 $3.21 D (Right to Buy) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ====================================================================================================================================
Explanation of Responses: (1) The option with respect to 38,975 of the shares has already vested and is exercisable, and the remaining shares will vest and become exercisable in equal monthly installments starting March 1, 2003 until February 1, 2005. Lipid Sciences, Inc. /s/ Sandra Gardiner February 13, 2003 --------------------------------------------- ----------------------- Name: Sandra Gardiner Date Title: Chief Accounting Officer ** 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.