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FORM 4 WASHINGTON, D.C. 20549 OMB APPROVAL
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/ / CHECK THIS BOX IF NO STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OMB NUMBER: 3235-0287
LONGER SUBJECT TO EXPIRES: JANUARY 31, 2005
SECTION 16. FORM 4 OR Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, ESTIMATED AVERAGE BURDEN
FORM 5 OBLIGATIONS MAY Section 17(a) of the Public Utility Holding Company Act of 1935 or HOURS PER RESPONSE .... 0.5
CONTINUE. SEE Section 30(h) of the Investment Company Act of 1940 -----------------------------
INSTRUCTION 1(b).
(Print or Type Responses)
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1. Name and Address of Reporting Person* 2. Issuer Name AND Ticker or Trading Symbol 6. Relationship of Reporting Person(s)
to Issuer (Check all applicable)
Diacrin, Inc. X Director 10% Owner
Fraser, Thomas H. DCRN ---- ----
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(Last) (First) (Middle) 3. I.R.S. Identification 4. Statement for ---- title ---- (specify
Number of Reporting Month/Day/Year below) below)
c/o Diacrin, Inc. Person, if an entity President and CEO
Building 96 13th Street (voluntary) 1/13/03 -----------------------------------
- -------------------------------------------- --------------------- 7. Individual or Joint/Group Filing
(Street) 5. If Amendment, (Check Applicable Line)
Date of Original _X_Form filed by One Reporting Person
(Month/Day/Year) ___Form filed by More than One
Boston, MA 02129 Reporting Person
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(City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of 2. Trans- 2A. Deemed 3. Trans- 4. Securities Acquired (A) 5. Amount of 6. Owner- 7. Nature
Security action Execution action or Disposed of (D) Securities ship of In-
(Instr. 3) Date Date, Code (Instr. 3, 4 and 5) Beneficially Form: direct
if any (Instr. 8) Owned Follow- Direct Bene-
(Month/ (Month/ ing Reported (D) or ficial
Day/ Day/ ------------------------------------------ Transaction(s) Indirect Owner-
Year) Year) (A) or (Instr. 3 (I) ship
Code V Amount (D) Price and 4) (Instr. 4) (Instr. 4)
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Common Stock
$.01 par value 505,988 D
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/s/ Thomas H. Fraser 1/14/03
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**Signature of Reporting Person Date
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).
** 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 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 CONTROL NUMBER.
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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1. Title of Derivative Security 2. Conver- 3. Trans- 3A. Deemed 4. Transac- 5. Number of Deriv- 6. Date Exer-
(Instr. 3) sion or action Execution tion Code ative Securities Ac- cisable and Ex-
Exercise Date Date, (Instr. 8) quired (A) or Dis- piration Date
Price of (Month/ if any posed of (D) (Month/Day/
Deriv- Day/ (Month/ (Instr. 3, 4, and 5) Year)
ative Year) Day/
Security Year)
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Date Expira-
Exer- tion
Code V (A) (D) cisable Date
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Employee Stock Option
(right to buy) $1.06 1/13/03 A 7,500 1/13/04 1/13/13
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Employee Stock Option
(right to buy) $1.06 1/13/03 A 7,500 1/13/05 1/13/13
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Employee Stock Option
(right to buy) $1.06 1/13/03 A 7,500 1/13/06 1/13/13
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Employee Stock Option
(right to buy) $1.06 1/13/03 A 7,500 1/13/07 1/13/13
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7. Title and Amount of 8. Price of 9. Number of 10. Ownership 11. Nature of
Underlying Securities Derivative Derivative Form of Indirect
(Instr. 3 and 4) Security Securities Derivative Beneficial
(Instr. 5) Beneficially Securities: Ownership
Owned Direct (D) or (Instr. 4)
Following Indirect (I)
Reported (Instr. 4)
Transaction(s)
----------------------- (Instr. 4)
Title Amount or
Number of
Shares
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Common Stock 7,500
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Common Stock 7,500
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Common Stock 7,500
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Common Stock 7,500 30,000 D
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Explanation of Responses:
/s/ Thomas H. Fraser 1/14/03
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**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 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 CONTROL NUMBER.