3 1 j9499708e3.txt NOMOS CORP. (DAVID J. HAFFNER) -------------------------- OMB APPROVAL -------------------------- OMB Number: 3235-0104 -------------------------- FORM 3 Expires: January 31, 2005 U.S. SECURITIES AND EXCHANGE COMMISSION -------------------------- WASHINGTON, D.C. 20549 Estimated average burden hours per response....0.5 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 | 2. Date of Event Re- | 4. Issuer Name and Ticker or Trading Symbol Person(*) | quiring Statement | NOMOS Corporation NMOS Haffner David J. | (Month/Day/Year) |------------------------------------------------------------------ ---------------------------------------| | 5. Relationship of Reporting | 6. If Amendment, Date of (Last) (First) (Middle) | June 26, 2002 | Person(s) to Issuer | Original (Month/Day/Year) c/o NOMOS Corporation |-------------------------| (Check all applicable) | N/A 2591 Wexford Bayne Road | 3. IRS or Social | ___ Director _____ 10% Owner|------------------------------- ---------------------------------------| Security Number | _X_ Officer _____ Other | 7. Ind.or Joint/Group Filing (Street) | of Reporting | (give title (specify | (Check applicable line) | Person (Voluntary) | below below) | _X_ Form Filed by One | | | Reporting Person Sewickley PA 15143 | | VP, Finance and Administration | ___ Form Filed by More than | | and CFO One Reporting Person ------------------------------------------------------------------------------------------------------------------------------------ (City) (State) (Zip) TABLE I - NON-DERIVATIVE SECURITIES BENEFICIALLY OWNED ------------------------------------------------------------------------------------------------------------------------------------ 1. Title of Security | 2. Amount of Securities | 3. Ownership | 4. Nature of Indirect Beneficial (Instr. 4) | Beneficially Owned | Form: Direct | Ownership (Instr. 4) | (Instr. 4) | (D) or Indirect | | | (I) (Instr. 5) | ---------------------------------------|---------------------------------|----------------------|----------------------------------- Common Stock, $.0001 par | 0 | | ---------------------------------------|---------------------------------|----------------------|----------------------------------- | | | ---------------------------------------|---------------------------------|----------------------|----------------------------------- | | | ---------------------------------------|---------------------------------|----------------------|----------------------------------- | | | ---------------------------------------|---------------------------------|----------------------|----------------------------------- | | | ---------------------------------------|---------------------------------|----------------------|----------------------------------- | | | ---------------------------------------|---------------------------------|----------------------|----------------------------------- | | | ---------------------------------------|---------------------------------|----------------------|----------------------------------- | | | ---------------------------------------|---------------------------------|----------------------|----------------------------------- | | | ------------------------------------------------------------------------------------------------------------------------------------ (Over)
FORM 3 (CONTINUED) TABLE II - DERIVATIVE SECURITIES BENEFICIALLY OWNED (E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES) ------------------------------------------------------------------------------------------------------------------------------------ 1.Title of Derivative Security | 2.Date Exer- | 3.Title and Amount of Securities | 4.Conver- | 5. Owner- | 6. Nature of Indirect (Instr. 4) | cisable and | Underlying Derivative Security | sion or | ship | Beneficial | Expiration | (Instr. 4) | Exercise | Form of | Ownership | Date | | Price of | Deriv- | (Instr. 5) | (Month/Day/ | | Deriv- | ative | | Year) | | ative | Security:| |---------------|----------------------------------| Security | Direct | |Date | Expir-| | Amount | | (D) or | |Exer- | ation | Title | or | | Indirect | |cisable| Date | | Number | | (I) | | | | | of | | (Instr. 5) | | | | | Shares | | | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- Options |1/2/03 | 1/2/12| Common Stock |16,920 | $3.94 | D | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- | | | | | | | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- Options |1/2/04 | 1/2/12| Common Stock |16,920 | $3.94 | D | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- | | | | | | | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- Options |1/2/05 | 1/2/12| Common Stock |16,921 | $3.94 | D | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- | | | | | | | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- | | | | | | | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- | | | | | | | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- | | | | | | | -------------------------------|-------|-------|-------------------------|--------|-----------|-------------|----------------------- | | | | | | | ------------------------------------------------------------------------------------------------------------------------------------ Reminder: Report on a separate line for each class of securities beneficially owned, directly or indirectly. Explanation of Responses: /s/ David J. Haffner June 26, 2002 ------------------------------------ ----------------- Signature of Reporting Person(**) Date (*) If the form is filed by more than one reporting person, see Instruction 5(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 provided is insufficient, see Instruction 6 for procedure.