4 1 form4rlgblsi012903.txt U.S. SECURITIES AND EXCHANGE COMMISSION Washington, DC 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [_] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). ________________________________________________________________________________ 1. Name and Address of Reporting Person* GIPSON ROBERT L. -------------------------------------------------------------------------------- (Last) (First) (Middle) C/O INGALLS & SNYDER LLC, 61 BROADWAY SUITE 3100 -------------------------------------------------------------------------------- (Street) NEW YORK NY 10006 -------------------------------------------------------------------------------- (City) (State) (Zip) ________________________________________________________________________________ 2. Issuer Name and Ticker or Trading Symbol BOSTON LIFE SCIENCES INC. ________________________________________________________________________________ 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) ________________________________________________________________________________ 4. Statement for Month/Year January 27, 2003 ________________________________________________________________________________ 5. If Amendment, Date of Original (Month/Year) ________________________________________________________________________________ 6. Relationship of Reporting Person to Issuer (Check all applicable) [_] Director [X] 10% Owner [_] Officer (give title below) [_] Other (specify below) ________________________________________________________________________________ 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. Code ------------------------------- Owned at End (D) or Indirect 1. Transaction (Instr. 8) (A) of Month Indirect Beneficial Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ COMMON STOCK 684,000 D ------------------------------------------------------------------------------------------------------------------------- COMMON STOCK 4,000 I owned by spouse ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- =========================================================================================================================
* If the Form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. (Print or Type Responses) (Over) (Form 4-07/99) 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 Derivative 6. of Underlying 8. ities Secur- of Exer- 4. Securities Date Securities Price Bene- ity: In- cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene- 1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner- Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship Security Secur- Day/ ------ ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) ------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- SENIOR NOTES 2.00 7/26/02 6/1/05 COMMON ST 2,000,000 I NOTE 1 ------------------------------------------------------------------------------------------------------------------------- WARRANTS 2.16 7/26/02 7/24/07 COMMON ST 500,000 I NOTE 1 ------------------------------------------------------------------------------------------------------------------------- WARRANTS 2.75 2/26/02 3/1/07 COMMON ST 50,000 D ------------------------------------------------------------------------------------------------------------------------- WARRANTS 2.00 11/22/02 12/31/06 COMMON ST 1,000,000 D ------------------------------------------------------------------------------------------------------------------------- SENIOR NOTES 2.00 01/27/03 J 143,333 01/27/03 6/1/05 COMMON ST 71,667 100 I NOTE 1 & 2 ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ====================================================================================================================================
Explanation of Responses: NOTE 1: Securities reported under indirect ownership are owned by Ingalls & Snyder Value Partners, L.P. ("ISVP"), an investment partnership managed under an Investment Advisory contract with Ingalls & Snyder LLC ("I&S"). Robert L. Gipson ("Gipson"), a Senior Director of I&S and Thomas O. Boucher, Jr., a Managing Director of I&S, are General Partners of ISVP and as such, share the power to vote the shares owned by it. ISVP owns a $4,000,000 convertible senior secured promissory note issued by BLSI which may be converted into 2,000,000 shares of BLSI common stock until 6/1/05. ISVP also owns 500,000 BLSI warrants. Each warrant gives ISVP the right to purchase one share of BLSI common stock for $2.16 until 7/24/07. Gipson's directly owned shareholdings, when added to the shares owned by ISVP, aggregate in excess of 10% of the outstanding adjusted common shares of Boston Life. Gipson disclaims beneficial ownership of ISVP shares in excess of his economic interest in ISVP. NOTE 2: BLSI elected to pay the interest on the $4,000,000 convertible senior secured promissory note held by ISVP in kind. BLSI issued to ISVP $143,333 face amount of additional notes which are convertible into 71,667 shares of BLSI. /s/ ROBERT L. GIPSON 01/29/03 --------------------------------------------- ----------------------- **Signature of Reporting Person Date ** 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 provided is insufficient, see Instruction 6 for procedure. Page 2 EDGARLink 7.0 (8/00) Ver. 3.1