OMB APPROVAL |
OMB Number: 3235-0287 |
Expires: January 31, 2005 |
Estimated average burden hours per response...0.5 |
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 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(h) of the Investment Company Act of 1940
o | 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* |
2. | Issuer Name and Ticker or
Trading Symbol |
3. | I.R.S. Identification
Number of Reporting Person, if an entity (Voluntary) |
|||||||
Clemens, Peter A. (Last) (First) (Middle) |
Halsey Drug Co., Inc.
Symbol: HDGC |
|||||||||||
c/o Halsey Drug
Co., Inc. 695 N. Perryville Rd. Bldg. 2 (Street) |
4. | Statement for Month/Day/Year | 5. | If Amendment, Date of Original (Month/Day/Year) | ||||||||
1/03 |
||||||||||||
6. | Relationship of Reporting Person(s) to Issuer (Check All Applicable) |
7. | Individual or Joint/Group
Filing (Check Applicable Line) |
|||||||||
Rockford, Illinois 61107 (City) (State) (Zip) |
x | Director | o | 10% Owner | o | Form Filed by One Reporting Person | ||||||
x | Officer (give title below) | o | Form Filed by More than One Reporting Person | |||||||||
o | Other (specify below) | |||||||||||
Vice President & Chief Financial
Officer |
||||||||||||
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). |
Table I Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||||||||||
1. | Title of Security (Instr. 3) |
2. | Transaction Date (Month/Day/Year) |
2A. | Deemed Execution Date, if any (Month/Day/Year) |
3. | Transaction Code (Instr. 8) |
4. | Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. | Amount of Sec- urities Beneficially Owned Following Reported Trans- action(s) (Instr. 3 and 4) |
6. | Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. | Nature
of Indirect Beneficial Ownership (Instr. 4) |
||||||||
Code | V | Amount | (A) or (D) |
Price | |||||||||||||||||||
Common Stock ($.01 par value) | 12/20/02 | J(7) | V | 17,506 | A | $1.01 | D | ||||||||||||||||
Common Stock ($.01 par value) | 12/20/02 | J(7) | V | 14,916 | A | $1.01 | D | ||||||||||||||||
Common Stock ($.01 par value) | 12/20/02 | J(7) | V | 5,538 | A | $1.01 | D | ||||||||||||||||
Common Stock ($.01 par value) | 12/20/02 | J(7) | V | 4,720 | A | $1.01 | 46,050 | D | |||||||||||||||
Page 2
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) |
2. | Conversion or Exercise Price of Derivative Security |
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) |
||||||
Code | V | (A) | (D) | ||||||||||||||
5% Convertible Senior Secured Debentures | $ .58(6) | 3/10/98 | A | (1) | |||||||||||||
5% Convertible Senior Secured Debentures | $.58(6) | 6/12/98 | A | (2) | |||||||||||||
Non-qualified Stock Options | $2.375 | 2/19/98 | A | ||||||||||||||
5% Convertible Senior Secured Debentures | $.47(6) | 4/1/99 | A | (5) | |||||||||||||
Non-qualified Stock Options | $1.125 | 4/12/99 | A | (4) | |||||||||||||
5% Convertible Senior Secured Debentures | $1.06(6) | 7/1/99 | A | (5) | |||||||||||||
Non-qualified Stock Options | $1.875 | 2/17/00 | A | (4) | |||||||||||||
5% Convertible Senior Secured Debentures | $.75(6) | 4/1/00 | A | (5) | |||||||||||||
Non-qualified Stock Options | $1.1125 | 6/29/00 | A | (4) | |||||||||||||
5% Convertible Senior Secured Debentures | $.49(6) | 7/1/00 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.40(6) | 10/1/00 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.27(6) | 01/01/01 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.45(6) | 04/01/01 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.97(6) | 07/01/01 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.97(6) | 10/01/01 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.81(6) | 01/01/02 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.88(6) | 04/01/02 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.75(6) | 07/01/02 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $.76(6) | 10/01/02 | A | (5) | |||||||||||||
