4 1 kkimberlin_form-4.txt U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 --------------- --------------------------- FORM 4 OMB APPROVAL --------------- --------------------------- [_] Check this box if STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB Number: 3235-0287 no longer subject to Expires: January 31, 2005 Section 16. Form 4 or Form 5 Estimated average obligations may continue. See Filed pursuant to Section 16(a) ofthe Securities Exchange Act of 1934, burden hours per Instruction 1(b). Section 17(a) of the Public Utility Holding Company Act of 1934 response................0.5 or Section 30(h) of the Investment Company Act of 1940 ---------------------------
(Print or Type Response) ________________________________________________________________________________ 1. Name and Address of Reporting Person* KIMBERLIN KEVIN B. -------------------------------------------------------------------------------- (Last) (First) (Middle) 535 MADISON AVENUE, 18TH FLOOR -------------------------------------------------------------------------------- (Street) NEW YORK NEW YORK 10022 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol THE IMMUNE RESPONSE CORPORATION ________________________________________________________________________________ 3. I.R.S. Identification Number of Reporting Person, if an entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year NOVEMBER 22, 2002 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) [X] Director [X] 10% Owner [ ] Officer (give title below) [_] Other (specify below) Chairman, President & CEO ________________________________________________________________________________ 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 ================================================================================ 6. 4. 5. Owner- Securities Acquired (A) or Amount of ship 3. Disposed of (D) Securities Form: 7. Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of 2. 2A. Deemed Code ----------------------------- Owned Follow- (D) or Indirect 1. Transaction Execution Day (Instr. 8) (A) ing Reported Indirect Beneficial Title of Security Date if any ------------ Amount or Price Transaction (I) Ownership (Instr. 3) (mm/dd/yy) (mm/dd/yy) Code V (D) (Inst.3 and4) (Instr.4) (Instr. 4) --------------------------------------------------------------------------------------------------------------------------------- Common Stock, par value $.0025 per 8,750 I See Note share (1) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.0025 per 4,000 I See Note share (2) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.0025 per 56,979 I See Note share (3) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock, par value $.0025 per See 448,717 I See Note share Note (4) (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 Issuer'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. SEC 1474 (3-99) *If the form is filed by more than one reporting person, see Instruction 4(b)(v). Page 1 of 3 ------------------------------------------------------------------------------------------------------------------------------------
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 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or 3A. Derivative 6. of Underlying 8. ities Secur- of Exer- Deemed 4. Securities Date Securities Price Bene- ity: In- cise 3. Execu- Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- tion action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Date, Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date if any (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------------------ Option to $73.00 12/15/92 A Immed. 12/15/02 Common 6,250 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $32.00 9/19/94 A Immed. 9/19/04 Common 1,563 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $21.76 6/14/95 A Immed. 6/14/05 Common 1,563 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $49.00 5/30/96 A Immed. 5/30/06 Common 1,563 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $35.00 5/22/97 A Immed. 5/22/07 Common 1,563 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $54.76 6/11/98 A Immed. 6/11/08 Common 1,563 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $29.25 5/25/99 A Immed. 5/25/09 Common 1,563 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $23.125 8/17/99 A Immed. 8/17/09 Common 1,180 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $23.752 5/25/00 A Immed. 5/25/10 Common 1,563 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $15.752 11/27/00 A Immed. 11/27/10 Common 7,341 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Option to $15.752 11/14/00 A See 11/14/10 Common 17,659 D buy Common Note Stock Stock (5) ------------------------------------------------------------------------------------------------------------------------------------ Option to $13.80 6/21/01 A 6/22/02 6/21/11 Common 1,563 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ Option to $2.36 6/17/02 A 6/17/03 6/17/12 Common 1,563 44,931 D buy Common Stock Stock ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $4.6144 11/9/01 P 433,426 Immed. Common 433,426 I See Debenture due Stock Note 2004 (6) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to $5.768 11/9/01 P 433,426 Immed. 11/9/11 Common 433,426 866,851 I See buy Common Stock Note Stock (6) ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $4.144 02/14/02 P 429,000 Immed. Common 429,000 I See Debenture due Stock Note 2005 (7) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to $4.662 02/14/02 P 429,000 Immed. 02/14/12 Common 429,000 858,000 I See buy Common Stock Note Stock (7) ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $1.728 05/03/02 P 2,319,109 Immed. Common 2,319,109 I See Debenture due Stock Note 2005 (8) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to $2.16 05/03/02 P 2,319,109 Immed. 05/03/12 Common 2,319,109 4,638,218 I See buy Common Stock Note Stock (8) ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $1.9104 06/24/02 P 523,451 Immed. Common 523,451 I See Debenture due Stock Note 2005 (9) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to $2.388 06/24/02 P 523,451 Immed. 06/24/12 Common 523,451 1,046,901 I See buy Common Stock Note Stock (9) ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $1.5968 07/11/02 P 354,858 Immed. 