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| FORM 4 |
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[_] Check this box if U.S. SECURITIES AND EXCHANGE COMMISSION
no longer subject WASHINGTON, D.C. 20549
to Section 16. STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Form 4 or Form 5
obligations may Filed pursuant to Section 16(a) of the Securities
continue. See Exchange Act of 1934, Section 17(a) of the
Instruction 1(b). Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
(Print or Type Responses)
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1. Name and Address of Reporting Person*
Hansen Larry C.
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(Last) (First) (Middle)
4901 Searle Parkway, A-3
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(Street)
Skokie, IL 60077
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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 or Social Security Number of Reporting Person
(voluntary)
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4. Statement for Month/Year
12/00
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person(s) to Issuer (Check all applicable)
X Director Other
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Officer 10% Owner
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(give title below) (specify below)
Member of Board of Directors
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7. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
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Form filed by More than One Reporting Person
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Table I--Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
<TABLE>
<CAPTION>
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1. Title 2. Trans- 3. Transaction 4. Securities Acquired (A) 5. Amount of 6. Ownership 7. Nature of
of action Code or Disposed of (D) Securities Form: Indirect
Security Date (Instr. 8) (Instr. 3, 4 and 5) Beneficially Direct Beneficial
(Instr. 3) (Month/ Owned at (D) or Ownership
Day/ ----------------------------------------------- End of Indirect (Instr. 4)
Year) Month (I)
Code V Amount (A) or Price (Instr. 3 and 4) (Instr. 4)
(D)
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<S> <C> <C> <C> <C> <C> <C> <C> <C> <C>
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</TABLE>
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
If the form is filed by more than one reporting person, see
Instruction 4(b)(v).
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.
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FORM 4 (continued)
Table II--Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
<TABLE>
<CAPTION>
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1. Title of Derivative 2. Conver- 3. Trans 4. Transaction 6. Number of Deriv-
Security (Instr. 3) sion or action Code ative Securities
Exercise Date (Instr. 8) Acquired (A) or
Price of (Month/ Disposed of (D)
Derivative Day/ (Instr. 3, 4, and 5)
Security Year)
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Code V (A) (D)
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<S> <C> <C> <C> <C> <C> <C>
Employee Stock Option
(right to buy) $4.91 12/5/00 A 10,000
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<CAPTION>
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7. Date Exer- 8. Title and Amount of 8. Price 9. Number of 10. Ownership 11. Nature of
cisable and Underlying Securities of Derivative Form Indirect
Expiration (Instr. 3 and 4) Deriv- Securities of De- Bene-
Date ative Beneficially rivative ficial
(Month/Day/ Secur- Owned Securities Ownership
Year) ity at End Bene- (Instr.4)
(Instr.5) of ficially
------------------- ------------------------- Month Owned at
Date Expira- Amount or (Instr. 4) End of
Exer- tion Title Number of Month(1)
cisable Date Shares (Instr. 4)
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<S> <C> <C> <C> <C> <C> <C> <C>
Employee
Stock
Option
(right to
12/5/00 12/5/10 buy) 10,000 10,000 D
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</TABLE>
Explanation of Responses:
/s/ Larry C. Hansen 01/10/2001
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** Signature of Reporting Person Date
** Intentional misstatements or ommissions 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 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.
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