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 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) - -------------------------------- ------------- ------------- ---------------- 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 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 - --------------------------------------- -------------------------- **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).
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) ---------------------- ----------------------------------------------------------- Date Amount or 1. Title of Derivative Exercis- Expiration Title Number of Security (Instr. 4) able Date Shares - ---------------------------------------------- ---------- ---------- ---------------------------------------------- ----------- 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 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) - ---------------------------------------------- ------------- ------------- -------------- 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)