FORM 4 OMB APPROVAL
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OMB NUMBER: 3235-0287
EXPIRES: FEBRUARY 1, 2001
ESTIMATED AVERAGE BURDEN
HOURS PER RESPONSE .... 1.0
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U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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(1) OF THE INVESTMENT COMPANY ACT OF 1940
[ ] Check this box if no longer
subject to Section 16. Form 4 or
Form 5 obligations may
continue. See instruction 1(b).
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1. Name and Address of Reporting Person
Clemens Peter A.
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(Last) (First) (Middle)
C/o Halsey Drug Co., Inc. 695 N. Perryville Rd. Bldg. 2
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(Street)
Rockford, Illinois 61107
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Halsey Drug Co., Inc. Symbol: HDGC
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3. IRS or Social Security Number of Reporting Person (Voluntary)
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4. Statement for Month/Year
01/02
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5. If Amendment, Date of Original (Month/Year)
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [_] 10% Owner
[X] Officer (give title below) [_] Other (specify below)
Vice President & Chief Financial Officer
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TABLE I -- NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF,
OR BENEFICIALLY OWNED
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6.
4. 5. Owner-
Securities Acquired (A) or Amount of ship
3. Disposed of (D) Securities Form: 7.
Transaction (Instr. 3, 4 and 5) Beneficially Direct Nature of
2. Code ---------------------------- Owned at End (D) or Indirect
1. Transaction (Instr. 8) (A) of Month Indirect Beneficial
Title of Security Date ------------ Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (Month/Day/ Code V (D) and 4) (Instr.4) (Instr. 4)
Year)
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(over)
(Print or Type Responses) SFC 1474 (3/91)
*See footnote 2 on Table II
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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10.
9. Owner-
Number ship
of Form
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- 4. Securities Date Securities Price Bene- ity: In-
cise 3. Trans- Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- action or Disposed Expiration Date ---------------- Deriv- Owned (D) or Bene-
1. of action Code of(D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date (Instr. (Instr. 3, ---------------- or Secur- of direct Owner-
Derivative ative (Month/ 8) 4 and 5) Date Expira- Number ity Month (I) ship
Security Secur- Day/ --------- ------------ Exer- tion of (Instr. (Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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5% Convertible
Senior Secured Common
Debentures $ 1.404 3/10/98 A (1) 3/10/98 3/15/03 Stock 71,225 D
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Common
Warrants $ 1.404 3/10/98 A (1) 3/10/98 3/15/05 Stock 10,791 D
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Common
Warrants $ 2.279 3/10/98 A (1) 3/10/98 3/15/05 Stock 10,526 92,542 D
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5% Convertible
Senior Secured Common
Debentures $ 1.404 6/12/98 A (2) 6/12/98 3/15/03 Stock 17,121 D
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Common
Warrants $ 1.404 6/12/98 A (2) 6/12/98 3/15/05 Stock 2,594 D
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Common
Warrants $ 2.279 6/12/98 A (2) 6/12/98 3/15/05 Stock 2,530 114,787 D
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Non-qualified Common
Stock Options $ 2.375 2/19/98 A (3) 2/19/08 Stock 300,000 414,787 D
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5% Convertible
Senior Secured Common
Debentures $1.1312 4/1/99 A (5) 4/1/99 3/15/03 Stock 1,370 D
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Non-qualified Common
Stock Options $ 1.125 4/12/99 A (4) 4/12/00 4/12/09 Stock 100,000 516,157 D
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5% Convertible
Senior Secured Common
Debentures $2.4250 7/1/99 A (5) 7/1/99 3/15/03 Stock 647 516,804 D
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Non-qualified Common
Stock Options $ 1.875 2/17/00 A (4) 2/17/01 2/17/10 Stock 125,000 641,804 D
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5% Convertible
Senior Secured Common
Debentures $ 1.722 4/1/00 A (5) 4/1/00 3/15/03 Stock 923 642,727 D
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Non-qualified Common
Stock Options $1.1125 6/29/00 A (4) 6/29/01 6/29/10 Stock 100,000 742,727 D
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5% Convertible
Senior Secured Common
Debentures $1.1125 7/1/00 A (5) 7/01/00 3/15/03 Stock 1,446 744,173 D
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5% Convertible
Senior Secured Common
Debentures $ .9071 10/1/00 A (5) 10/01/00 3/15/03 Stock 1,709 745,882 D
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5% Convertible
Senior Secured Common
Debentures $ .6258 01/01/01 A (5) 01/01/01 3/15/03 Stock 2,477 748,359 D
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5% Convertible
Senior Secured Common
Debentures $ 1.03 04/01/01 A (5) 04/01/01 3/15/03 Stock 1,505 749,864 D
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5% Convertible
Senior Secured Common
Debentures $ 2.22 07/01/01 A (5) 07/01/01 3/15/03 Stock 698 750,562 D
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5% Convertible
Senior Secured Common
Debentures $ 2.22 10/01/01 A (5) 10/01/01 3/15/03 Stock 698 751,260 D
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5% Convertible
Senior Secured Common
Debentures $ 1.86 01/01/02 A (5) 01/01/02 3/15/03 Stock 833 752,093 D
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EXPLANATION OF RESPONSES:
(1) Purchased in connection with a private offering on March 10, 1998
consisting of a Convertible Debenture convertible at any time and Stock
Purchase Warrants (10,791 shares of which are presently exercisable at
$1.404 per share and 10,526 shares of which are presently exercisable at
$2.279 per share).
(2) Acquired pursuant to an option exercise in June 1998, consisting of: (i) a
Convertible Debenture, convertible at any time, (ii) Warrants to purchase
shares of common stock (2,594 shares of which are presently exercisable at
$1.404 per share and 2,530 shares of which are presently exercisable at
$2.279 per share.
(3) Options vest quarterly, with 25,000 options vesting every quarter effective
May 1, 1998.
(4) Options vest 25% annually.
(5) Certain quarterly interest payments are paid in the form of convertible
debentures.
By: /s/Peter A. Clemens January 29, 2002
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Peter A. Clemens
SIGNATURE OF REPORTING PERSON
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.