5 1 a5.txt FORM 5
------------------------------------- --------------------------------- FORM 5 OMB APPROVAL ------------------------------------- OMB NUMBER 3235-0362 ESTIMATED AVERAGE BURDEN / / CHECK THIS BOX IF NO LONGER U.S. SECURITIES AND EXCHANGE COMMISSION HOURS PER RESPONSE ... 1.0 SUBJECT TO SECTION 16. FORM 5 WASHINGTON, D.C. 20549 --------------------------------- OBLIGATIONS MAY CONTINUE. SEE ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP INSTRUCTION 1(b). / / FORM 3 HOLDINGS REPORTED / / FORM 4 TRANSACTIONS REPORTED 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(f) of the Investment Company Act of 1940
---------------------------------------------- --------------------------------------- -------------------------------------------- 1. NAME AND ADDRESS OF 2. ISSUER NAME AND TICKER 6. RELATIONSHIP OF REPORTING PERSON* OR TRADING SYMBOL REPORTING PERSON TO ISSUER (Check if applicable) _X_ Director ___ 10% Owner __ Officer ___ Other (give title (specify below) below) Sistermans Joop IGEN International, Inc. ----------------------- ---------------------- ----------------------------- ----------------- ------------------------------------ (Last) (First) (Middle) 3. IRS OR SOCIAL SECURITY 4. STATEMENT FOR NUMBER OF REPORTING MONTH/YEAR PERSON (VOLUNTARY) ----------------------------------- Origin International, BV 03/31/00 7. INDIVIDUAL OR JOINT/GROUP Groeneweoudseweg 1 FILING (CHECK APPLICABLE LINE) 5621 BA Eindhover VH9-room 8 X Form filed by One Reporting --- Person ___ Form filed by More than One Reporting Person -------------------------------------------- ------------------ (Street) 5. IF AMENDMENT, DATE OF ORIGINAL (MONTH/YEAR) 5600MD The Eindhoven Netherlands
----------------------- --------------------- --------------------------------- ---------------------------------------------------- (City) (State) (Zip) TABLE 1 - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED ----------------------- --------------------- --------------------------------- ---------------------------------------------------- 1. Title of 2. Trans- 3. Transac- 4. Securities Acquired (A) or 5. Amount of 6. Ownership 7. Nature Security action tion Disposed of (D) Securities Form: of In- (Instr. 3) Date Code (Instr. 3, 4, and 5) Beneficially Direct direct (Month/ (Instr. Owned at End (D) or Beneficial Day/ 8) of Issuer's (I) Indirect Ownership Year) Fisc. Y (Instr. 4) (Instr. (Instr. 3 . 4) and 4) ---------------------------------------- Amount (A) or (D) Price ------------------------------------------------------------------------------------------------------------------------------------ None ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------
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). (Print or Type Responses) FORM 5 (CONTINUED) TABLE II - DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
---------------------------------------------------------------------------------------------------------------- 1. Title of Derivative Security 2. Conversion 3. Trans- 4. Trans- 5. Number of 6. Date Exercisable (Instr. 3) or Exercise action action Derivative and Expiration Date Price of Date Code Securities (Month/Day/Year) Derivative (Month/ (Instr.8) Acquired (A) Security Day/ or Disposed Year) of (D) (Instr. 3, 4, and 5) ----------------------- Date Expiration Exercis- Date able ------------------- (A) (D) ---------------------------------------------------------------------------------------------------------------- Option (Right to Buy) $ 24.69 9/16/99 A 10,000 (1) 9/15/09 ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------ 1. Title of Derivative Security 7. Title and Amount of 8. Price of 9. Number 10. Ownership 11. Nature (Instr. 3) Underlying Securities Derivative of Derivative of of (Instr. 3 and 4) Security Securities Derivative Indirect (Instr.5) Beneficially Security: Benefi- Owned Direct (D) cial at End or Indirect Owner- of Year (1)(Instr.4) ship (Instr. 4) (Instr.4) --------------------- Title Amount or Number of Shares ------------------------------------------------------------------------------------------------------------------------------ Option (Right to Buy) Common 10,000 0 D Stock ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------
Explanation of Responses: (1) Options granted under the Issuer's 1994 Non Employee Directors' Stock Option Plan. Twenty percent of the options vest one year from the grant date and then an additional 5 percent vest each quarter thereafter. ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations. SEE 18 U.S.C. 1001 and 15 U.S.C. 78ff(a) /s/ Joop Sistermans July 25, 2000 --------------------------------------------- **Signature of Reporting Person Date Joop Sistermans Note: File three copies of this Form, one of which must be manually signed. If space provided 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 respond unless the form displays a currently valid OMB Number. 2