5 1 ox-565513_5.txt FORM 5 ------------------------- ------------------------------ FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION OMB Approval ------------------------- Washington, D.C. 20549 ------------------------------ [ ] Check this box if no OMB Number: 3235-0362 longer subject to Expires: December 31, 2001 Section 16. Form 4 ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Estimated average burden or Form 5 obligations hours per response.......1.0 may continue. See ------------------------------ Instruction 1(b). Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, [ ] Form 3 Holdings Section 17(a) of the Public Utility Holding Company Act of 1935 or Reported Section 30(f) of the Investment Company Act of 1940 [X] Form 4 Transactions Reported
--------------------------------------------------- ------------------------------------------------------ ------------------------- 1. Name and Address of Reporting Person* 2. Issuer Name and Ticker or Trading Symbol 6. Relationship of Reporting Person(s) to Issuer (Check all applicable) OXiGENE, Inc. (OXGN) Soderberg Per-Olof [X] Director [ ] 10% Owner ------------------------------------------------------------------------------------------ [ ] Officer (give [ ] Other (specify (Last) (First) (Middle) 3. I.R.S. Identification 4. Statement for title below) Number of Reporting Month/Year below) Person, if an entity (Voluntary) 12/31/00 c/o OXiGENE Inc., 321 Arsenal Street ------------------------------------------ ------------------------------------------------------------- (Street) 5. If Amendment, 7. Individual or Joint/Group Reporting Date of Original (Check Applicable Line) (Month/Year) [X] Form Filed by One Reporting Person [ ] Form Filed by More than One Watertown, MA 02472 Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security 2. Trans- 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of (Instr. 3) action Code (Instr. or Disposed of (D) Securities Form: Indirect Date 8) (Instr. 3, 4 and 5) Beneficially Direct (D) Beneficial (Month/ Owned at End or Indirect Ownership Day/ of Issuer's (I) (Instr. 4) Year) Fiscal Year (Instr. 4) (Instr. 3 and 4) ------------------------------------------------------------------------------------------------------------------------------------ Amount (A) or (D) Price ------------------------------------------------------------------------------------------------------------------------------------ Common Stock 11/13/00 A4 20,000 A $7.25 239,210 D ------------------------------------------------------------------------------------------------------------------------------------ 1,320 I By spouse and minor children ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ * If the form is filed by more than one reporting person, see Instruction 4(b)(v). Page 1 of 2 SEC 2270 (3-99)
FORM 5 (continued) TABLE II -- DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ 1. Title 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date 7. Title 8. Price 9. Number 10. Owner- 11. Nature of of sion or action action Derivative Exer- and of of ship Form Indirect Deriv- Exercise Date Code Securities cisable Amount Deriv- Deriv- of Deriv- Beneficial ative Price of (Month/ (Instr. Acquired (A) and Expir- of ative ative ative Ownership Secu- Deriv- Day/ 8) or Disposed ation Under- Secu- Secu- Security: (Instr. 4) rity ative Year) of (D) Date lying rity rities Direct (Instr. Security (Instr. 3, (Month/ Securi- (Instr. Benefi- (D) or 3) 4, and 5) Day/ ties 5) cially Indirect Year) (Instr. Owned (I) 3 and 4) at End (Instr. of 4) Year (Instr. 4) ---------------------------------------------------- (A) (D) Date Expir- Title Amount Exercis- ation or able Date Number of Shares ----------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ Common Stock $7.25 11/13/00 A4 20,000 Immed. 11/13/10 Common 20,000 20,000 D Option (right Stock> to purchase)(1) ------------------------------------------------------------------------------------------------------------------------------------ Common Stock $7.25 11/13/00 D4 20,000 Immed. 11/13/10 Common 20,000 0 D Option (right Stock> to purchase)(1) ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ Explanation of Responses: (1) The Common Stock Options were issued pursuant to the OXiGENE 1996 Stock Incentive Plan, as amended, and in accordance with the laws of Sweden, were immediately exercisable upon the date of grant. The Common Stock Options were exercised on 11/13/00 by execution of a promissory note in the amount of the aggregate exercise price, payable to OXiGENE and secured by the shares of Common Stock purchased by the reporting person, which are subject to divestiture under certain circumstances. ** 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 /s/ Per-Olof Soderbeg May 10, 2001 signed. If space is insufficient, see Instruction 6 for ------------------------------------ -------------------- procedure. Per-Olof Soderberg Date ** Signature of Reporting Person Potential persons who are to respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. Page 2 of 2 SEC 2270 (3-99)