View:
Download DOC
Download PDF
Download XLS
FORM 5 (PAUL C. ZAMECNIK)
 

OMB APPROVAL
OMB Number: 3235-0362
Expires: January 31, 2005
Estimated average burden
hours per response...1.0


UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, DC 20549

FORM 5

ANNUAL 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(h) of the Investment Company Act of 1940

o Check box if no longer
subject to Section 16.
Form 4 or Form 5
obligations may continue.
See Instruction 1(b).
o Form 3 Holdings Reported
þ Form 4 Transactions Reported
1. Name and Address of Reporting
Person*		 2. Issuer Name and Ticker or Trading
Symbol		 3. I.R.S. Identification Number of Reporting
Person, if an entity (Voluntary)
  ZAMECNIK, PAUL C.
(Last) (First) (Middle)		   HYBRIDON, INC. (HYBN)
  
   
                 
  101 CHESTNUT STREET
 4. Statement for Month/Year 5. If Amendment, Date of Original (Month/Year)
    DECEMBER 31, 2001
   DECEMBER 31, 2001
  (Street) 6. Relationship of Reporting Person(s)
to Issuer (Check All Applicable)		 7. Individual or Joint/Group Reporting
(Check Applicable Line)
  BOSTON, MA 02108
(City)        (State)        (Zip)		   þ  Director o  10% Owner   þ Form filed by One Reporting Person
    o  Officer (give title below)   o Form filed by More than One Reporting Person
    o  Other (specify below)  
     
     
*   If the form is filed by more than one reporting person, see instruction 4(b)(v).

 

                                                 
Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of
Security
(Instr. 3)		 2. Transaction
Date
(Month/Day/Year)		 2A. Deemed Execution
Date, if any
(Month/Day/Year)		 3. Transaction
Code
(Instr. 8)		 4. Securities Acquired (A)
or Disposed of (D)
(Instr. 3, 4 and 5)		 5. Amount of Securities
Beneficially Owned
at the End of Issuer's
Fiscal Year
(Instr. 3 and 4)		 6. Ownership
Form:
Direct (D) or
Indirect (I)
(Instr. 4)		 7. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
                    Amount (A)
or
(D)		 Price            
  COMMON STOCK   10/1/00     P4   187,922   A $1.08         D  
  COMMON STOCK   4/9/01     P4   46,429   A $0.56         D  
  COMMON STOCK   4/23/01     G   120,000   D         D  
  COMMON STOCK   7/19/01     X4   31,250   A $0.55         D  
  COMMON STOCK   7/19/01     X4   199,543   A $0.37         D  
  COMMON STOCK   7/19/01     C   266,500   A         D  
  COMMON STOCK   10/7/01     G   60,000   D         D  
  COMMON STOCK   12/10/01     P   1,000   A $1.85         D  
  COMMON STOCK   12/10/01     P   1,500   A $1.87         D  
  COMMON STOCK   12/10/01     P   2,000   A $1.84         D  
  COMMON STOCK   12/10/01     P   5,500   A $1.95         D  
  COMMON STOCK   12/10/01     P   7,000   A $1.90         D  
  COMMON STOCK   12/17/01     P   16,765   A $1.70     846,789     D  

Page 2

 
Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned
  (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative
Security
(Instr. 3)		 2. Conversion or Exercise
Price of Derivative
Security		 3. Transaction Date
(Month/Day/Year)		 3A. Deemed Execution
Date, if any
(Month/Day/Year)		 4. Transaction Code
(Instr. 8)		 5. Number of Derivative Securities
Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
                            (A) (D)
  STOCK OPTION (RIGHT TO BUY)     $2.00     5/1/00     A4   5,000
  STOCK OPTION (RIGHT TO BUY)     $0.93     5/1/01     A4   5,000
  8% CONVERTIBLE DEBENTURES DUE 2002     $0.60     12/13/99     P4   $26,000
  SERIES B CONVERTIBLE PREFERRED STOCK*     250-FOR-1**     7/19/01     C   1,066
  SERIES B CONVERTIBLE PREFERRED STOCK     200-FOR-1     3/5/01     P4   750
  COMMON STOCK WARRANTS (RIGHT TO BUY)     $0.55     7/19/01     X4   31,250
  COMMON STOCK WARRANTS (RIGHT TO BUY)     $0.37     7/19/01     X4   199,543
               
               
               

Page 3

 
Table II — Derivative Securities Acquired, Disposed of, or Beneficially Owned — Continued
(e.g., puts, calls, warrants, options, convertible securities)
6. Date Exercisable and
Expiration Date
(Month/Day/Year)		 7. Title and Amount of
Underlying Securities
(Instr. 3 and 4)		 8. Price of Derivative
Security
(Instr. 5)		 9. Number of Derivative
Securities Beneficially
Owned at End of
Year
(Instr. 4)		 10. Ownership of
Derivative Security:
Direct (D)
or Indirect (I)
(Instr. 4)		 11. Nature of
Indirect
Beneficial
Ownership
(Instr. 4)
  Date
Exercisable		 Expiration
Date		   Title Amount or
Number of
Shares		                        
  (1) 5/1/10   COMMON STOCK 5,000           5,000     D  
  (2) 5/1/11   COMMON STOCK 5,000           5,000     D  
  IMMED. 11/30/02   COMMON STOCK 43,333           0     D  
  IMMED.     COMMON STOCK 266,500           0     D  
  IMMED. 11/30/02   COMMON STOCK 150,000           0     D  
  IMMED. 5/4/03   COMMON STOCK 31,250           0     D  
  IMMED. 5/4/03   COMMON STOCK 199,543           0     D  
                       
                       
                       

Explanation of Responses:

(1) This option vested in full on April 30, 2001.

(2) This option vests in full on April 30, 2002.

* The Series B Convertible Preferred Stock was issued upon the conversion of the 8% Convertible Debentures due 2002 with a face amount of $26,000.

** The Series B Convertible Preferred Stock had a conversion rate of 200 shares of common stock for each share of Series B Convertible Preferred Stock. The Company converted such stock to common at a special rate of 250-for-1 to encourage the conversion thereof.

/s/ Paul C. Zamecnik   1/26/03
**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 4