07/11/05 Common 354,858 $566,638 I See Debenture due Stock Note 2005 (10) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to buy $1.996 07/11/02 P 354,858 Immed. 07/11/12 Common 354,858 709,716 I See Common Stock Stock Note (10) ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $1.1852 07/30/02 P 430,068 Immed. 07/30/05 Common 430,068 $637,189 I See Debenture due Stock Note 2005 (11) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to $1.4816 07/30/02 P 430,068 Immed. 07/30/12 Common 430,068 860,136 I See buy Common Stock Note Stock (11) ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $1.1424 11/12/02 P 4,243,354 Immed. 11/12/05 Common 4,243,354 $4,849,453.79 I See Debenture due Stock Note 2005 (12) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Warrant to $1.428 11/12/02 P 4,243,354 Immed. 11/12/12 Common 4,243,354 8,486,708 I See buy Common Stock Note Stock (12) ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $1.1456 11/15/02 P 174,581 Immed. 11/15/12 Common 174,581 $200,000 I See Debenture due Stock Note 2005 (13) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to $1.432 11/15/02 P 174,581 Immed. 11/15/12 Common 174,581 349,162 I See buy Common Stock Note Stock (13) ------------------------------------------------------------------------------------------------------------------------------------ 8% Convertible $1.0832 11/20/02 P 184,638 Immed. 11/20/12 Common 184,638 $200,000 I See Debenture due Stock Note 2005 (14) ------------------------------------------------------------------------------------------------------------------------------------ Warrant to $1.3540 11/20/02 P 184,638 Immed. 11/20/12 Common 184,638 369,276 I See buy Common Stock Note Stock (14) ------------------------------------------------------------------------------------------------------------------------------------ (5) An equal portion of the options to purchase 17,659 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 433,425 shares of the Issuer's common stock and (b) a warrant to purchase 433,425 shares of the Issuer's common stock. (7) On February 14, 2002, Oshkim Limited Partnership, of which the reporting person is an affiliate, purchased (a) a promissory note initially convertible into 429,000 shares of the Issuer's common stock and (b) a warrant to purchase 429,000 shares of the Issuer's common stock. (8) On May 3, 2002, Oshkim Limited Partnership, of which the reporting person is an affiliate, purchased (a) a promissory note initially convertible into 2,319,109 shares of the Issuer's common stock and (b) a warrant to purchase 2,319,109 shares of the Issuer's common stock. (9) On June 24, 2002, Oshkim Limited Partnership, of which the reporting person is an affiliate, purchased (a) a promissory note initially convertible into 523,450 shares of the Issuer's common stock and (b) a warrant to purchase 523,450 shares of the Issuer's common stock. The promissory note is alternatively convertible (at the option of the reporting person and subject to the receipt of all necessary corporate and regulatory approvals) into 10 units (rather than the Issuer's common stock) to be sold by the Issuer as part of a contemplated private offering of units comprised of the Issuer's common stock and warrants. (10) On July 11, 2002, The Kimberlin Family 1998 Irrevocable Trust, of which the reporting person is an affiliate, purchased (a) a promissory note initially convertible into 354,858 shares of the Issuer's common stock and (b) a warrant to purchase 354,858 shares of the Issuer's common stock. The promissory note is alternatively convertible (at the option of the reporting person and subject to the receipt of all necessary corporate and regulatory approvals) into units (at a price of $100,000 per unit) to be sold by the Issuer as part of a contemplated private offering of units comprised of the Issuer's common stock and warrants. (11) On July 30, 2002, The Kimberlin Family 1998 Irrevocable Trust, of which the reporting person is an affiliate, purchased (a) a promissory note initially convertible into 537,621 shares of the Issuer's common stock and (b) a warrant to purchase 537,621 shares of the Issuer's common stock. $433,362 of the promissory note is alternatively convertible (at the option of the reporting person and subject to the receipt of all necessary corporate and regulatory approvals) into units (at a price of $100,000 per unit) to be sold by the Issuer as part of a contemplated private offering of units comprised of the Issuer's common stock and warrants. (12) On November 12, 2002, Cheshire Associates LLC, of which the reporting person is a related party, purchased (a) a promissory note initially convertible into 4,243,354 shares of the Issuer's common stock and (b) a warrant to purchase 4,243,354 shares of the Issuer's common stock. (13) On November 15, 2002, Cheshire Associates LLC, of which the reporting person is a related party, purchased (a) a promissory note initially convertible into 174,581 shares of the Issuer's common stock and (b) a warrant to purchase 174,581 shares of the Issuer's common stock. (14) On November 20, 2002, Cheshire Associates LLC, of which the reporting person is a related party, purchased (a) a promissory note initially convertible into 184,638 shares of the Issuer's common stock and (b) a warrant to purchase 184,638 shares of the Issuer's common stock. THE NUMBER OF SHARE AND PRICE PER SHARE AMOUNTS SET FORTH IN THIS FORM HAVE BEEN CALCULATED TO TAKE INTO ACCOUNT THE EFFECTS OF THE 1 FOR 4 REVERSE STOCK SPLIT EFFECTED ON OR ABOUT OCTOBER 9, 2002 BY THE ISSUER. ------------------------------------------------------------------------------------------------------------------------------------ ** Intentional misstatements or omissions of /S/ Kevin B. Kimberlin NOVEMBER 22, 2002 facts constitute Federal Criminal Federal ------------------------------------------- ----------------------- Criminal Violations. SEE 18 U.S.C. 1001 **Signature of Reporting Person Date and 15 U.S.C. 78ff(a). Note: File three copies of this Form, one of which must be manually signed. If space provided is insufficient, see Instruction 6 for procedure. o Potential persons who are to respond to the collection of information contained in this for are not required to respond unless the form displays a currently valid OMB Number. Page 3 of 3