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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 3
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935
or Section 30(f) of the Investment Company Act of 1940
1. Name and Address of Reporting Person*
Koly M. S.
(Last) (First) (Middle)
c/o Delcath Systems, Inc., 1100 Summer St.
(Street)
Stamford CT 06905
(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/19/00
3. I.R.S. Identification Number of Reporting Person, if an entity (voluntary)
4. Issuer Name and Ticker or Trading Symbol
Delcath Systems, Inc. and "DCTH" (1) and "DCT" (2)
5. Relationship of Reporting Person to Issuer (Check all applicable)
/X/ Director /X/ 10% Owner
/X/ Officer (give title below) / / Other (specify below)
Chief Executive Officer, President, and Treasurer
6. If Amendment, Date of Original (Month/Day/Year)
7. Individual or Joint/Group Reporting (Check applicable line)
/X/ Form filed by One Reporting Person
/ / Form filed by More than One Reporting Person
* If the Form is filed by more than one Reporting Person, see instruction
5(b)(v).
<TABLE>
<CAPTION>
Table I -- Non-Derivative Securities Beneficially Owned
2. Amount 3. Ownership
of Secu- Form:
rities Direct 4. Nature of
Bene- (D) or Indirect
ficially Indirect Beneficial
Owned (I) Ownership
1. Title of Security (Instr. 4) (Instr. 5) (Instr. 5)
-------------------------------- ------------- ------------- ----------------
<S> <C> <C> <C>
Common Stock, par value
$.01 per share 6,007 I By Venkol Inc.
Common Stock, par value
$.01 per share 11,732 I By son
Common Stock, par value
$.01 per share 1,404,013 I By Venkol Trust
</TABLE>
<TABLE>
<CAPTION>
Table II--Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
2. Date Exercisable
and Expiration Date 3. Title and Amount of Securities Underlying Derivative
(Month/Day/Year) Security (Instr. 4)
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Date Amount or
1. Title of Derivative Exercis- Expiration Title Number of
Security (Instr. 4) able Date Shares
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<S> <C> <C> <C> <C>
Options (3) 01/04 Common stock, par value $.01 per share 40,578
Options 1/28/01 01/04 Common stock, par value $.01 per share 20,289
Options (3) 01/04 Common stock, par value $.01 per share 25,396
Options (3) 12/04 Common stock, par value $.01 per share 26,741
Options 12/07/00 12/04 Common stock, par value $.01 per share 26,741
Warrants (4) 1/16/01 Common stock, par value $.01 per share 2,760
<CAPTION>
5. Ownership
Form of
Derivative
4. Conver- Security:
sion or Direct 6. Nature of
Exercise (D) or Indirect
Price of Indirect Beneficial
1. Title of Derivative Derivative (I) Ownership
Security (Instr. 4) Security (Instr. 5) (Instr. 5)
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<S> <C> <C> <C>
Options $4.93 D
Options $4.93 I By Venkol Trust (5)
Options $4.93 D
Options $2.90 D
Options $2.90 I By Venkol Trust (5)
Warrants $10.87 I By Venkol Trust (5)
</TABLE>
Explanation of Responses:
(1) Nadaq symbol.
(2) Boston Stock Exchange symbol.
(3) These options have vested and are presently exercisable.
(4) These warrants are presently exercisable.
(5) The reporting person is a trustee of the Venkol Trust and is deemed
the beneficial owner of its shares.
/s/ M.S. Koly 10/19/00
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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).