5% Convertible Senior Secured Debentures | $1.02 | 1/01/03 | A | (5) | |||||||||||||
Warrants | $.57 | 12/20/02 | D | J(7) | V | ||||||||||||
Warrants | $.92 | 12/20/02 | D | J(7) | V | ||||||||||||
Warrants | $.57 | 12/20/02 | D | J(7) | V | ||||||||||||
Warrants | $.92 | 12/20/02 | D | J(7) | V | ||||||||||||
Page 3
Table II Derivative
Securities Acquired, Disposed of, or Beneficially Owned
Continued (e.g., puts, calls, warrants, options, convertible securities) |
|||||||||||||||||
6. | Date Exercisable and Expiration Date (Month/Day/Year) |
7. | Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. | Price of
Derivative Security (Instr. 5) |
9. | Number of Derivative
Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. | Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. | Nature
of Indirect Beneficial Ownership (Instr. 4) |
||||||
Date Exercisable |
Expiration Date |
Title | Amount or Number of Shares |
||||||||||||||
3/10/98 | 3/31/06 | Common Stock | 172,414(6) | D | |||||||||||||
6/12/98 | 3/31/06 | Common Stock | 41,445(6) | D | |||||||||||||
(3) | 2/19/08 | Common Stock | 300,000 | D | |||||||||||||
4/1/99 | 3/31/06 | Common Stock | 3,300(6) | D | |||||||||||||
4/12/00 | 4/12/09 | Common Stock | 100,000 | D | |||||||||||||
7/1/99 | 3/31/06 | Common Stock | 1,480(6) | D | |||||||||||||
2/17/01 | 2/17/10 | Common Stock | 125,000 | D | |||||||||||||
4/1/00 | 3/31/06 | Common Stock | 2,120(6) | D | |||||||||||||
6/29/01 | 6/29/10 | Common Stock | 100,000 | D | |||||||||||||
7/01/00 | 3/31/06 | Common Stock | 3,284(6) | D | |||||||||||||
10/1/00 | 3/31/06 | Common Stock | 3,875(6) | D | |||||||||||||
01/01/01 | 3/31/06 | Common Stock | 5,741(6) | D | |||||||||||||
04/01/01 | 3/31/06 | Common Stock | 3,444(6) | D | |||||||||||||
07/01/01 | 3/31/06 | Common Stock | 1,598(6) | D | |||||||||||||
10/01/01 | 3/31/06 | Common Stock | 1,598(6) | D | |||||||||||||
01/01/02 | 3/31/06 | Common Stock | 1,914(6) | D | |||||||||||||
04/01/02 | 3/31/06 | Common Stock | 1,761(6) | D | |||||||||||||
07/01/02 | 3/31/06 | Common Stock | 2,067(6) | D | |||||||||||||
10/01/02 | 3/31/06 | Common Stock | 2,039(6) | D | |||||||||||||
1/01/03 | 3/31/06 | Common Stock | 1,520 | 874,600 | D | ||||||||||||
3/10/98 | 3/15/05 | Common Stock | 25,259(6) | 0 | D | ||||||||||||
3/10/98 | 3/15/05 | Common Stock | 24,696(6) | 0 | D | ||||||||||||
6/12/98 | 3/15/05 | Common Stock | 7,992(6) | 0 | D | ||||||||||||
6/12/98 | 3/15/05 | Common Stock | 7,814(6) | 0 | D | ||||||||||||
Explanation of Responses:
(1) Purchased in connection with a private offering on March 10, 1998 consisting of a Convertible Debenture convertible at any time.
(2) Acquired pursuant to an option exercise in June 1998, consisting of a Convertible Debenture, convertible at any time.
(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.
(6) Adjusted to reflect results of an anti-dilution calculation contained in the instrument.
(7) Pursuant to a recapitalization exempt under Rule 16b-7, the warrants were exchanged for shares of common stock.
/s/ Peter A. Clemens | January 6, 2003 | |
**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). | |
Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. |
Page 4