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UNITED
STATES SECURITIES AND EXCHANGE COMMISSION ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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OMB Number: 3235-0362 | |||
Expires: January 31, 2005 | |||
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Check box if no longer
subject to Section 16. Form 4 or Form 5 obligations may continue. See
instructions 1(b). |
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1. Name and Address of Reporting Person* Koly, M. S. |
2. Issuer Name and Ticker or Trading Symbol Delcath Systems, Inc. ("DCTH" (1) and "DCT" (2)) |
6. Relationship of Reporting Person(s) to Issuer |
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1100 Summer Street, 3rd Floor |
3.
I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
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4. Statement for Month/Year December 2002 |
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5.
If Amendment, Date of Original (Month/Year) |
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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(City) (State) (Zip) | Table I Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
1. Title of Security (Instr. 3) |
2. Trans- |
2A.
Deemed Execution Date, if any (mm/dd/yy) |
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 end of Issuer's Fiscal Year(Instr. 3 and 4) |
6. Owner- ship Form: Direct (D) or Indirect (I) (Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Amount |
(A) or (D) |
Price | |||||||
Common Stock, par value $0.01 | 78,057 | D | |||||||
1,245,864 | I | By Venkol Trust | |||||||
11,731 | I | By Son (3) | |||||||
* If the form is filed by more than one reporting person, see Instructions 4(b)(v). |
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Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently vaild OMB control Number. | (Over) SEC 2270 (9-02) |
FORM
5 (continued) |
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) |
3. A Deemed |
4. Transaction Code (Instr. 8) |
5. Number
of Derivative Securities Acquired (A) or Disposed of(D) (Instr. 3, 4 and 5) |
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) | ||||
(A) | (D) | Date Exercisable |
Expiration Date |
Title | Amount
or Number of Shares |
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Option (Right to Buy) | $4.93 | (4) | 1/27/04 | Common Stock | 60,867 | ||||||||||
Option (Right to Buy) | $4.93 | (4) | 1/27/04 | Common Stock | 25,396 | ||||||||||
Option (Right to Buy) | $2.90 | (4) | 12/6/04 | Common Stock | 53,483 | ||||||||||
Incentive Stock Option (Right to Buy) | $3.3125 | 12/1/00 | 12/1/05 | Common Stock | 30,150 | ||||||||||
Nonqualified Stock Option (Right to Buy) | $3.3125 | 12/1/00 | 12/1/05 | Common Stock | 41,700 | ||||||||||
Incentive Stock Option (Right to Buy) | $3.3125 | 1/1/01 | 12/1/06 | Common Stock | 30,150 | ||||||||||
Option to Purchase Common Stock | $0.60 | (5) | 11/12/06 | Common Stock | 100,000 | ||||||||||
Incentive Stock Option | $0.71 | 9/19/02 | 4A | 100,000 | (5) | 9/19/07 | Common Stock | 100,000 | 441,746 | D | |||||
Explanation of Responses: (1) Nasdaq symbol. (2) Boston Stock Exchange Symbol. (3) The reporting person has neither sole or shared voting power nor sole or shared investment power with respect to such shares. (4) These options are currently exercisable. (5) Exercisable as to 50,000 shares on the first anniversary of grant and in full on the second anniversary of grant through the expiration date. |
** | Intentional
misstatements or omissions of facts constitute Federal Criminal Violations .See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
/s/ M. S. KOLY **Signature of Reporting Person |
February 13, 2003 Date |
Note: | File three
copies of this Form, one of which must be manually signed. If space provided 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. | Page 2 |