SEC FORM
4
SEC Form 4
| FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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| OMB Number: |
3235-0287 |
| Estimated average burden |
| hours per response: |
0.5 |
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|
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue.
See
Instruction 1(b). |
1. Name and Address of Reporting Person*
| 1100 SUMMER STREET 3RD FLOOR |
|
(Street)
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2. Issuer Name and Ticker or Trading Symbol
DELCATH SYSTEMS INC
[ DCTH ]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
| X |
Director |
|
10% Owner |
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Officer (give title below) |
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Other (specify below) |
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3. Date of Earliest Transaction
(Month/Day/Year)
03/17/2005
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4. If Amendment, Date of Original Filed
(Month/Day/Year)
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6. 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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| Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned |
|---|
| 1. Title of Security (Instr.
3)
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2. Transaction Date
(Month/Day/Year) |
2A. Deemed Execution Date, if any
(Month/Day/Year) |
3. Transaction Code (Instr.
8)
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4. Securities Acquired (A) or Disposed Of (D) (Instr.
3, 4 and 5)
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5.
Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr.
3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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7. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
Amount |
(A) or (D) |
Price |
| Common Stock, par value $0.01 |
03/17/2005 |
|
M |
|
30,000 |
A |
$0.71
|
41,500 |
D |
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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)
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2. Conversion or Exercise Price of Derivative Security
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3. Transaction Date
(Month/Day/Year) |
3A. Deemed Execution Date, if any
(Month/Day/Year) |
4. Transaction Code (Instr.
8)
|
5.
Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr.
3, 4 and 5)
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6. Date Exercisable and Expiration Date
(Month/Day/Year) |
7. Title and Amount of Securities Underlying Derivative Security (Instr.
3 and 4)
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8. Price of Derivative Security (Instr.
5)
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9.
Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr.
4)
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10. Ownership Form: Direct (D) or Indirect (I) (Instr.
4)
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11. Nature of Indirect Beneficial Ownership (Instr.
4)
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| Code |
V |
(A) |
(D) |
Date Exercisable |
Expiration Date |
Title |
Amount or Number of Shares |
| Warrant to Purchase |
$6.6
|
10/30/2001 |
|
J
|
|
0 |
|
10/19/2001 |
10/18/2005 |
Common Stock |
1,500 |
$0
|
106,500 |
D |
|
| Nonqualified Stock Option (right to buy) |
$0.85
|
12/17/2001 |
|
J
|
|
0 |
|
|
12/17/2006 |
Common Stock |
30,000 |
$0
|
106,500 |
D |
|
| Nonqualified Stock Option (right to buy) |
$1.03
|
08/25/2003 |
|
J
|
|
0 |
|
|
08/25/2008 |
Common Stock |
75,000 |
$0
|
106,500 |
D |
|
| Nonqualified Stock Option (right to buy) |
$0.71
|
03/17/2005 |
|
X |
|
30,000 |
|
|
09/19/2007 |
Common Stock |
30,000 |
$0
|
106,500 |
D |
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| Explanation of Responses: |
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|
|
MARK A. CORIGLIANO, By PAUL G. HUGHES, Attorney-in-Fact |
03/21/2005 |
|
** Signature of Reporting Person |
Date |
| 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). |
| ** Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See
18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| Note: File three copies of this Form, one of which must be manually signed. If space is insufficient,
see
Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |
POWER OF ATTORNEY
The undersigned, a director or officer of DELCATH SYSTEMS, INC., a Delaware
corporation (the "Company"), hereby severally constitutes and appoints M. S.
Koly and Paul G. Hughes, and each of them singly, my true and lawful attorneys
with full power to them, and each of them singly, with full powers of
substitution and resubstitution, to sign for me and in my name any report that I
am required to file pursuant to Section 16 of the Securities Exchange Act of
1934, as amended (the "Exchange Act"), with respect to my ownership of
securities of the Company and generally to do all such things in my name and on
my behalf to enable me to comply with the provisions of Section 16 of the
Exchange Act, and all requirements of the Securities and Exchange Commission,
hereby ratifying and confirming my signature as it may be signed by my
attorneys, or any of them, or their substitute or substitutes, to a report filed
under such Section 16 on my behalf. This Power of Attorney shall remain in full
force and effect until such time as I file a new Power of Attorney with the
Securities and Exchange Commission designating one or more different attorneys
for purposes of signing on my behalf such reports under Section 16 of the
Exchange Act with respect to the securities of the Company.
/s/ MARK A. CORIGLIANO
------------------------
Mark A. Corigliano
Date: December 11, 2003
