4 1 kim175518form4.txt FORM 4
------------------------ FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION ----------------------------- ------------------------ WASHINGTON, D.C. 20549 OMB APPROVAL ----------------------------- [ ]Check this box if STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0287 no longer subject Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Expires:December 31, 2001 to Section 16. Section 17(a) of the Public Utility Holding Company Act of 1935 or Estimated average burden Form 4 or Form 5 Section 30(f) of the Investment Company Act of 1940 hours per response:.......0.5 obligations may continue. ----------------------------- SEE Instruction 1(b) (Print or Type Response) ----------------------------------------------------------------------------------------------------------------------------------- 1. Name and Address of Reporting 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person* Person(s) to Issuer Kimberlin Kevin B. The Immune Response Corporation (Check all applicable) -------------------------------------------------------------------------------------- (Last) (First) (Middle) 3. IRS or Social 4. Statement for x Director x 10% Owner Security Number Month/Year ___ ___ of Reporting Officer (give Other specify Person November, 2001 ___ (title below) ____ (below (Voluntary) below) 535 Madison Avenue, 18th Floor ----------------------------------------------------------------------------------------------------------------------------------- (Street) 5. If Amendment, 7. Individual or Joint/Group Date of Original Filing (Check Applicable Line) (Month/Year) x Form filed by One Reporting Person ___ New York, NY 10022 Form filed by More than One Reporting ___ Person ----------------------------------------------------------------------------------------------------------------------------------- (City) (State) (Zip) TABLE 1 - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ----------------------------------------------------------------------------------------------------------------------------------- 1. Title of Security 2. Trans- 3. Trans 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature (Instr. 3) action action or Disposed of (D) Securities ship- of Date Code (Instr. 3, 4 and 5) Beneficially Form: Indirect (Instr. 8) Owned at Direct Beneficial End of Month (D) or Owner- Indirect ship --------------------------------------- (I) (Month/ (A) Day/ or Year Code V Amount (D) Price (Instr. 3 and 4) (Instr. 4) (Instr. 4) -------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $.0025 per share 35,000 I See Note (1) ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $.0025 per share 16,000 I See Note (2) ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $.0025 per share 227,916 I See Note (3) ----------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $.0025 per share See Note (4) 1,794,871 I See Note (4) ----------------------------------------------------------------------------------------------------------------------------------- 1. Held by the reporting person's spouse. 2. Held in a retirement account for the benefit of the reporting person. 3. Held by Kimberlin Family Partners L.P. a Colorado limited partnership, of which the reporting person is the general partner. 4. The reported securities were included in Units, each of which included one share of the Inssuer's common stock and one warrant to purchase one share of the Issuer's common stock (which warrants have subsequently expired), purchased in 1997 for $7.80 per Unit by Kevin Kimberlin Partners, L.P., a Delaware limited partnership, of which the general partner is KKP Management LLC, a Nevada limited liability company, of which the reporting person is the managing member. ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Over) * If the form is filed by more than one reporting person, SEE Instruction 4(b)(v). SEC 1474 (7-96)
FORM 4 (continued) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ---------------------------------------------------------------------------------------------------------------------------------- 1.Title of 2.Conver- 3.Trans- 4.Trans- 5.Number of 6.Date Exer- 7.Title 8.Price 9.Number 10.Owner- 11.Nature Derivative sion or action action of Deriv- cisable and and of of ship of Security Exercise Date Code ative Expiration Amount Deriv- Deriv- Form of Indirect (Instr. 3) Price of (Instr. Securities date (Month/ of ative ative Deriv- Benefi- Deriva- (Month/ 8) Acquired Day/ Under- Secur- Secur- ative cial tive Day/ (A) or Dis- Year) lying) ity ities Secur- Owner- Security Year) posed of (D) Securi- Instr. Benefi- ity: ship (Instr. 3, ties 5) cially Direct (Instr. 4 and 5) (Instr. owned (D) or 4) 3 and 4) at end Indirect of (I) month (Instr. 4) ----------------------------------------------------------------------- Amount Date Expira- or Exer- tion Number Code V (A) (D) isable Date Title of Shares ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $18.25 12/15/92 A Immed. 12/15/02 Common 25,000 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $8.00 9/19/94 A Immed. 09/19/04 Common 6,250 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $5.44 6/14/95 A Immed. 6/14/05 Common 6,250 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $12.25 5/30/96 A Immed. 5/30/06 Common 6,250 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $8.75 5/22/97 A Immed. 5/22/07 Common 6,250 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $13.69 6/11/98 A Immed. 6/11/08 Common 6,250 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $7.3125 5/25/99 A Immed. 5/25/09 Common 6,250 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $5.78125 8/17/99 A Immed. 8/17/09 Common 4,719 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $5.9380 5/25/00 A Immed. 5/25/10 Common 6,250 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $3.9380 11/27/00 A Immed. 11/27/01 Common 29,367 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $3.9380 11/14/01 A See 11/14/10 Common 70,638 179,724 D Common Stock Note (5) Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $3.450 6/21/01 A 6/22/02 6/21/11 Common 6,250 D Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $1.1536 11/9/01 P 1,733,703 Immed. Common 1,733,703 I See Note Common Stock Stock (6) ------------------------------------------------------------------------------------------------------------------------------------ Option to buy $1.4420 11/9/01 P 1,733,703 Immed. 11/9/11 Common 1,733,703 3,467,406 I See Note Common Stock Stock (6) ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (5) An equal portion of the options to purchase 70,638 shares of the Issuer's common stock, which were granted to the reporting person on November 14, 2000, vest each day that the reporting person remains a member of the Issuer's board of directors, with the entire grant to become fully vested on January 1, 2003. (6) On November 9, 2001, Kevin Kimberlin Partners, L.P., a Delaware limited partnership, of which the general partner is KKP Management LLC, a Nevada limited liability company, of which the reporting person is the managing member, purchased (a) a promissory note initially convertible into 1,733,703 shares of the Issuer's common stock and (b) a warrant to purchase 1,733,703 shares of the Issuer's common stock. ** Intentional misstatements or omissions of facts constitute /s/ Kevin B. Kimberlin December 7, 2001 Federal Criminal Violations. ------------------------------------ ----------------- SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). **Signature of Reporting Person Date 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 SEC 1474 (7-96) respond unless the form displays a currently valid OMB Number. Page 2 of 2