U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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 of Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
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1. Name and Address of Reporting Person*
Ingersoll William Brett
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(Last) (First) (Middle)
c/o Chase Capital Partners
1221 Avenue of the Americas-40th Floor
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(Street)
New York New York 10020
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
MediChem Life Sciences, Inc. ("MCLS")
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
October 2000
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[_] Officer (give title below) [_] Other (specify below)
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7. Individual or Joint/Group Filing (Check applicable line)
[X] Form filed by one Reporting Person
[_] Form filed by more than one Reporting Person
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Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
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<TABLE>
<CAPTION>
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)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Common Stock (FN 1) 10/30/00 C 3,241,253 A N/A 4,031,497 I (FN 2)
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Common Stock 10/30/00 P 390,244 A $7.00 4,031,497 I (FN 2)
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</TABLE>
* 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)
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<TABLE>
<CAPTION>
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)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C> <C>
Class A Conver-
tible Preferred
Stock of MCR 18.65557 Common
Holdings for 1 10/30/00 C 195,183.18 (FN 1) N/A Stock 3,641,253 N/A -0- I (FN 2)
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</TABLE>
Explanation of Responses:
1) Pursuant to the Articles of Incorporation of MCR Holdings, Inc. ("MCR"),
the parent of MediChem Life Sciences, Inc. (the "Issuer") prior to the merger of
the Issuer and MCR, the Class A Convertible Preferred Stock of MCR converted
into shares of Class B Redeemable Stock of MCR, which were redeemed for cash,
and on a 1-for-1 basis into shares of the Class A Common Stock of MCR.
Immediately prior to the close of the Issuer's public offering, MCR was merged
into the Issuer and all outstanding shares of the Class A Common Stock of MCR
were converted into Common Stock of the Issuer.
2) The amounts shown represent the beneficial ownership of equity securities
of the Issuer by Chase MediChem Partners, LLC ("MediChem") after the conversion
and merger. A portion of the securities owned by MediChem may be deemed
attributable to the reporting person because he is a general partner of Chase
Capital Partners ("CCP"), the managing member of Chase Equity Associates, LP
("CEA"). CEA is the non-managing member of MediChem. The actual pro rata
portion of the reporting person's beneficial ownership is not readily
determinable because it is subject to several variables including CEA's and
CCP's internal rate of return and vesting. Mr. Ingersoll disclaims ownership of
the securities shown in the table to the extent it exceeds his indirect
pecuniary interest in the Issuer.
/s/ W. Brett Ingersoll 11/9/00
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W. Brett Ingersoll 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.
