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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). |
Estimated
average burden hours per response. . . . . . . . . 1.0 |
1. Name and Address of Reporting Person* Nevins, Victor |
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 | 16,100 | D | |||||||
1,000 | I | By spouse | |||||||
* 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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Warrant to Purchase | $6.60 | 10/19/01 | 10/18/05 | Common Stock | 4,000 | ||||||||||
Warrant to Purchase | $6.60 | 10/19/01 | 10/18/05 | Common Stock | 1,000 | ||||||||||
Non-qualified Stock Option (right to buy) | $0.85 | (3) | 12/17/06 | Common Stock | 30,000 | ||||||||||
Nonqualified Stock Option (right to buy) | $0.71 | 9/19/02 | 4A | 30,000 | (4) | 9/19/07 | Common Stock | 30,000 | 64,000 | D | |||||
1,000 | I | By spouse |
Explanation of Responses: (1) Nasdaq symbol. (2) Boston Stock Exchange Symbol. (3) Currently exercisable as to 50% of the shares and exercisable as to 50% on 12/17/2003. (4) Exercisable as to 50% of the shares on 9/19/03 and as to 50% of 9/19/04. |
** | Intentional
misstatements or omissions of facts constitute Federal Criminal Violations .See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
/s/
VICTOR NEVINS
**Signature of Reporting Person |
February 11, 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 |