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FORM 4
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, D.C. 20549 ---------------------------
OMB APPROVAL
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP ---------------------------
/ / Check this box if no OMB Number: 3235-0287
longer subject to Filed pursuant to Section 16(a) of the Securities Expires: September 30, 1998
Section 16. Form 4 Exchange Act of 1934, Section 17(a) of the Estimated average burden
or Form 5 obligations Public Utility Holding Company Act of 1935 hours per response......0.5
may continue. See or Section 30(f) of the Investment Company ---------------------------
Instruction 1(b). Act of 1940
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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)
Burchett John A. Hanover Capital Mortgage Holdings, Inc. HMC to Issuer (Check all applicable)
- ------------------------------------------- -------------------------------------------- X Director 10% Owner
(Last) (First) (Middle) 3. IRS or Social Security 4. Statement for ---- ---
Number of Reporting Month/Year X Officer (give Other (Specify
90 West Street Suite 1508 Person (Voluntary) May, 1999 ---- title --- below)
- --------------------------------------------- ------------------- below)
(Street) -------------------- 5. If Amendment, President, CEO, Chairman of Board
New York, New York 10006 Date of Original 7. Individual or Joint/Group Filing
- --------------------------------------------- (Month/Year) (Check Applicable Line)
(City) (State) (Zip) X Form filed by One Reporting Person
------------ __ Form filed by more than One
Reporting Person
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TABLE 1 -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
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1. Title of Security 2. Trans- 3. Transac- 4. Securities Acquired (A) 5. Amount of Se- 6. Owner- 7. Nature
(Instr. 3) action tion or Disposed of (D) curities Benefi- ship of In-
Date Code (Instr. 3, 4 and 5) cially Owned at Form: direct
(Instr. 8) End of Month Direct Benefi-
(Month/ (Instr. 3 and 4) (D) or cial
Day/ --------------------------------------- Indirect Owner-
Year) Code V Amount (A) or Price (I) ship
(D) (Instr. 4) (Instr.
4)
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Common Stock 5/6/99 P 1,000 A 5.50 414,277 D
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Common Stock** 3,000 I
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** Held by Children.
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).
(Over)
(Print or Type Responses) SEC 1474 (7-96)
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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)
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1. Title of Derivative 2. Conver- 3. Trans- 4. Trans- 5. Number of 6. Date Exer- 7. Title and Amount 8. Price
Security sion or action action Derivative cisable and of Underlying of
(Instr. 3) Exercise Date Code Securities Ac- Expiration Securities Deriv-
Price of (Month/ (Instr. 8) quired (A) or Date (Instr. 3 and 4) ative
Deriv- Day/ Disposed of (D) (Month/Day/ Secur-
ative Year) (Instr. 3, 4, Year) ity
Security and 5) (Instr. 5)
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Date Expira- Amount or
-------------------------- Exer- tion Title Number of
Code V (A) (D) cisable Date Shares
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Common
Rights to Acquire Stock 119,167
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Options Common
Stock 113,737
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Common
Warrants 15.00 3/15/98 9/15/00 Stock 22,000
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Common
Warrants** 15.00 3/15/98 9/15/00 Stock 3,000
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1. Title of Derivative 9. Number of 10. Ownership 11. Nature of
Security Derivative Form of Indirect
(Instr. 3) Securities Derivative Beneficial
Beneficially Security: Ownership
Owned at End Direct (D) (Instr. 4)
of Month or Indirect (I)
(Instr. 4) (Instr. 4)
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Rights to Acquire 119,167 D
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Options (Rights
to Acquire) 113,737 D
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Warrants 22,000 D
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Warrants** 3,000 I
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Explanation of Responses:
** Held by Children.
*** Intentional misstatements or omissions of facts constitute Federal Criminal /s/ JOHN A. BURCHETT 6/10/99
Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). ------------------------------- -------
***Signature of Reporting Person Date
Note. File three copies of this Form, one of which must be manually signed. John A. Burchett
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.
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Page 2 (Bulletin No. 177, 10-15-97)